Nursing Notes

May 17, 2011

Health Coaching

Here is a wonderful article that showcases Health Coaching in a very positive light and show the benefit our patients get from such a great program, when it is available.  Health Coaching goes hand-in-hand with the work that nurses at the bedside do.  We do education and review of behaviors, the health coach makes a game plan with our patients and follows up with them to encourage participation.

With all the focus on healthcare changes right now, it is very uplifting to find such a wonderful article about this new profession.  I firmly believe that health coaching is here to stay and we need to figure out how to integrate this activity into our patient care.

This article is from Hospital and Health Networks Magazine.  This magazine is full of timely and useful information about all the changes taking place in the healthcare field today.  I recommend you visit the site and spend some time reading there.

Let me know what you think about this article and about health coaching, won’t you?

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By Tracy Granzyk Wetzel

Hospitals update their playbooks to make patients active members of the care team

Clint Coon is a computer network manager for the Iowa Department of Safety, still working full time at 66 years of age while managing health conditions affecting his heart, kidneys, vasculature and sleep—in addition to cancer.

Achieving effective communication between two specialty groups is an accomplishment; managing five at once is nearly miraculous. But Coon has a partner on the inside—Dave Swieskowski, M.D., CEO of Mercy Clinics in Des Moines. Swieskowski is a data hound who believes that systems must be redesigned to better harness technology developed over the last 50 years. And he strongly believes patients must be more involved in their own care.

Engaging patients at Mercy Clinics is now part of daily operating procedure. At the forefront is their physician office-based health coach program, which allows Mercy to proactively manage the blood pressure, glucose levels and immunization rates of more than 25,000 patients.

“Any clinical goal we set, we can hit pretty easily,” Swieskowski says. “Cholesterol, cancer screening—it’s all the same process. Any type of follow-up that needs to be done, we think we can get 95 to 97 percent of patients to do so.”

Mercy has been tracking patient outcomes for about 15 years, and success is equal parts patient and provider effort. Through the health coach and shared decision-making programs, patients are trained to become active participants in their care. Health coaches ask patients to set health behavior goals versus outcome goals, and together, coach and patient develop a behavior-change plan with one- to two-week follow-up compared with the typical three months.

“You have to know your patients, track them and measure what is going on with them,” Swieskowski says.

The majority of Coon’s health care takes place at Family Medicine in Urbandale, Iowa. After discharge from a recent hospital stay, Coon’s first stop was the clinic. He walked in without an appointment, and within minutes was in his coach’s office, filling in gaps of information not yet received from the hospital.

“This kind of relationship is greatly appreciated—this go-between, or breaking down of the extended time you can’t reach a doctor,” he says. “I think patients are more comfortable because they get a fairly rapid response.”

Health & Human Services has made patient engagement a priority. In March, Secretary Kathleen Sebelius released the National Strategy for Quality Improvement in Health Care. The strategy, mandated by the Affordable Care Act, defines three broad aims and six national priorities, including “Ensuring that each person and family are engaged partners in their care.”

The pressure to reduce avoidable readmissions underscores the need to engage patients better. In an April 2, 2009, New England Journal of Medicine article, Stephen Jencks, M.D., reported that 50.2 percent of Medicare beneficiaries readmitted within 30 days had not seen a physician between discharge and readmission.

Though many readmissions are planned, experts say some could be avoided partly by helping patients understand their conditions and what they need to do once they’re out of the hospital, and then to stay in contact with them to make sure they are following through.

“The best organizations will thrive in new ways when thinking differently about engaging patients,” Institute for Healthcare Improvement President and CEO Maureen Bisognano said at the American College of Healthcare Executives national conference in March. “We need to understand the entire journey of our patients.”

‘Not Just the Medical Stuff’

Health systems in search of excellence, like Mercy Clinics, are leading the way in coordinating care for their patients and engaging them in the process.

Steven Counsell, professor of medicine at Indiana University and a scientist at the Center for Aging Research, designed the Geriatric Resources for Assessment and Care of Elders program, first implemented at Wishard Health Services in Indianapolis. The GRACE program uses a team approach combining transitional and primary care via home visits, and engaging patients in a care plan individualized to their needs. A social worker and nurse practitioner perform an in-home assessment of patients; collaborate with the GRACE team, which includes a geriatrician, pharmacist and mental-health case manager; and remain the link between patient and primary care physician. Weekly team conferences keep everyone on target.

“It’s not just the medical stuff,” Counsell says. “You can have a great plan for heart failure, correct…[read more]

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3 Comments »

  1. ..Are we disease managing the wrong patients?A report in the New England Journal of Medicine entitled A Randomized Trial of a Telephone Care Management Strategy from no relation to thisblog suggests that the telephone health coach model which has shown mixed and often disappointing results in several tests aimed at a population of very old and very sick people may have more impact when offered to a broader cross section of people at risk for high medical costs from a larger set of conditions and when concepts of shared or informed decision-making were integrated with more standard health coaching. The abstract of theNEJMstudy is full article can be accessed via Health Dialog In a randomized control trial of more than 174 000 patients one group received standard health coaching and management the other group enhanced support What did they do differently than the Medicare disease management telephone support programs weve all heard about?A lot of the recent disease management pilots sounded simple. Identify really sick really expensive patients and give them some extra support usually by telephone.

    Comment by business daily — May 22, 2011 @ 1:29 am | Reply

  2. In response to the Health Coaching article:
    I do not believe the nurse needs to find a way to integrate this field into the nurses work schedule. Doesn’t the staff/charge/manager nurse have her hands in many pies already? She monitors labs and calls the doctor [why don’t the lab techs inform the doctor?Then the doc calls the nurse with any changes he wants]. She monitors the meds and calls the pharmacist and doctor [why doesn’t the pharmacist call the doctor] She monitors the x-rays and calls the doctor[ why doesn’t the Radiologist call the doctor]. I am of the opinion that in an effort to be the patient advocate, nurses have slid into the ‘watch dog role’ and in the process lost our standing as actual patient care givers.
    However, I do feel that as a nursing field, Health Coach is very much needed. I am presently taking classes as a Life Coach and can see how a new field for nurses as a Health Coach is very possible.

    Comment by Donna L Hames — May 26, 2011 @ 1:01 pm | Reply

  3. […] Health Coaching (nursingtrends.wordpress.com) […]

    Pingback by Inglis: Efficiency can make health care better and cheaper « Nursing Notes — June 13, 2011 @ 6:39 pm | Reply


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