COUNTY HEALTH COACHING PROGRAM (2013)
Pamela Gibson, Employee Wellness Program – HRD133
Susan Vana,Nurse Health Coach (contractor) – HRD133
Scott Morrow, Medical Advisor – HLT312
Brian Schonfeld, Baysport Clinical Screening (contractor)
Describe the Program. What are the program services, goals and objectives? When was the program initiated?
The County Health Coaching Program is an employee service provided under the Employee Wellness Program. The program is targeted to employees with elevated health risks that increase their likelihood of future cardiovascular conditions and/or diabetes. The program emphasizes lifestyle changes and/or medical management to reduce identified cardiovascular and diabetes risk. The program goals and objectives are:
- to improve overall health status of high risk employees
- to reduce clinical health risks associated with cardiovascular health and diabetes
- to modifyunhealthy lifestyle and health habits related to cardiovascular health and diabetes
- to reduce the #employees who are identified as high-risk for cardiovascular conditions and/or diabetes
High-risk employees are identified as the result of their participation in the County’s Wellness Screening Program at the beginning of each calendar year. A referral is made and the employee is invited to join the Health Coaching for the duration of the calendar year. In a series of individual Health Coaching sessions conducted in person and/or telephonically, the employee meets with a Nurse Health Coach to improve lifestyle and health habits and ensure medication compliance. The employee’s physician is notified, consulted and involved as needed, especially for medication management.
The risk reduction priorities are: smoking cessation, reducing LDL-Cholesterol, increasing HDL-cholesterol, normalizing glucose and insulin, reducing excess weight, increasing daily physical activity, promoting a plant-based diet, and reducing psychological stress.
The current program has evolved from a nurse case management model that was developed by Stanford University and beta-tested at San Mateo County from 1996-2005 as part of the Stanford HEAR2T Program research study led by Dr. William Haskell. When Stanford’s funding for the project ended in 2005, the County continued the program on its own, following the same case management model, protocols and processes andadhering to national clinical treatment guidelines. In 2011, the program was re-named to the County Health Coaching Program.
To ensure confidentiality and privacy, the Nurse Health Coach is a contract position and currently works 16-18 hours /week or approximately 750 hours/year. This year’s caseload is 98employees. Scott Morrow, the County Health Officer, acts as its medical adviser. The Program’s office is in Redwood City.
Identify the methods used to measure the program’s performance and the process used to gather data.
The Program is targeted to employees who are high risk for future cardiovascular health problems and/or diabetes. This is determined based upon their clinical results at the Wellness Screenings held at the beginning of each year. At the end of the calendar year (or at the Wellness Screening the following year), clinical samples are obtained and compared to the first samples to determine changes. Whenever possible, anecdotal information is collected and recorded.
The Nurse Health Coach is responsible for maintaining all data associated with the program. Every 3-5 years, the Nurse conducts an outcome-based study to ensure that positive outcomes continue to mirror those experienced during the Stanford HEAR2T Program research study.
Discuss the program’s performance. What specific actions were taken during the year to improve performance measure results or what has been done to sustain a high level of performance? Please include trend information.
Recruitment / Outreach. One critical aspect of the Program relates to the initial timing and outreach efforts to recruit new participants into the program. The first contact should be made with an employee at a point in time after s/he participates in the County Wellness Screening AND remains motivated to take positive action about his/her high-risk condition(s). This year, there was closer communication and greater coordination with BaySport, the clinical screening vendor, to transfer clinical screening results to the Nurse Health Coach within a shorter period of time after the Wellness Screenings were conducted. This allowed for earlier identification, follow-up and contact of the high risk employees by the Nurse Health Coach, reaching a still-motivated target group, and resulting in a higher initial registration rate than in previous years. In addition, the Nurse Health Coach attended many of the larger Wellness Screening clinics to be available to talk to potential future clients and to answer questions about the program and services.
Nutrition Consultations. A second enhancement these past two years has been the introduction of on-site nutrition counseling for program participants. The Nurse Health Coach works with the Wellness Program’s contract dietitian to assign a dietitian onsite on specified days each month. Interested high risk employees have the option of scheduling a counseling appointment with the dietitian for 1-2 visits to address nutrition/food matters affecting their heart or diabetes risks. This has become a popular component of the program.
Remote Scheduling. Another innovation that has resulted in increased caseload is scheduling appointments at other work locations than the private office in Redwood City. The Nurse Health Coach visits nine other worksite locationsto provide Health Coaching services on dedicated days/times. This has resulted in increasing access to the program for employees who ordinarily would be unable to travel to Redwood City. It also has resulted in more employee referrals of colleagues into the Health Coaching program. Approximately 40% of the current caseloadparticipates in the program via remote scheduling.
What is the impact of program results on outcomes (at the program, department or County level)? Include how the program aligns with the County’s Shared Vision 2025.
One outcome indicator we measured this year is the change in clinical values as the result of participation in the Health Coaching Program. We compared the percent changes in the Health Coaching group values against those of the general employee population who participated in the Wellness Screening only. These are matched cohort groups composed of the same employees for the first and second data collection points.
Table One documents the % aggregate change in clinic values for each clinical indicator and a calculated Framingham Risk Score for each cohort group.
(The Framingham Risk Score is a gender-specific algorithm used to determine an individual's chances of developing cardiovascular disease within a 10-year period. Individuals withlow riskhave 10% or less CHD risk at 10 years, withintermediate risk10-20%, and withhigh risk20% or more)
The first cohort group (blue bar) is composed of 715 employees who attended at least two Wellness Screenings between 2011 and 2013 (shown as “ALL”). The second cohort group (red bar) is composed of 67 employees who completed the Health Coaching Program in 2012and for whom pre-and post-test values were available (shown as “COACH”).
By comparing the data for each cohort group, it clearly shows that Health Coaching cohort group documented healthier changes for all clinical indicators (represented in this graph as a negative/neutral value, except for HDL which is a positive value).
Table Two shows specific aggregate information for the same Health Coaching cohort group (N=67). Using a Population Health Management approach, individuals in the Health Coaching cohort group were counted if they had a high-risk clinical indicator when they started the Health Coaching Program and then (re)counted if they had a high-risk clinical indicator at the end of the program. Each individual’s Framingham Risk Score was calculated at the beginning and end of the program and tallied if the Score was high risk. The results clearly show a positive trend in reducing the #employees with high health risks.
We showed the clinical values and results to Dr. Scott Morrow, the County Health Officer, who stated that the changes in the Framingham Risk Scoresfor the Health Coachcohort group in both tables were “unprecedented, outside a structured, intensive clinical intervention”.
As the result of these most recent evaluations, we have clearly demonstrated meeting our program objectives:
- to improve overall health status of high risk employees
- to reduce clinical health risks associated with cardiovascular health and diabetes
- to modifyunhealthy lifestyle and health habits related to cardiovascular health and diabetes
- to reduce the #employees who are identified as high-risk for cardiovascular conditions and/or diabetes
The County Health Coaching Program aligns with the County’s Shared Vision 2025 – Healthy Community by providing seamless services to high-risk County employees in order to improve individual and workforce clinical indicators and reduce the #high risk employees in the workforce.
What is the program’s plan for sustaining high performance?
We continue to value the Health Coaching program as an important component to our Wellness Screening program and follow-up and will continue to offer its services to employees. We intend to continue to innovate, modify and evolve the program for maximum effectiveness. One area of interest is utilizing on-line health monitoring toolsto provide real-time health data about participants for the Health Coach.