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Wyoming County Nurse Wellness Coach Program Evaluation. Wyoming County Department of Mental Health Stephen Snell, LCSW Wyoming County Mental Health Clinic Joyce Barker, RN Well-Balanced Program, University of Rochester, Consultants Eva Bellis, RN, BSN, CCM
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Wyoming County Nurse Wellness Coach Program Evaluation Wyoming County Department of Mental Health Stephen Snell, LCSW Wyoming County Mental Health Clinic Joyce Barker, RN Well-Balanced Program, University of Rochester, Consultants Eva Bellis, RN, BSN, CCM Donna Tortoretti, RNC, MS, CMAC Patricia Lindley, PhD, RN
Program Design: 2006 • “Embedded” nurse wellness coach (clinic employee) works in tandem with mental health clinicians and care coordinators on client-determined physical health issues • Caseload: 20 slots, revolving enrollment, attends SPOA • Not time limited; pace/frequency of contacts vary • Eligibility: Care coordination enrollees with moderate to high risk physical health problems, by referral • Program dovetails with Monroe’s Well Balanced Program, using same assessment, documentation and planning tools • Not disease-specific: interventions customized to individual health problems, client wishes, capacities and readiness • Maximize internet, disease-management protocols “best practices” for education
Assessment and Enrollment • Client interview • Comprehensive Health Risk Assessment (HRA) yields numerical score and suggested areas for intervention (see sample) • Home visit • Laboratory
2006 Client Participation – 20 client caseload Referred and Assessed Total N=32 • Did not enroll n = 6; • 3/6 completed HRA • Dropped Out n = 7 • Decided to pursue on own 1 • Moved out of county 2 • To nursing home 1 • Client chose not to pursue 3 Enrolled, completed HRA, bloodwork and individualized plan N=26 Completed Pre-to- Post Analysis: N=15 10+ direct contacts plus all tests and information
Client Psychiatric Diagnoses Axis I *% adds to > 100; clients may have more than 1 diagnosis
Client Medical Diagnoses Axis III: Wyoming County N = 15 *% adds to > 100; clients may have more than 1 diagnosis
Contacts: LocationsWyoming County N = 15 Total Contacts = 222
Nursing Interventions: Health GoalsWyoming County N = 15 Total Health Interventions = 346 Behavior, communication, relationships, development Function of life sustaining processes Maintain and promote wellness, recovery, and/or rehabilitation
Direct & Indirect Contact Times: Wyoming County N = 15 Note. Mean is average; mode is most frequent.
Client Service Utilization: Wyoming County N = 15 Note: Pre-program data may be less reliable because it is recall data.
Consumer Health Status: Wyoming County N = 15 Entering: 1.25 packs/20 years (average)Completing: 0.78 packs1 Quit 4 months, 4 reduced >1/2 ppd
Higher the score, lower the risk Consumer Health Status: Wyoming County N = 15
Consumer Satisfaction: Wyoming County N = 15 Rating 1 – 4 (1 lowest to 4 highest) 1 = Quality Service 2 = Got Service 3 = Met Goals 4 = Recommend 5 = Satisfied Help 6 = Helped Problems 7 = Satisfied Overall 8 = Come Back
Client Goals Recommended and Selected HRA Recommended Goals Client Selected Goals Blood Pressure 3 2 Exercise 10 7 Cholesterol 7 5 Mammogram 2 0 Smoking 10 6 Weight 10 8
Wellness Areas of Change SOCIALIZATION Two clients began attending Social Club regularly. DIABETES MANAGEMENT Two clients with diabetes who were not testing or using insulin began testing regularly and using insulin regularly Three clients with diabetes who had not attended medical appointments began seeing their physical care provider.
Wellness Areas of Change (cont’d) NUTRITION - Eight clients made significant improvements in their diets, such as eating more fruits and vegetables, increasing low fat dairy products and lean meats, and decreasing sweets. - Three clients met with a dietitian for additional help in improving their diets. EXERCISE - Eight clients increased their level of exercise by walking more or riding a bicycle more.
Wellness Areas of Change (cont’d) MEDICAL CARE -Five clients were accompanied to medical care appointments resulting in improved communication with the provider, and additional diagnostic testing and treatment options. -Three clients’ medical care was adjusted based on information provided by the Nurse Wellness Coach
Other findings and lessons learned “Wellness coach” P-C approach reduces client wariness of nurse involvement Obtaining laboratory data is often difficult and time-consuming HRA is a very useful tool for client, nurse and program; gives useful patient-friendly information key to starting change behaviors, tracks progress, encourages positive lifestyle shifts, provides aggregate data Interventions must be adjusted to client situation, considering current mental status, learning styles, literacy; Time, patience relationship-building often required; changes often start slowly, build on earlier steps; individual readiness often surprises Individual support usually most effective; formal disease management protocols, written materials often minimally effective; many take well to charting progress (e.g. weight or exercise charts) especially if gains are being made Medical practitioners build confidence in nurse over time, welcome help from useful data (lab, etc.), better follow-up, enhanced client education and support; improves medical attention to health problems “Health assessment and referral” are required, Medicaid-reimbursable services under 14 NYCRR Parts 587 and 588
