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Babich JS, McMacken M, Correa L, Polito-Moller K, Chen K, Adams E, Morgenstern S, Katz M, Long TG, Joshi S, Wallach AB, Shah S, Boas R. Advancing Lifestyle Medicine in New York City's Public Health Care System. Mayo Clin Proc Innov Qual Outcomes 2024; 8:279-292. [PMID: 38828080 PMCID: PMC11141270 DOI: 10.1016/j.mayocpiqo.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Chronic diseases are the leading cause of death and disability in the United States, and much of this burden can be attributed to lifestyle and behavioral risk factors. Lifestyle medicine is an approach to preventing and treating lifestyle-related chronic disease using evidence-based lifestyle modification as a primary modality. NYC Health + Hospitals, the largest municipal public health care system in the United States, is a national pioneer in incorporating lifestyle medicine systemwide. In 2019, a pilot lifestyle medicine program was launched at NYC Health + Hospitals/Bellevue to improve cardiometabolic health in high-risk patients through intensive support for evidence-based lifestyle changes. Analyses of program data collected from January 29, 2019 to February 26, 2020 demonstrated feasibility, high demand for services, high patient satisfaction, and clinically and statistically significant improvements in cardiometabolic risk factors. This pilot is being expanded to 6 new NYC Health + Hospitals sites spanning all 5 NYC boroughs. As part of the expansion, many changes have been implemented to enhance the original pilot model, scale services effectively, and generate more interest and incentives in lifestyle medicine for staff and patients across the health care system, including a plant-based default meal program for inpatients. This narrative review describes the pilot model and outcomes, the expansion process, and lessons learned to serve as a guide for other health systems.
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Affiliation(s)
- John S. Babich
- NYC Health + Hospitals/Bellevue, New York, NY
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Michelle McMacken
- NYC Health + Hospitals/Bellevue, New York, NY
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
- NYC Health + Hospitals, New York, NY
| | | | | | - Kevin Chen
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
- NYC Health + Hospitals, New York, NY
| | - Eric Adams
- 110th Mayor of the City of New York, New York, NY
| | - Samantha Morgenstern
- Sodexo, Healthcare, Sodexo USA, Gaithersburg, MD
- Food & Nutrition Services, NYC Health + Hospitals, New York, NY
| | | | - Theodore G. Long
- NYC Health + Hospitals, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Shivam Joshi
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
- Department of Veterans Affairs, Orlando, FL
| | - Andrew B. Wallach
- NYC Health + Hospitals/Bellevue, New York, NY
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
- NYC Health + Hospitals, New York, NY
| | - Sapana Shah
- NYC Health + Hospitals/Bellevue, New York, NY
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Rebecca Boas
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
- NYC Health + Hospitals, New York, NY
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Bassin SR, Ferreira De Carvalho J, Gulati M. A Review of Plant-Based Diets for Obesity Management. Endocr Pract 2024:S1530-891X(24)00513-5. [PMID: 38729570 DOI: 10.1016/j.eprac.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/03/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Obesity is the most prevalent chronic disease in the United States with over 70% of the American population suffering from overweight/obesity. Recently, the popularity of plant-based diets (PBDs) has grown, with individuals adopting these diets for ethical, health and environmental reasons. Our aim is to evaluate the effect of a PBD on weight loss among patients who are overweight or obese. METHODS A literature review of PBDs for the treatment of obesity was conducted using PubMed and Scopus. Our search yielded 27 intervention trials (3361 participants) and 6 metanalyses (9168 participants, 61 trials). RESULTS Among the intervention trials evaluated, 75% showed a significant increase in weight loss or decrease in weight in the intervention group, on average -5.0 kg (range -1.8 to -12.1 kg). Other outcomes included energy intake (-420 Kcal/d), systolic blood pressure (-3.78 mmHg), fasting plasma glucose (-2.0 mmol/L), hemoglobin A1c (-0.5%, -3.4 mmol/L), total cholesterol (-0.40 mmol/L), low-density lipoprotein (-0.38 mmol/L), triglyceride levels (+0.13 mmol/L), and fiber intake (+10.8 g/d). The 6 meta-analyses showed weight loss (average -2.9 kg, range -2.02 kg to -4.1 kg), body mass index reduction, and improvements in hemoglobin A1c, low-density lipoprotein, and total cholesterol. CONCLUSION PBDs result in significant weight loss and improve metabolic outcomes. PBDs offer a sustainable approach to long-term weight loss maintenance. Health care providers should encourage open discussions with their patients regarding their dietary habits to assist them in setting feasible lifestyle goals and consider shared medical appointments to support patients in transitioning to PBDs.
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Affiliation(s)
- Sandhya Rao Bassin
- Department of Endocrine, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - Mahima Gulati
- Department of Medical Sciences, Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, Connecticut
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3
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Albert SL, Massar RE, Kwok L, Correa L, Polito-Moller K, Joshi S, Shah S, McMacken M. Pilot Plant-Based Lifestyle Medicine Program in an Urban Public Healthcare System: Evaluating Demand and Implementation. Am J Lifestyle Med 2024; 18:403-419. [PMID: 38737881 PMCID: PMC11082870 DOI: 10.1177/15598276221113507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Lifestyle interventions that optimize nutrition, physical activity, sleep health, social connections, and stress management, and address substance use, can reduce cardiometabolic risk. Despite substantial evidence that healthful plant-based diets are beneficial for long-term cardiometabolic health and longevity, uncertainty lies in how to implement plant-based lifestyle programs in traditional clinical settings, especially in safety-net contexts with finite resources. In this mixed-methods implementation evaluation of the Plant-Based Lifestyle Medicine Program piloted in a large public healthcare system, we surveyed participants and conducted qualitative interviews and focus groups with stakeholders to assess program demand in the eligible population and feasibility of implementation within the safety-net setting. Program demand was high and exceeded capacity. Participants' main motivations for joining the program included gaining more control over life, reducing medication, and losing weight. The program team, approach, and resources were successful facilitators. However, the program faced administrative and payor-related challenges within the safety-net setting, and participants reported barriers to access. Stakeholders found the program to be valuable, despite challenges in program delivery and access. Findings provide guidance for replication. Future research should focus on randomized controlled trials to assess clinical outcomes as a result of program participation.
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Affiliation(s)
- Stephanie L. Albert
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Rachel E. Massar
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Lorraine Kwok
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Lilian Correa
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Krisann Polito-Moller
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Shivam Joshi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Sapana Shah
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Michelle McMacken
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
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Albin JL, Thomas OW, Marvasti FF, Reilly JM. There and Back Again: A Forty-Year Perspective on Physician Nutrition Education. Adv Nutr 2024:100230. [PMID: 38705195 DOI: 10.1016/j.advnut.2024.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Medical education faces an urgent need for evidence-based physician nutrition education. Since the publication of the 1985 National Academies report "Nutrition Education in the United States Medical Schools," little has changed. Although several key efforts sought to increase nutrition content in undergraduate medical education over the past 40 y, most medical schools still fail to include the recommended minimum of 25 h of nutrition training. Without foundational concepts of nutrition in undergraduate medical education, graduate medical education unsurprisingly falls short of meeting patient needs for nutritional guidance in clinical practice. Meanwhile, diet-sensitive chronic diseases continue to escalate, although largely preventable and treatable by nutritional therapies and dietary lifestyle changes. Fortunately, recent recognition and adoption of Food is Medicine programs across the country increasingly connect patients with healthy food resources and nutrition education as core to their medical care, and physicians must be equipped to lead these efforts alongside their dietitian colleagues. Filling the gap in nutrition training will require an innovative and interprofessional approach that pairs nutrition with personal wellness, interprofessional practice, and community service learning. The intersectional benefits of connecting these domains will help prepare future physicians to address the social, behavioral, and lifestyle determinants of health in a way that recognizes nourishing food access as a core part of clinical practice. There are numerous strategies to integrate nutrition into education pathways, including didactic and experiential learning. Culinary medicine, an evidence-based field combining the culinary arts with nutritional science and medicine, is 1 promising educational framework with a hands-on, interprofessional approach that emphasizes community engagement. Advancing the critical need for widespread adoption of nutrition education for physicians will require support and engagement across societal stakeholders, including co-leadership from registered dietitian nutritionists, health system and payor reform, and opportunities for clinical innovation that bring this essential field to frontline patient care.
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Affiliation(s)
- Jaclyn Lewis Albin
- Departments of Internal Medicine and Pediatrics, the University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | | | - Farshad Fani Marvasti
- Department of Family, Community, and Preventive Medicine, University of Arizona College of Medicine-Phoenix and School of Nutritional Sciences and Wellness, College of Agricultural, Life and Environmental Sciences, University of Arizona, Tucson, AZ, United States
| | - Jo Marie Reilly
- Clinical Family Medicine and Population and Public Health, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
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Mirsky J, Artz K. Lifestyle Medicine Shared Medical Appointments: A proposed framework for high value chronic disease care. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2023; 11:100723. [PMID: 37984311 DOI: 10.1016/j.hjdsi.2023.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Jacob Mirsky
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA; Harvard Medical School, Boston, MA, 02115, USA.
| | - Kristi Artz
- Department of Population Health and Lifestyle Medicine, Corewell Health West, Grand Rapids, MI, 49503, USA
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Chorya H, Coloma HS, Cortiana V, Joshi M, Menon GP, Balasubramanian M, Park CH, Leyfman Y. The Potential of Lifestyle Medicine: Strategies to Optimize Health and Well-Being in Oncology Care with Dr. Amy Comander. Cancers (Basel) 2023; 15:5323. [PMID: 38001584 PMCID: PMC10670222 DOI: 10.3390/cancers15225323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
The field of lifestyle medicine in cancer care and survivorship is undergoing significant transformation, presenting both challenges and opportunities. This collection of insights and reflections by an esteemed speaker aims to address critical facets of this evolving landscape and the intersection of healthcare, lifestyle, and cancer. With a focus on optimizing the health of cancer survivors, the speaker emphasizes the correlation between general population health and strategies for mitigating cancer risk. Evidence-based resources have a key role in their comprehensive insights into lifestyle changes' role in cancer prevention and survivorship. Lifestyle interventions also have a promising role in mitigating the late effects in the pediatric context. Therefore, encouraging the early adoption of healthy practices in childhood cancer survivors emerges as a pivotal strategy. Furthermore, challenges in enhancing education and access to lifestyle medicine are addressed. This highlights the importance of patient-centered communication, motivational interviewing, and personalized guidance in facilitating lifestyle changes with patients. Finally, the role of nutritionists in advising breast cancer patients to consider calorie restriction to lower IGF-1 levels is explored. This collection underscores the multifaceted nature of lifestyle medicine in cancer care, highlighting challenges, opportunities, and the transformative power of passion and curiosity in shaping healthcare careers.
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Affiliation(s)
| | | | - Viviana Cortiana
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
| | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi 0186, Georgia
| | | | | | | | - Yan Leyfman
- Icahn School of Medicine at Mount Sinai South Nassau, Oceanside, NY 11572, USA
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7
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Parkinson MD, Stout R, Dysinger W. Lifestyle Medicine: Prevention, Treatment, and Reversal of Disease. Med Clin North Am 2023; 107:1109-1120. [PMID: 37806726 DOI: 10.1016/j.mcna.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Lifestyle medicine (LM) expands the scope of preventive medicine by focusing on the promotion of healthy lifestyles while preventing, treating, and reversing the vast majority of chronic diseases caused by behaviors and environmental factors. LM focuses on six pillars-a plant-predominant eating pattern; physical movement; restorative sleep; management of stress; avoidance of risky substances; and positive social connections. Advances in LM competencies, education, certification, resources, and practice models are accelerating with a particular need and focus on underserved and most seriously impacted patients and communities. A comprehensive and integrated strategy addressing "whole person health" is emerging as a compelling framework for providers and health systems which combines a foundational commitment to prevention with a systematic approach to the actual and root causes of premature disease, disability, and death.
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Affiliation(s)
- Michael D Parkinson
- P3 Health, LLC (Prevention, Performance, Productivity), 5864 Aylesboro Avenue, Pittsburgh, PA 15217, USA.
| | - Ron Stout
- Ardmore Institute of Health, PO Box 1269, Ardmore, OK 73402, USA
| | - Wayne Dysinger
- Lifestyle Medical, 4368 Central Avenue, Riverside, CA 92506, USA
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Abstract
The rapid growth of Lifestyle Medicine (LM) and Value-Based Care (VBC) are occurring simultaneously yet are not fully aligned in the minds of key stakeholders. Both focus on bending the healthcare cost curve by improving patient outcomes, providing greater access to chronic disease risk reduction services and in the case of LM, driving toward chronic disease remission and reversal. Both require strong physician engagement to be effective and will greatly benefit from thoughtful use of digital health technologies. In this review, key focus areas will be highlighted as foundational aspects in which LM is synonymous with high-value care. Continued efforts in these key areas will ensure that LM becomes the foundation for VBC.
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Affiliation(s)
- Kristi Artz
- Corewell Health Lifestyle Medicine, Grand Rapids, MI, USA
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9
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Finn EB, Whang C, Hong PH, Costa SA, Callahan EA, Huang TTK. Strategies to improve the implementation of intensive lifestyle interventions for obesity. Front Public Health 2023; 11:1202545. [PMID: 37559739 PMCID: PMC10407556 DOI: 10.3389/fpubh.2023.1202545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/04/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Emily Benjamin Finn
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Christine Whang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Peter Houlin Hong
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Sergio A. Costa
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | | | - Terry T. -K. Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
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Mirsky JB, Bui TXV, Grady CB, Pagliaro JA, Bhatt A. Hypertension Control and Medication Titration Associated With Lifestyle Medicine Virtual Group Visits and Home Blood Pressure Monitoring. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221108060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Less than a quarter of the 116 million adults with hypertension in the United States have blood pressure (BP) lower than the guideline-recommended goal of 130/80 mmHg. There is a critical need for novel interventions that integrate evidence-based recommendations—such as lifestyle medicine and home BP monitoring (HBPM)—into clinical care. In this study, we tested the hypothesis that a four-part, primary care physician-led Virtual Group Visit (VGV) series combining lifestyle medicine, Health and Wellness Coaching (HWC), and HBPM could lead to a reduction in BP and antihypertensive medications. There was a decrease in systolic (β = −.108 mmHg per day; P = .046) and diastolic (β = −.058 mmHg per day; P = .026) BP. Thirteen of the 22 patients (59%) who started the VGV series on medications had at least one medication dosage reduced or discontinued during the VGV series, and 8 of the 18 patients (44%) who finished the VGV series on medications had at least one medication dosage reduced or discontinued in the 180 days after the VGV series. This pilot study demonstrates for the first time that lifestyle medicine VGVs, coupled with HWC and HBPM, are associated with improved BP control and medication deprescribing.
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Affiliation(s)
- Jacob B. Mirsky
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA (JBM); Harvard Medical School, Boston, MA, USA (JBM, AB); Center for Innovation in Digital HealthCare, Massachusetts General Hospital, Boston, MA, USA (TXVB); Department of Biostatistics, Informatics, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (CBG); and Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA (JAP, AB)
| | - Tiffany X. V. Bui
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA (JBM); Harvard Medical School, Boston, MA, USA (JBM, AB); Center for Innovation in Digital HealthCare, Massachusetts General Hospital, Boston, MA, USA (TXVB); Department of Biostatistics, Informatics, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (CBG); and Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA (JAP, AB)
| | - Connor B. Grady
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA (JBM); Harvard Medical School, Boston, MA, USA (JBM, AB); Center for Innovation in Digital HealthCare, Massachusetts General Hospital, Boston, MA, USA (TXVB); Department of Biostatistics, Informatics, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (CBG); and Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA (JAP, AB)
| | - Jaclyn A. Pagliaro
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA (JBM); Harvard Medical School, Boston, MA, USA (JBM, AB); Center for Innovation in Digital HealthCare, Massachusetts General Hospital, Boston, MA, USA (TXVB); Department of Biostatistics, Informatics, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (CBG); and Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA (JAP, AB)
| | - Ami Bhatt
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA (JBM); Harvard Medical School, Boston, MA, USA (JBM, AB); Center for Innovation in Digital HealthCare, Massachusetts General Hospital, Boston, MA, USA (TXVB); Department of Biostatistics, Informatics, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (CBG); and Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA (JAP, AB)
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11
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Nuñez D, Marino-Nuñez D, Staab EM, Dinh T, Zhu M, Wan W, Schaefer CT, Campbell A, Quinn MT, Baig AA. Adapting in-person diabetes group visits to a virtual setting across federally qualified health centers. FRONTIERS IN HEALTH SERVICES 2022; 2:961073. [PMID: 36925842 PMCID: PMC10012803 DOI: 10.3389/frhs.2022.961073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022]
Abstract
Diabetes group visits (GVs) have been shown to improve glycemic control, enrich patient self-care, and decrease healthcare utilization among patients with type 2 diabetes mellitus (T2DM). While telehealth has become routine, virtual GVs remain understudied, especially in federally qualified health centers (FQHCs). We conducted a 5-year cluster randomized trial with a waitlist control group to test the impact of diabetes GVs on patients' outcomes in Midwestern FQHCs. Due to COVID-19, the 6 waitlisted FQHCs adapted to virtual GVs. FQHC staff were provided training and support to implement virtual GVs. The GV intervention included 6 monthly 1-1.5-h long education sessions and appointments with a primary care provider. We measured staff perspectives and satisfaction via GV session logs, monthly webinars, and staff surveys and interviews. Adaptations for implementation of virtual GV included: additional staff training, video conferencing platform use, decreased session length and group size, and adjusting study materials, activities, and provider appointments. Sites enrolled a total of 48 adults with T2DM for virtual GVs. Most FQHCs were urban and all FQHCs predominantly had patients on public insurance. Patients attended 2.1 ± 2.2 GVs across sites on average. Thirty-four patients (71%) attended one or more virtual GVs. The average GV lasted 79.4 min. Barriers to virtual GVs included patient technology issues and access, patient recruitment and enrollment, and limited staff availability. Virtual GV facilitators included providing tablets, internet access from the clinic, and technical support. Staff reported spending on average 4.9 h/week planning and implementing GVs (SD = 5.9). On average, 6 staff from each FQHC participated in GV training and 1.2 staff reported past GV experience. All staff had worked at least 1 year at their FQHC and most reported multiple years of experience caring for patients with T2DM. Staff-perceived virtual GV benefits included: empowered patients to manage their diabetes, provided patients with social support and frequent contact with providers, improved relationships with patients, increased team collaboration, and better patient engagement and care-coordination. Future studies and health centers can incorporate these findings to implement virtual diabetes GVs and promote accessible diabetes care.
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Affiliation(s)
- Daisy Nuñez
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Diana Marino-Nuñez
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Erin M Staab
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Tracy Dinh
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Wen Wan
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | | | - Amanda Campbell
- Midwest Clinicians' Network, East Lansing, MI, United States
| | - Michael T Quinn
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Arshiya A Baig
- Department of Medicine, University of Chicago, Chicago, IL, United States
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Cassoobhoy A, Sardana JJ, Benigas S, Tips J, Kees A. Building Health Equity: Action Steps From the American College of Lifestyle Medicine's Health Disparities Solutions Summit (HDSS) 2020. Am J Lifestyle Med 2022; 16:61-75. [PMID: 35185429 PMCID: PMC8848123 DOI: 10.1177/15598276211052248] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Affiliation(s)
| | | | - Susan Benigas
- American College of Lifestyle Medicine, Chesterfield, MO, USA
| | - Jean Tips
- American College of Lifestyle Medicine, Chesterfield, MO, USA
| | - Alexandra Kees
- American College of Lifestyle Medicine, Chesterfield, MO, USA
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Freeman KJ, Grega ML, Friedman SM, Patel PM, Stout RW, Campbell TM, Tollefson ML, Lianov LS, Pauly KR, Pollard KJ, Karlsen MC. Lifestyle Medicine Reimbursement: A Proposal for Policy Priorities Informed by a Cross-Sectional Survey of Lifestyle Medicine Practitioners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111632. [PMID: 34770148 PMCID: PMC8583485 DOI: 10.3390/ijerph182111632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/18/2022]
Abstract
Lifestyle medicine (LM) is a rapidly emerging clinical discipline that focuses on intensive therapeutic lifestyle changes to treat chronic disease, often producing dramatic health benefits. In spite of these well-documented benefits of LM approaches to provide evidence-based care that follows current clinical guidelines, LM practitioners have found reimbursement challenging. The objectives of this paper are to present the results of a cross-sectional survey of LM practitioners regarding lifestyle medicine reimbursement and to propose policy priorities related to the ability of practitioners to implement and achieve reimbursement for these necessary services. Results from a closed, online survey in 2019 were analyzed, with a total of n = 857 included in this analysis. Results were descriptively analyzed. This manuscript articulates policy proposals informed by the survey results. The study sample was 58% female, with median age of 51. A minority of the sample (17%) reported that all their practice was LM, while 56% reported that some of their practice was LM. A total of 55% of practitioners reported not being able to receive reimbursement for LM practice. Of those survey respondents who provided an answer to the question of what would make the practice of LM easier (n = 471), the following suggestions were offered: reimbursement overall (18%), reimbursement for more time spent with patients (17%), more support from leadership (16%), policy measures to incentivize health (13%), education in LM for practitioners (11%), LM-specific billing codes and billing knowledge along with better electronic medical record (EMR) capabilities and streamlined reporting/paperwork (11%), and reimbursement for the extended care team (10%). Proposed policy changes focus on three areas of focus: (1) support for the care process using a LM approach, (2) reimbursement emphasizing outcomes of health, patient experience, and delivering person-centered care, and (3) incentivizing treatment that produces disease remission/reversal. Rectifying reimbursement barriers to lifestyle medicine practice will require a sustained effort from health systems and policy makers. The urgency of this transition towards lifestyle medicine interventions to effectively address the epidemic of chronic diseases in a way that can significantly improve outcomes is being hindered by current reimbursement policies and models.
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Affiliation(s)
- Kelly J. Freeman
- Department of Member Engagement & Administration, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA;
- Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202, USA
- Correspondence:
| | - Meagan L. Grega
- Department of Lifestyle Medicine, Kellyn Foundation, Tatamy, PA 18015, USA;
| | - Susan M. Friedman
- School of Medicine and Dentistry, Department of Medicine, University of Rochester, Rochester, NY 14642, USA;
| | - Padmaja M. Patel
- American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (P.M.P.); (L.S.L.)
- Lifestyle Medicine Center, Midland Health, Midland, TX 79703, USA
| | - Ron W. Stout
- Ardmore Institute of Health, Ardmore, OK 73401, USA;
| | - Thomas M. Campbell
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Michelle L. Tollefson
- Department of Health Professions, Lifestyle Medicine Program, Metropolitan State University of Denver, Denver, CO 80204, USA;
| | - Liana S. Lianov
- American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (P.M.P.); (L.S.L.)
- Global Positive Health Institute, Sacramento, CA 95825, USA
| | - Kaitlyn R. Pauly
- Department of Member Engagement & Administration, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA;
| | - Kathryn J. Pollard
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.J.P.); (M.C.K.)
| | - Micaela C. Karlsen
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.J.P.); (M.C.K.)
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Patel P. Successful Use of Virtual Shared Medical Appointments for a Lifestyle-Based Diabetes Reversal Program. Am J Lifestyle Med 2021; 15:506-509. [PMID: 34646098 DOI: 10.1177/15598276211008396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Padmaja Patel
- Medical Director, Lifestyle Medicine Program, Midland Health, Midland, Texas
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