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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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Albert SL, Massar RE, Correa L, Kwok L, Joshi S, Shah S, Boas R, Alcalá HE, McMacken M. Change in cardiometabolic risk factors in a pilot safety-net plant-based lifestyle medicine program. Front Nutr 2023; 10:1155817. [PMID: 37153909 PMCID: PMC10157493 DOI: 10.3389/fnut.2023.1155817] [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: 01/31/2023] [Accepted: 03/20/2023] [Indexed: 05/10/2023] Open
Abstract
Introduction Interventions emphasizing healthful lifestyle behaviors are proliferating in traditional health care settings, yet there is a paucity of published clinical outcomes, outside of pay-out-of-pocket or employee health programs. Methods We assessed weight, hemoglobin A1c (HbA1c), blood pressure, and cholesterol for 173 patients of the Plant-Based Lifestyle Medicine Program piloted in a New York City safety-net hospital. We used Wilcoxon signed-rank tests to assess changes in means, from baseline to six-months, for the full sample and within baseline diagnoses (i.e., overweight or obesity, type 2 diabetes, prediabetes, hypertension, hyperlipidemia). We calculated the percentage of patients with clinically meaningful changes in outcomes for the full sample and within diagnoses. Findings The full sample had statistically significant improvements in weight, HbA1c, and diastolic blood pressure. Patients with prediabetes or overweight or obesity experienced significant improvements in weight and those with type 2 diabetes had significant improvements in weight and HbA1c. Patients with hypertension had significant reductions in diastolic blood pressure and weight. Data did not show differences in non-high-density lipoprotein cholesterol (non-HDL-C), but differences in low-density lipoprotein cholesterol (LDL-C) were approaching significance for the full sample and those with hyperlipidemia. The majority of patients achieved clinically meaningful improvements on all outcomes besides systolic blood pressure. Conclusion Our study demonstrates that a lifestyle medicine intervention within a traditional, safety-net clinical setting improved biomarkers of cardiometabolic disease. Our findings are limited by small sample sizes. Additional large-scale, rigorous studies are needed to further establish the effectiveness of lifestyle medicine interventions in similar settings.
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Affiliation(s)
- Stephanie L. Albert
- NYU Grossman School of Medicine, New York, NY, United States
- *Correspondence: Stephanie L. Albert,
| | | | | | - Lorraine Kwok
- NYU Grossman School of Medicine, New York, NY, United States
| | - Shivam Joshi
- NYU Grossman School of Medicine, New York, NY, United States
- Veterans Affairs, Orlando, FL, United States
| | - Sapana Shah
- NYU Grossman School of Medicine, New York, NY, United States
- NYC Health + Hospitals, New York, NY, United States
| | - Rebecca Boas
- NYU Grossman School of Medicine, New York, NY, United States
- NYC Health + Hospitals, New York, NY, United States
| | - Héctor E. Alcalá
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
- Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, United States
| | - Michelle McMacken
- NYU Grossman School of Medicine, New York, NY, United States
- NYC Health + Hospitals, New York, NY, United States
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