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Chronic Disease Management via Health Coaches, Wearables, and SMS Integration @ UCLA Health

Keywords: Chronic Disease, Weight, Diet, Exercise, Wearables, SMS, Text, Health Coaches

Overview

This intervention trained pre-medical students to serve as health coaches in an integrated SMS-based and wearable-tracker-based 16-week-long chronic disease prevention program in a primary care setting.

Innovators

Daniel Croymans MD MBA MS

Paul Bixenstine MD

Editors

Ashley Shaw

Meg Krasne MPH, Director of Content

Location

UCLA Health Internal Medicine, Primary Care, Los Angeles, California

Organizational Context

  • UCLA Health is an academic medical healthcare system consisting of four tertiary academic medical centers and the David Geffen School of Medicine at UCLA as well as UCLA Health Clinics and the UCLA Faculty Group.
  • UCLA Health has over 170 primary care and specialty care clinics throughout Southern California.

  • As a provider system, UCLA Health was in the midst of moving away from fee-for-service contracts with payors and moving towards being “at risk” for an increasing number of patients. Leaders recognized a need across the health system to provide more time and resources towards addressing and managing lifestyle diseases as a way to curtail risk early on in a patient’s relationship with the health system. There was also a system-wide interest in integrating wearable technology into the clinic. 

Population Served

  • Patients from age 18-64
  • Ethnicity: White / African-American / Asian / Hispanic
  • Moderately complex patients
  • Insured by Medicare or commercial plans, no Medicaid beneficiaries
     

Project Leadership

  • Co-Founder: Daniel Croymans MD
  • Co-Founder: Paul Bixenstine MD
  • Advisor: Michael Ong - Director of Population Health Management, Chief, Hospital Medicine of West Los Angeles Veterans Administration Hospital
  • Advisor: Alex Kuo, Chair, Medicine-Pediatrics Department

Project Tools & Components

Project Research & Planning

The team reviewed relevant literature studying health outcomes pertinent to:

  • Wearable Devices
  • Health Coaching
  • Fundamentals of Behavior Change
  • Behavioral Economics

The leadership team worked with the UCLA Health Compliance Office while building an IT platform which would integrate wearable device data with SMS-based data to ensure data compliance and security within the health system.

Project Funding

  • The leadership team secured funding from UCLA Health Innovation and from various other UCLA institutional and departmental grants. 
  • The leadership team also secured donations of trackers from Jawbone Health and Fitbit.

Project Tools Developed

  • MyLife Health Coach Guidebook
  • Chorus, an SMS-based platform that consists of 100 unique, branching logic messages that leverage several key behavior change techniques
  • Epic EMR smartphrase for PCPs to share information about the MyLife program with patients embedded in their After Visit Summary
  • New Epic EMR workflow integrating patient-entered responses into Epic eFlowsheets visible to clinicians
  • For pilot phase: New IT platform (built in-house) which integrated Jawbone data, Fitbit data, and Chorus-based SMS text messages as well as patient responses.

Project Training

  • The Core Training team consisted of Dr. Croymans, Dr. Bixenstine, and volunteer student Health Coach Directors.
    • The leadership team recruited 20 undergraduate and post-baccaulaureate pre-medical students from UCLA by targeting student health groups and pre-medical extension courses. They received 30 responses within two weeks of and selected 20 of these students for the initial cohort.
    • Each student health coach receives two 2-hour in-person training sessions and then must complete six to eight 45-minute online training sessions for a total of 10 hours of training per health coach.

Other Steps to Implementation

  • The MyLife program has undergone three PDSA cycles.

Tech

Team Members

  • Physicians
  • Community Health Workers
  • Clinical Trainee or Student

Daily Workflow

  1. Clinic and physician recruitment: 
    • The leadership team sends an e-mail to the clinic manager and all the physicians at a UCLA primary care clinic notifying them of the MyLife Study. 
    • If they receive an affirmative response that the clinic or physicians would like to be eligible, the leadership team travels to the clinic and gives a 5-minute presentation at their periodic clinic lead meeting and follows up by sending visually-based flyers which are posted around the clinic about the MyLife program.
    • These flyers and the presentation instruct the interested PCPs to offer the MyLife program to adult patients with BMI 27, sedentary, and interested in losing weight and improving their lifestyle, within the context of their annual visit
  2. Patient recruitment:
    • PCPs recruit patients during clinic visit. Clinics share information with patients via flyers. Patients go to our website www.uclamylife.org to learn more and initiative the enrollment process into the 16 week MyLife program.
  3. 16-Week MyLife Program
    • Patients attend an in-person intake and outtake visits. 
    • Patients receive a Jawbone UP3 and more recently a Fitbit Charge 2 device and are instructed to wear the device continuously for 16 weeks.
    • Patients complete short surveys over the course of the 16-week program. 
    •  Over 16 weeks, the pre-medical, post-baccalaureate, or undergraduate personalized health coach uses proven behavior change techniques, real-time data analytics from the patient’s Fitbit activity trackers, automated text messaging, semi-structured surveys, and biweekly teleconferencing to build rapport with patients and motivate them to adopt and maintain healthier lifestyles.
    • In our randomized controlled trial (see the website) they get randomized into Fitbit vs Fitbit plus Health Coach.

Budget

$9000

Budget Details:

Current Status

  • The pilot intervention has completed and given positive outcomes they have started a larger randomized controlled trial
  • The pilot was conducted between late spring 2016 to Dec 2017. During this time 3 PDSA cycles of 10 patients each were recruited and underwent a 16- week intervention. In between each PDSA cycle the team reviewed feedback from patients, providers, health coaches, and the core team to direct improvements in the intervention.  and ran for 16 weeks. 
  • As of August 2018, we are now enrolling patients into our larger randomized controlled trial. More information can be found on our website: www.uclamylife.org
     

Outcomes

These outcomes were observed during the 16 week proof of concept phase of this intervention.

Patient Outcomes:

  • Patients increased physical activity by an average of 66 minutes per week.
  • Patients lost 4% of their body weight.
  • Patient Engagement: Patients responded to 70% of text messages sent to them.

Process Outcomes:

  • These results suggest that trained student volunteers can utilize wearable device data and validated behavior change techniques to improve meaningful clinical outcomes.

Future Outcomes

Benefits

  • This intervention offered a new service to patients and allowed them to experiment with wearable devices.
  • This intervention offered a new service to physicians and allowed them to experiment with integrating wearable devices into their practice.

Challenges

Unique Challenges to the Intervention:

  • Information Technology Integration, Compliance, and Security:
    • The leadership team was challenged to integrate Jawbone, Fitbit, and SMS-based data into one IT platform. 
    • The team felt that having to build an integrative IT platform in-house was a large barrier but felt it was necessary as it gave them the capacity to iterate constantly.
    • Building this platform took hundreds of hours.
    • They partnered with Way to Health to customize their patient engagement platform.

Personnel Challenges:

  • The leadership team felt that they would have benefited from additional team members to manage the logistics of the intervention. 

Additional Resources

Relevant Quality Metrics

Summary by Jeremy Ziring

Coming Soon!

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