Overview

Organization Name

UCLA Health Internal Medicine, Primary Care

Organization Type

• Academic Hospital
• Academic Medical Center
• Community outpatient clinic
• Integrated healthcare system/network

National/Policy 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.

Patient Population Served and Payor Information

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

Leadership

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

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.

Tools or Products 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.
  • This was used in our pilot efforts, but for our larger randomized controlled trial (www.uclamylife.org) we have now partnered with Way To Health

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.

Tech Involved

• Chorus SMS-based platform
• Electronic medical record
• Epic
• Fitbit Tracker
• Integrated digital health patient engagement platform
• SMS
• Telephone

Team Members Involved

• Clinical Trainee or Student
• Community Health Worker
• Physicians
• Volunteer

Workflow Steps

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

• $10K to $25K

Budget Details

• $9000 for administrative costs
• 50 Jawbone Trackers Donated (Retail Value $30/each) for total value of $1500
• 50 Fitbit 2 Charge Trackers Donated (Retail Value $120/each) for total value of $6000

Where We Are

• 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

Future Outcomes

• The leadership team is conducting a multi-site randomized control trial comparing two groups of 50 patients with and without the aid of a health coach over the next year.
• The leadership team hopes to scale the MyLife program into the Health for America fellows which will provide fifty thousand students who apply annually to medical school the opportunity to work as health coaches.

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.

Unique Challenges

• 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.