Implementation of an Interdisciplinary Weight Loss Counseling Intervention in Primary Care: BMI PDSA
Maura Moran Brain, DNP(c), ANP Jennifer Hackel, DNP & Eileen M. Stuart-Shor, PhD, ANP
Introduction & Background
 National data about obesity rates show an increase in frequency and a
disproportionate burden on minorities (1)
 In the index primary care practice BMI is calculated but not shared with the pt.
 Two approaches to patient counseling have been shown to be effective in evoking
weight loss - MI and the 5 As (2,3)
 Weight loss counseling done by support staff yields promising outcomes (1)
Aim
The purpose of this project was to implement a BMI stratification and educational
intervention to address obesity within one primary care team.
Methods
Primary Objectives:
Implementation of the intervention will lead to:
1.
2.
3.
Targeted pts demonstrate greater knowledge of the risks of their BMI on their health
Involved staff & pts report greater satisfaction about their healthcare team
Feedback provided feasibility of dissemination of this intervention through practice
Implementation:
 Pre-implementation training for MA & RN
 All pts scheduled for routine visits have BMI calculation of ht/wt measures, those with
BMI 30-34.9 are identified as potential participants and given 5 As by the MA as well as
NIH readiness questionnaire
 Pts who scored a high level of readiness (> 8 on the NIH tool) were invited to receive an
RN phone call
 If patient agreed to this call patient information was given to RN so f/u call could be
Results
Conclusions
 This 6 wk QI project occurred at Healthcare Associates, a large academic primary
care practice in Boston, MA
 MAs can be trained to provide well-received pt education & resources about BMI and
its connection to health
 RN MI phone calls were often derailed due to pt being unavailable or having a more
pressing concern to discuss
 Due to the short time of this QI it was hard to capture data on weight trends. As of
10/23/14 chart review revealed 8 pts had no new weights, 4 pts had no weight change,
7 pts had weight gain, 11 pts had weight loss. There was no correlation between RN
calls or NIH scoring & weight loss or gained thus far in review of weights
 30 pts met criteria and agreed to be checked in by MAs using the algorithm
 Of 30 pts 25 = female and 5 = male. Age range 24–81 yrs, mean age of 66. Average
BMI = 32.5. Average weight was 188.3. Average NIH readiness score = 8.1 (range 010). Pts were almost exactly 50% private/50% public insurance
 25 pts qualified for a (MI) RN phone call based on NIH scoring. Chart review
revealed 9 pts received MI based phone call by RN. 10 pts received vm by RN (no
documentation of call back). 4 pts had calls by RN where acute health concerns
were addressed (MI counseling was deferred). 2 charts had no doc RN call
 4 providers out of approximately 16 completed provider questionnaire. Team based
care and the value of MAs in partnering with pts was universally valued in returned
questionnaires
 Pt questionnaires showed high rate of satisfaction with health info shared and
interaction with MA
 MA feedback revealed comfort with knowledge about BMI & BMI PDSA pt
interactions
 PDSA format was well suited for this pilot as every 2 wk reassessments allowed PI to
capture data about the relationship of clinic staffing to identifying subjects for pilot
(as can be seen in below annotated run chart)
Summary:
 Teaming with MAs to provide counseling to pts about BMI may be a cost effective
intervention well received by pts that could occur before a pt encounter with provider.
This may help create a more informed and educated pt that, as described in the chronic
care model, is more ready to engage in their healthcare
Next Steps:
 Assess weight changes of above participants 6 months after QI project. Explore the
feasibility of a practice-wide adoption of MA sharing a BMI chart with each pt at weigh
in with a brief definition of how BMI connects to health
Lessons Learned
 Enthusiastic and invested MAs likely contributed to success of intervention
 RNs felt time pressures & urgent care responsibilities were a more pressing need of
their time. This likely contributed to barriers experienced connecting with pts in post
made
 PCP seeing pt reviewed information gathered by MA and addressed it in visit
visit f/u
 MA staffing, late pt arrivals, and resident provider’s single room to see pt’s in were
challenges that were not able to be overcome that affected the success and
sustainability of this project
Measures:
Limitations:
 BMI tracking, pre/post staff questionnaires, NIH scoring questionnaire, chart audits
The 5 As Table in BMI Counseling
Anecdotally the 5 As table worked well for educating MAs about how to interact with pts
about weight, and MAs often shared it with pts to talk about BMI (informally)
ASK
ASK ABOUT KNOWLEDGE OF BMI AND HEALTH?
ADVISE
ADVISE ABOUT HEALTH RISK
ASSESS
ASSESS PTS READINESS AND INTEREST IN CHANGE WITH NIH READINESS TOOL
ASSIST
GIVE INFO ABOUT RESOURCE OPTIONS/PRACTICE OPTIONS
ARRANGE
GUIDE PTS ON NEXT STEP OF FOLLOW THROUGH ON RESOURCES (IF APPT) AND TEAM COMMUNICATION
 Small sample of pts who were highly motivated agreed to be part of this QI project.
These pts were 5 to 1 female. Findings may not be transferrable to other types of pt
populations
References:
1. Dennison Himmelfarb CR. New evidence and policy support primary care-based weight loss interventions. J
Cardiovasc Nurs. 2012;27(5):379-381.
2. Alexander SC, Cox ME, Boling Turer C,L., et al. Do the five A's work when physicians counsel about weight loss? Fam
Med. 2011;43(3):179-184.
3. Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y. Clinical review: Modified 5 as: Minimal intervention for obesity
counseling in primary care. Can Fam Physician. 2013;59(1):27-31.
4. National Institute of Health. 3 Steps to initiate discussion about weight management with your patients.
http://nhibinih.gov. Accessed October 23, 2014