A pilot program that provides transitions coaching to patients hospitalized for heart attack, CHF or pneumonia has reduced unnecessary rehospitalizations at five Baton Rouge hospitals by 80 percent, according to early feedback from the program. The CMS-funded pilot targets patients 65 years and older, then pairs these older patients with a health coach. The coach works with the patients while they are hospitalized, but the real work begins once the patients are discharged.

Introduced to the patient upon admission, the health coach establishes a relationship, letting the patient know what to expect while in the hospital and after they are discharged. By the time they are ready to leave the hospital, the patient has been given advice and information about how to manage their own care. This includes information about rest and exercise, managing medicines and their potential complications, using a personal health record (PHR), when to schedule an appointment with their primary care doctor and what to do if something goes wrong.

Gary Curtis, president of the Louisiana Health Care Review (LHCR), said he is pleased with the results of the program after its first six months, which is in place at Baton Rouge General Medical Center, Lane Regional Medical Center, Ochsner Medical Center – Baton Rouge, Our Lady of the Lake Regional Medical Center and St. Elizabeth Hospital in Gonzales. “We’ve worked with about 93 patients and have only had four readmissions, a 4 percent rate, and an almost 80 percent improvement.”

"Ideally, an informed, empowered, educated and confident member will go to their primary care physician with a list of medications, developed and noted by a credible and reliable nurse practitioner (NP). Typically, doctors are grateful to know that an NP reviewed these medications. They can then make decisions based on this information. There are usually two to three follow-up calls from the NP to the patient. The goal of this program is not long-term case management but rather to empower members at risk for hospitalization with the knowledge they need to feel confident taking control of their healthcare.”
                                        — Danielle Butin is the former director of Northeast Health Services for SecureHorizons, a division of UnitedHealthcare.

Virtual coaching under development at the Frances Payne Bolton School of Nursing at Case Western Reserve University will use avatars to improve communications between doctors and patients. The nursing school is leading an interdisciplinary research team of nurses, doctors and engineers to develop technologies with avatar doctors similar to the ones found in computer games to help patients hone their communications skills.

About 80 percent of healthcare is managed by individual patients or family caregivers, according to John Clochesy, an Independence Foundation professor of nursing education who is directing the project. Having the right information is important in the treatment of these chronic illnesses and doing what the doctor prescribes, he says.

The goal of the two-year, $1.3 million research effort is to eventually make the technology available in hospitals and clinics to help patients after they receive a diagnosis. Clochesy envisions patients stopping by a kiosk before a doctor's visit and practicing how to ask the important questions. Clochesy says the effort might close the health disparity gap by focusing on teaching the patient the skills needed to be successful in managing their health through better communications with the doctor.

"We want people to get the healthcare information they need to manage their chronic illnesses," says Clochesy.

Question: Should quality in a coaching effort be measured throughout the coaching process or only at its conclusion?

Response: We provide the process and summative evaluation by listening to tapes. We rate their proficiency in their technique, as well as doing inner rater reliability where we look at how they’re taking notes in terms of how they’re rating someone’s importance, commitment strength and confidence levels. We emphasize our clinical outcomes and we use both long-term and intermediary measures. Our intermediary measures are locked into our HRA, self-efficacy, the SF-12, which is a mental and physical health status.

(Susan Butterworth, Ph.D., is director of health management services at Oregon Health & Science University.)

Quantifying the impact of health and behavior change resulting from health coaching interventions on healthcare utilization and medical costs is still a major challenge, especially in this time of tough budget scrutiny. In Health Coaching Evaluation: Measuring the ROI on Healthcare Utilization and Costs, a 60-minute webinar on January 13, 2010, health coaching experts will discuss the challenges of evaluating and reporting on a health coaching ROI and how they are responding to these challenges.

HealthCoach Huddle subscribers can use ordering code HCH to purchase this resource at a special price!

As 2009 draws to a close, which products and services served healthcare companies best this year? What were the greatest operational challenges they faced in 2009? Looking ahead, are healthcare organizations more or less optimistic about the 12 months to come? Which aspect of healthcare reform will have the greatest impact on their business, and will there be a new healthcare bill by the new year? This just-published executive summary of responses from 100 healthcare organizations to HIN's November 2009 Healthcare Trends for 2010 e-survey identifies reform priorities, top-of-mind concerns for the year ahead and best and worst business decisions in 2009.