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Features Projects Iowa City VA Wins Star Award
Features Projects Iowa City VA Wins Star Award
Iowa City VA Wins Star Award
Iowa City VA Wins Star Award
Lessons learned:
1. The most important lesson learned from this experience is that it is possible to accomplish goals by working together as a highly effective team. Goals are clear, challenging, related to the purpose of the team, and were established by the team members. Team members developed the strategies for achieving the goals. All members are held accountable and are expected to participate to achieve team goals. Team members have a mutual respect and willingness to help each other.
• There is open communication between team members. Team members are able to express themselves openly and honestly without fear of retribution or rejection. All suggestions and comments are respected by each team member. Members listen to each other while differences of opinion and perspectives are valued and encouraged.
• Most importantly, individual contributions are recognized and appreciated by all members of the team. Each team member is made to feel good about their membership to the MOVE Program. Members have a strong sense of pride and satisfaction about their work. There is a strong awareness of cohesion and team spirit. The MOVE Program members are proud to be part of the MOVE Program!
2. The second lesson learned is the importance of customer service to our patients. Patient satisfaction is evident in the MOVE Program. Patients are succeeding in losing weight because they receive individualized attention, even in the class setting. Patients in the program are made to feel special and that they can succeed at their weight loss goals. Patients are encouraged to provide feedback to the MOVE Coordinator or team members on how we can make improvements and meet their needs. Many of our initiatives are based on patient suggestions. These initiatives are very successful because they are patient driven.
3. The third lesson learned is the willingness to take risks. The team challenged every process the previous MOVE Program had established. This team was willing to take risks and fail. All failures were considered as additional opportunities. All successes were considered as avenues to improve outcomes at an even higher level.
Project description:
Nearly seventy percent of all adult veterans are overweight or obese. Together overweight and obesity are the second leading cause of preventable death, primarily through effects on cardiovascular disease, diabetes, hypertension and dyslipidemia. Reducing morbidity and mortality related to obesity and overweight is a major public health priority, which the VA is addressing with an outpatient clinic-based program for weight reduction called MOVE. Despite enormous institutional efforts devoted to the MOVE Program, the impact on obesity in the VA population remains small and further evidence-based optimizations of the MOVE interventions are needed to improve outcomes.
On a national level there are very few evidence-based practice MOVE Programs. An over whelming majority of VA-MOVE Programs do not monitor data on systems redesign or patient outcomes such as weight lost. This project implemented several innovative interventions in the Iowa City MOVE Program to become more efficient and assist patients in losing weight. All innovations implemented can easily be instituted at other MOVE programs.
METHODS USED:
1. Held weekly team meetings to accomplish MOVE Program goals listed below.
2. Implemented all ten Advanced Clinic Access /System Redesign principles in every aspect of the MOVE Program.
3. Utilized PDSA cycle plan for monitoring continuous quality improvement for MOVE Program.
4. Performed skill assessment on team members to determine their educational needs to accomplish team goals.
5. Investigated alternative methods to increase MOVE Introductory classes to facilitate entry into the MOVE Program and patient attendance.
6. Examined responsibilities of all team members to determine if roles could be changed or expanded.
7. Evaluated clinic processes to determine clinic efficiency/inefficiencies to streamline patient care.
8. Developed moderator roles at each Community Based Outpatient Clinic (CBOC) and initiated monthly conference calls between CBOCs and Iowa City MOVE Program.
TEAM GOALS:
1. Eliminate MOVE Program wait list in 1 month.
2. Fully implement Advanced Clinic Access within the program.
3. Implement a no show policy for the MOVE Program.
4. Decrease no show rate from 80% to 10% for all MOVE classes.
5. Improve communication between Iowa City VAMC and the CBOCs.
6. All new consults will have a scheduled MOVE Introductory appointment within 7 days. Offer patients appointments same day as referral.
7. Improve and update class material and teaching strategies.
8. Optimize the health of the veteran by developing the following weight loss goals:
75% of all Level I patients will loose weight (average 1-2 pounds a week during the first 6 months).
75% of all Level II patients will loose weight (average 1-2 pounds a week during the first 6 months).
75% of all Support patients will maintain their weight loss.
9. All practices and initiatives will be evidence-based.
10. Initiate MOVE Physical Therapy and Dietary consults for one to one consultation for MOVE patients.
RESULTS: The Iowa City MOVE Program is one of the few MOVE Programs in the nation monitoring patient outcomes and the quality of care provided to patients. To date 83% of all patients in the Iowa City MOVE Program Level II have lost weight. This is considered an exceptional weight loss program. In Level I, 70 % of all patients have lost weight. In the MOVE Support Group, approximately 70% of the patients have lost weight or maintained their weight loss. This high level of weight loss is reflective of the high quality of care consistently being delivered to the patient.
On October 15, 2007 the Iowa City MOVE Program had 339 patients on a wait list. Many of these patients (40%) had been waiting for over one year to get into the MOVE Program. As of January 16, 2008 the Iowa City MOVE Program no longer had a wait list. During this time period another 69 new MOVE consults were referred by primary care providers. In a three month period a total of 408 patients were seen in the MOVE Introductory classes. This was accomplished by utilizing all ten System Redesign principles, stepping outside of the box and being creative, evaluating all practices and systems of the MOVE Program for inefficiencies, maximizing all current resources assigned to the MOVE Program, developing action plans and keeping the team very focused.
The MOVE Program continuously monitors veteran and family satisfaction by promoting patient-centered care and excellent customer satisfaction. The MOVE Program strives to be patient centered in all facets of care delivery by encouraging patient involvement and accountability. Patients determine their weight loss goal in the MOVE Introductory class. Patients also determine what changes they want to make in their dietary and activity life style. The patient makes the decision on which level of the program they feel best meets their current lifestyle. We allow the patient who is in Level I to attend Level II classes if they feel this would benefit their weight loss. If a patient is in Level II and can no longer attend class, we encourage them to change to Level I instead of dropping from the program. The Iowa City MOVE Program is very flexible and provides many options to the patient.
The Iowa City MOVE Program has been successful due to high employee satisfaction and an innovative approach to meet patient care issues. An example of one innovative approach was to take patients grocery shopping. This interactive experience was designed to better prepare patients to purchase food in a healthy and economical manner. First, MOVE patients attend a two hour educational class on the food pyramid, menu planning, developing a shopping list, understanding grocery store layouts, economically shopping using generic and national brands, reading food labels, and understanding protein alternatives. The MOVE Program secured funding so each patient has one hundred dollars to spend on groceries at the grocery store. We believe that we are the only MOVE Program in the nation that has taken this innovative approach to assist the patient lose weight. We encourage the person in the family who performs the grocery shopping along with the patient to participate in this class. The patient is set up to succeed in all avenues of this experience. We are measuring cognitive abilities of the patients in addition to the amount of weight loss with this experience.
Another innovative approach taken by the MOVE Program was developing the “Biggest Loser”. This program has been very successful in motivating patients to lose weight. In conjunction with the VA Canteen Service the patient who loses the most weight each month receives a twenty dollar gift certificate to the Canteen Retail Store. The next five biggest losers receive ten dollar gift certificates. This incentive program started January 2008. The average monthly cummulative weight loss for our Biggst Loser for six months (January to June) is 121 pounds each month, (See Graph III). To date we have had thirty-six patients lose a total of 897.2 pounds. The average weight lost per patient at the time when the Biggest Loser was awarded was 20.1 pounds. Since winning the Biggest Loser 90% of these patients continued to lose additional weight (170.7 pounds), while only 8% regained weight. The overall average weight lost per patient in the "Biggest Loser" was 26.9 pounds. The average body mass lost was 9%, ranging from 3% to 19.5%.The majority (75%) of these patients were participants in Level II classes while 25% of the winners were from Level I.
The third innovative approach to assist patients in losing weight is taking before and after pictures. All patients are offered to have their picture taken during a MOVE Introductory class. The patient is instructed to place this picture some place visible in their home like the refrigerator. They are also instructed to find a picture of themselves when they felt and looked good. The patients are instructed to place the pictures side by side to be used as a motivator to assist them in losing weight.
The Iowa City MOVE Program promotes providing quality care in an efficient manner. The MOVE Team challenged inefficiencies and established practices on all levels of the program.One inefficiency evaluated was the under utilization of resources assigned to the MOVE Program, in specific, the Dietitian and Physical Therapist. Prior to January 2008 these individuals taught class once a month even though they were assigned 1.0 and 0.5 FTEE respectively to the program. Since January 2008 the MOVE Physical Therapist and MOVE Dietitian are performing evaluations on a one to one basis with MOVE participants. This is a new feature that all MOVE participants are encouraged to undertake. Each patient receives a detailed written exercise/activity plan from the Physical Therapist. The MOVE Physical Therapist takes into consideration patient preferences, health needs and limitations of the patient. Patients are asked to fill out an activity log daily to bring to the return appointment in 4-6 weeks when the exercise plan is updated and new body measurements are taken. The Iowa City MOVE Program is one of the few MOVE Programs to utilize a Physical Therapist in this manner.
The MOVE Dietitian performs individual dietary evaluations, provides meal plans and develops low calorie menus for patients requiring specialized diets. The Dietitian meets with the patient, discusses/evaluates a weekly log of food that the patients have consumed and provides recommendations for healthy choices in their diet. The Dietitian also alters favorite recipes into lighter and healthier version. She is currently developing a low calorie cookbook with recipes provided by the MOVE participants. She also assists in case managing Level I patients by calling them and providing dietary advice.
Previously only one dietitian taught the MOVE Introductory class. This was changed to allow all MOVE providers, including the physical therapist, psychologist, nurse, and dietitian, the opportunity to teach a MOVE Introductory class. This increased the program’s flexibility and allowed an increased number of classes. If one instructor is not available to lead the class another instructor is able to step-in without loss of time and travel for the patient. A guideline was developed so all instructors would provide the same information and handouts at each class establishing continuity.
All MOVE classes are provided in a group environment. We were able to maximize all classroom space in our CBOCs. After visiting each CBOC we determined which rooms could hold the largest classes and held classes in those rooms. We went from 32 patients attending Level II classes to currently 105 patients in our Level II classes. To increase efficiency and patient flow moderator positions were developed in all CBOCs. This position assisted the MOVE Program in checking in the patient, weighing the patient, assisting with audiovisual equipment and providing assistance in the classroom when needed. A monthly conference call was established to improve communication and provide program updates to CBOC moderators. Both of these endeavors have greatly improved clinic flow for the MOVE Program.
A no show policy was established and enforced for the MOVE Program. A letter was mailed informing patients of policy updates. In October 2007 the no show rate for the MOVE Program Level II classes was approximately 80%. For fourth quarter FY 2008 the no show rate was approximate 12%. While this has been a drastic improvement in the no show rate, our goal is to have the rate under 10%. Previously, there were many patients who no showed for over 8 consecutive weeks and were still scheduled for the MOVE classes. Now if a patient misses 2 classes they are called to determine if they want to continue in the MOVE Program.
All processes implemented in the MOVE Program can be sustained over time without increasing cost to the Medical Center. The high sustainability of these processes is due to high patient and employee satisfaction. All of the processes can be replicated system wide within VAs without increasing cost to the current MOVE Programs.The National MOVE Program has endorsed all changes within the Iowa City MOVE Program. Positive patient outcomes such as weight loss and satisfaction have occurred from process changes and have significantly improved over time. It is anticipated that this significant weight loss and patient satisfaction will be maintained by the patients over time.
There were many methodology changes that have occurred to improve quality and patient outcomes. Same day referrals increased weight loss. By entering the patient into the MOVE Program the same day their provider discussed weight loss with them increased weight loss. During the MOVE Introductory class the MOVE Dietitian consults with the patient to determine dietary needs. When the patient sees the MOVE Physical Therapist they also see the Dietitian on the same day. During the Introductory Class a folder with weight loss information, pedometer and the "Get Fit For Life" CD is given to the patient to increase exercise and activity. Prior to October 2007 the Iowa City MOVE Program rarely provided pedometers, "Get Fit For Life CDs, Physical Therapy evaluations or Dietiary evaluations. Frequently patients did not receive class room handouts on time.
The MOVE employees increased their efficiency in all avenues of the program. The MOVE Clerk (0.5 FTEE to MOVE Program) makes an average of 874 appointments a month. The average primary care team in Iowa City has 2 FTEE assigned to each team making an average of 850-900 appointments a month. The MOVE Clerk has the same responsibilities of consults, answering phone calls, mailing letters, etc as the clerks on the primary care team. While the MOVE Program is as busy as a primary care team, the clerical staff is less than half of a primary care team. We have streamlined all clerical duties and responsibilities.
The Iowa City MOVE Program is both effective in positive patient outcomes and efficient in resource management. The MOVE Program has improved resource management as evidenced by outpatient stop code reports. The number of total individual encounters increased from seven in FY06, to 32 in FY07, to 610 in FY 4/08. The total cost of encounters decreased from $260 in FY06, to $341 in FY07, to $92 in FY08. The visit rate increased from 1.17 in FY06, to 1.45 in FY07, to 2.53 to FY 4/08. The Iowa City MOVE Program is 0.71 site per visit over the national average. The MOVE Program continues to perform well in group settings also. For FY06 the MOVE Program saw 446 patients, in FY07 saw 1451, and for FY 4/08 has seen 1286. It is projected that the MOVE Program will see an additional 500 patients in FY08 over that seen in FY07. The total cost per encounter decreased for group visits from $92 in FY06, to $130 in FY07, to $76 for FY 4/08. The direct cost per encounter for group visits also decreased from $57 in FY 06, to $78 in FY07, to $46 in FY 4/08. The Iowa City MOVE Program sees patients an average of 0.45 over the national average.
1. The most important lesson learned from this experience is that it is possible to accomplish goals by working together as a highly effective team. Goals are clear, challenging, related to the purpose of the team, and were established by the team members. Team members developed the strategies for achieving the goals. All members are held accountable and are expected to participate to achieve team goals. Team members have a mutual respect and willingness to help each other.
• There is open communication between team members. Team members are able to express themselves openly and honestly without fear of retribution or rejection. All suggestions and comments are respected by each team member. Members listen to each other while differences of opinion and perspectives are valued and encouraged.
• Most importantly, individual contributions are recognized and appreciated by all members of the team. Each team member is made to feel good about their membership to the MOVE Program. Members have a strong sense of pride and satisfaction about their work. There is a strong awareness of cohesion and team spirit. The MOVE Program members are proud to be part of the MOVE Program!
2. The second lesson learned is the importance of customer service to our patients. Patient satisfaction is evident in the MOVE Program. Patients are succeeding in losing weight because they receive individualized attention, even in the class setting. Patients in the program are made to feel special and that they can succeed at their weight loss goals. Patients are encouraged to provide feedback to the MOVE Coordinator or team members on how we can make improvements and meet their needs. Many of our initiatives are based on patient suggestions. These initiatives are very successful because they are patient driven.
3. The third lesson learned is the willingness to take risks. The team challenged every process the previous MOVE Program had established. This team was willing to take risks and fail. All failures were considered as additional opportunities. All successes were considered as avenues to improve outcomes at an even higher level.
Project description:
Nearly seventy percent of all adult veterans are overweight or obese. Together overweight and obesity are the second leading cause of preventable death, primarily through effects on cardiovascular disease, diabetes, hypertension and dyslipidemia. Reducing morbidity and mortality related to obesity and overweight is a major public health priority, which the VA is addressing with an outpatient clinic-based program for weight reduction called MOVE. Despite enormous institutional efforts devoted to the MOVE Program, the impact on obesity in the VA population remains small and further evidence-based optimizations of the MOVE interventions are needed to improve outcomes.
On a national level there are very few evidence-based practice MOVE Programs. An over whelming majority of VA-MOVE Programs do not monitor data on systems redesign or patient outcomes such as weight lost. This project implemented several innovative interventions in the Iowa City MOVE Program to become more efficient and assist patients in losing weight. All innovations implemented can easily be instituted at other MOVE programs.
METHODS USED:
1. Held weekly team meetings to accomplish MOVE Program goals listed below.
2. Implemented all ten Advanced Clinic Access /System Redesign principles in every aspect of the MOVE Program.
3. Utilized PDSA cycle plan for monitoring continuous quality improvement for MOVE Program.
4. Performed skill assessment on team members to determine their educational needs to accomplish team goals.
5. Investigated alternative methods to increase MOVE Introductory classes to facilitate entry into the MOVE Program and patient attendance.
6. Examined responsibilities of all team members to determine if roles could be changed or expanded.
7. Evaluated clinic processes to determine clinic efficiency/inefficiencies to streamline patient care.
8. Developed moderator roles at each Community Based Outpatient Clinic (CBOC) and initiated monthly conference calls between CBOCs and Iowa City MOVE Program.
TEAM GOALS:
1. Eliminate MOVE Program wait list in 1 month.
2. Fully implement Advanced Clinic Access within the program.
3. Implement a no show policy for the MOVE Program.
4. Decrease no show rate from 80% to 10% for all MOVE classes.
5. Improve communication between Iowa City VAMC and the CBOCs.
6. All new consults will have a scheduled MOVE Introductory appointment within 7 days. Offer patients appointments same day as referral.
7. Improve and update class material and teaching strategies.
8. Optimize the health of the veteran by developing the following weight loss goals:
75% of all Level I patients will loose weight (average 1-2 pounds a week during the first 6 months).
75% of all Level II patients will loose weight (average 1-2 pounds a week during the first 6 months).
75% of all Support patients will maintain their weight loss.
9. All practices and initiatives will be evidence-based.
10. Initiate MOVE Physical Therapy and Dietary consults for one to one consultation for MOVE patients.
RESULTS: The Iowa City MOVE Program is one of the few MOVE Programs in the nation monitoring patient outcomes and the quality of care provided to patients. To date 83% of all patients in the Iowa City MOVE Program Level II have lost weight. This is considered an exceptional weight loss program. In Level I, 70 % of all patients have lost weight. In the MOVE Support Group, approximately 70% of the patients have lost weight or maintained their weight loss. This high level of weight loss is reflective of the high quality of care consistently being delivered to the patient.
On October 15, 2007 the Iowa City MOVE Program had 339 patients on a wait list. Many of these patients (40%) had been waiting for over one year to get into the MOVE Program. As of January 16, 2008 the Iowa City MOVE Program no longer had a wait list. During this time period another 69 new MOVE consults were referred by primary care providers. In a three month period a total of 408 patients were seen in the MOVE Introductory classes. This was accomplished by utilizing all ten System Redesign principles, stepping outside of the box and being creative, evaluating all practices and systems of the MOVE Program for inefficiencies, maximizing all current resources assigned to the MOVE Program, developing action plans and keeping the team very focused.
The MOVE Program continuously monitors veteran and family satisfaction by promoting patient-centered care and excellent customer satisfaction. The MOVE Program strives to be patient centered in all facets of care delivery by encouraging patient involvement and accountability. Patients determine their weight loss goal in the MOVE Introductory class. Patients also determine what changes they want to make in their dietary and activity life style. The patient makes the decision on which level of the program they feel best meets their current lifestyle. We allow the patient who is in Level I to attend Level II classes if they feel this would benefit their weight loss. If a patient is in Level II and can no longer attend class, we encourage them to change to Level I instead of dropping from the program. The Iowa City MOVE Program is very flexible and provides many options to the patient.
The Iowa City MOVE Program has been successful due to high employee satisfaction and an innovative approach to meet patient care issues. An example of one innovative approach was to take patients grocery shopping. This interactive experience was designed to better prepare patients to purchase food in a healthy and economical manner. First, MOVE patients attend a two hour educational class on the food pyramid, menu planning, developing a shopping list, understanding grocery store layouts, economically shopping using generic and national brands, reading food labels, and understanding protein alternatives. The MOVE Program secured funding so each patient has one hundred dollars to spend on groceries at the grocery store. We believe that we are the only MOVE Program in the nation that has taken this innovative approach to assist the patient lose weight. We encourage the person in the family who performs the grocery shopping along with the patient to participate in this class. The patient is set up to succeed in all avenues of this experience. We are measuring cognitive abilities of the patients in addition to the amount of weight loss with this experience.
Another innovative approach taken by the MOVE Program was developing the “Biggest Loser”. This program has been very successful in motivating patients to lose weight. In conjunction with the VA Canteen Service the patient who loses the most weight each month receives a twenty dollar gift certificate to the Canteen Retail Store. The next five biggest losers receive ten dollar gift certificates. This incentive program started January 2008. The average monthly cummulative weight loss for our Biggst Loser for six months (January to June) is 121 pounds each month, (See Graph III). To date we have had thirty-six patients lose a total of 897.2 pounds. The average weight lost per patient at the time when the Biggest Loser was awarded was 20.1 pounds. Since winning the Biggest Loser 90% of these patients continued to lose additional weight (170.7 pounds), while only 8% regained weight. The overall average weight lost per patient in the "Biggest Loser" was 26.9 pounds. The average body mass lost was 9%, ranging from 3% to 19.5%.The majority (75%) of these patients were participants in Level II classes while 25% of the winners were from Level I.
The third innovative approach to assist patients in losing weight is taking before and after pictures. All patients are offered to have their picture taken during a MOVE Introductory class. The patient is instructed to place this picture some place visible in their home like the refrigerator. They are also instructed to find a picture of themselves when they felt and looked good. The patients are instructed to place the pictures side by side to be used as a motivator to assist them in losing weight.
The Iowa City MOVE Program promotes providing quality care in an efficient manner. The MOVE Team challenged inefficiencies and established practices on all levels of the program.One inefficiency evaluated was the under utilization of resources assigned to the MOVE Program, in specific, the Dietitian and Physical Therapist. Prior to January 2008 these individuals taught class once a month even though they were assigned 1.0 and 0.5 FTEE respectively to the program. Since January 2008 the MOVE Physical Therapist and MOVE Dietitian are performing evaluations on a one to one basis with MOVE participants. This is a new feature that all MOVE participants are encouraged to undertake. Each patient receives a detailed written exercise/activity plan from the Physical Therapist. The MOVE Physical Therapist takes into consideration patient preferences, health needs and limitations of the patient. Patients are asked to fill out an activity log daily to bring to the return appointment in 4-6 weeks when the exercise plan is updated and new body measurements are taken. The Iowa City MOVE Program is one of the few MOVE Programs to utilize a Physical Therapist in this manner.
The MOVE Dietitian performs individual dietary evaluations, provides meal plans and develops low calorie menus for patients requiring specialized diets. The Dietitian meets with the patient, discusses/evaluates a weekly log of food that the patients have consumed and provides recommendations for healthy choices in their diet. The Dietitian also alters favorite recipes into lighter and healthier version. She is currently developing a low calorie cookbook with recipes provided by the MOVE participants. She also assists in case managing Level I patients by calling them and providing dietary advice.
Previously only one dietitian taught the MOVE Introductory class. This was changed to allow all MOVE providers, including the physical therapist, psychologist, nurse, and dietitian, the opportunity to teach a MOVE Introductory class. This increased the program’s flexibility and allowed an increased number of classes. If one instructor is not available to lead the class another instructor is able to step-in without loss of time and travel for the patient. A guideline was developed so all instructors would provide the same information and handouts at each class establishing continuity.
All MOVE classes are provided in a group environment. We were able to maximize all classroom space in our CBOCs. After visiting each CBOC we determined which rooms could hold the largest classes and held classes in those rooms. We went from 32 patients attending Level II classes to currently 105 patients in our Level II classes. To increase efficiency and patient flow moderator positions were developed in all CBOCs. This position assisted the MOVE Program in checking in the patient, weighing the patient, assisting with audiovisual equipment and providing assistance in the classroom when needed. A monthly conference call was established to improve communication and provide program updates to CBOC moderators. Both of these endeavors have greatly improved clinic flow for the MOVE Program.
A no show policy was established and enforced for the MOVE Program. A letter was mailed informing patients of policy updates. In October 2007 the no show rate for the MOVE Program Level II classes was approximately 80%. For fourth quarter FY 2008 the no show rate was approximate 12%. While this has been a drastic improvement in the no show rate, our goal is to have the rate under 10%. Previously, there were many patients who no showed for over 8 consecutive weeks and were still scheduled for the MOVE classes. Now if a patient misses 2 classes they are called to determine if they want to continue in the MOVE Program.
All processes implemented in the MOVE Program can be sustained over time without increasing cost to the Medical Center. The high sustainability of these processes is due to high patient and employee satisfaction. All of the processes can be replicated system wide within VAs without increasing cost to the current MOVE Programs.The National MOVE Program has endorsed all changes within the Iowa City MOVE Program. Positive patient outcomes such as weight loss and satisfaction have occurred from process changes and have significantly improved over time. It is anticipated that this significant weight loss and patient satisfaction will be maintained by the patients over time.
There were many methodology changes that have occurred to improve quality and patient outcomes. Same day referrals increased weight loss. By entering the patient into the MOVE Program the same day their provider discussed weight loss with them increased weight loss. During the MOVE Introductory class the MOVE Dietitian consults with the patient to determine dietary needs. When the patient sees the MOVE Physical Therapist they also see the Dietitian on the same day. During the Introductory Class a folder with weight loss information, pedometer and the "Get Fit For Life" CD is given to the patient to increase exercise and activity. Prior to October 2007 the Iowa City MOVE Program rarely provided pedometers, "Get Fit For Life CDs, Physical Therapy evaluations or Dietiary evaluations. Frequently patients did not receive class room handouts on time.
The MOVE employees increased their efficiency in all avenues of the program. The MOVE Clerk (0.5 FTEE to MOVE Program) makes an average of 874 appointments a month. The average primary care team in Iowa City has 2 FTEE assigned to each team making an average of 850-900 appointments a month. The MOVE Clerk has the same responsibilities of consults, answering phone calls, mailing letters, etc as the clerks on the primary care team. While the MOVE Program is as busy as a primary care team, the clerical staff is less than half of a primary care team. We have streamlined all clerical duties and responsibilities.
The Iowa City MOVE Program is both effective in positive patient outcomes and efficient in resource management. The MOVE Program has improved resource management as evidenced by outpatient stop code reports. The number of total individual encounters increased from seven in FY06, to 32 in FY07, to 610 in FY 4/08. The total cost of encounters decreased from $260 in FY06, to $341 in FY07, to $92 in FY08. The visit rate increased from 1.17 in FY06, to 1.45 in FY07, to 2.53 to FY 4/08. The Iowa City MOVE Program is 0.71 site per visit over the national average. The MOVE Program continues to perform well in group settings also. For FY06 the MOVE Program saw 446 patients, in FY07 saw 1451, and for FY 4/08 has seen 1286. It is projected that the MOVE Program will see an additional 500 patients in FY08 over that seen in FY07. The total cost per encounter decreased for group visits from $92 in FY06, to $130 in FY07, to $76 for FY 4/08. The direct cost per encounter for group visits also decreased from $57 in FY 06, to $78 in FY07, to $46 in FY 4/08. The Iowa City MOVE Program sees patients an average of 0.45 over the national average.