The Secret to Improving Patient Outcomes in a Medical Practice

Here at TCLM, we strive to deliver excellent service and transform the health and lives of our patients. Our values display our high level of commitment to delivering compassionate and attentive care. Since we established Texas Center for Lifestyle Medicine in 2017, we have been continuously improving our collaborative treatment approach, which is based on patient outcomes and demands. We decided to implement health coaching as a means of meeting the needs of our patient population in order to support their healing. When we first started this model, it was very physician-focused; meaning that they provided medical care while being supported by allied health professionals and health coaches. However, through our work in the Houston community, we discovered that this traditional design does not work well.


Through receiving feedback from our patients, as well as taking a detailed look at our patient outcomes data, we realized the following: When health coaching becomes the central focus of our core values, patients develop a greater understanding of what our practice has to offer. We also observed that when patients receive little or no coaching, they tend not to fare as well as those who do go through the coach's program. We saw that those who undergo health coaching are generally more content during provider visits and see marked improvements in outcomes and compliance metrics.


This design of medicine—with health coaches at the center instead of physicians—is not one typically seen. We understand that health is determined by more than just medical treatment and have shifted from a traditional physician-centered model to one focused on health coaching. This shift has resulted in drastic improvements in the overall health of our patients, with many experiencing excellent outcomes as a result of attending health coaching sessions.


Our patient outcomes data has revealed that patients who did not receive any health coaching had a PROMIS Global Health score (a score used to determine mental health status) which improved by 7.4%. For those patients with five or fewer coaching visits, the score improved by 19%. For individuals with 5 to 20 coaching sessions, their PROMIS Global Health score improved by 40%. Those patients with more than 20 coaching sessions showed an improvement of 22.7%. Based on this data, it was concluded that our patients who had 5-20 coaching sessions showed the greatest improvements in their health.


Although it is worth noting that those who had more than 20 coaching sessions generally started with worse health conditions, there might be a selection bias for patients who had received more than 20 visits. Nonetheless, anyone who received health coaching significantly outperformed in their PROMIS Global Health scores compared to no coaching visits in the two-year span.


Similarly, our data determined that 5-20 coaching visits drastically improved PHQ-9 scores (a questionnaire used to track and screen for depression, in a population of patients diagnosed with major depressive disorder who were taking at least one antidepressant) by 74%! No significant improvements were shown in patients with similar initial scores who received no coaching. Those with five or fewer coaching visits saw a much greater improvement, averaging 9.2 points at the start, which improved to 8.1—a difference of 9.7%. The data is both shocking and encouraging, as implementing health coaching clearly surpasses the current standard of care in improving severe depression.


We also wanted to take a look at how health coaching visits impact physical health, specifically for those struggling with diabetes and metabolic issues. We utilized data from Quest Diagnostics looking at serum hemoglobin A1C values in our type 2 diabetes patients. Our no-coaching visit patients had an average starting A1C of 7.3%, which improved by 0.4% after two years, down to an A1C of 6.7%. For patients with five or fewer coaching visits, the starting A1C was 7.2%, and these patients averaged a 1% improvement, down to an A1C of 6.2%. Patients who received 5-20 coaching visits had an starting A1c of 7.4%, on average, and these patients improved by 1.6% over two years down to an average A1c of  5.8% This means that those who received 5-20 coaching visits effectively lowered their hemoglobin A1c down below the diabetes threshold of 6.4%!


When reviewing patient data from those with hypertension, numbers revealed that patients who received 5-20 coaching visits had an average starting blood pressure of 144/90 mmHg, and these patients improved by 18.3/8.0 mmHg over two years, for a total improvement rate of 12.7%! Other statistics have shown that patients who receive health coaching are more likely to schedule and keep follow-up appointments, schedule external preventive medicine exams (such as those of podiatrists and ophthalmologists), and complete their annual wellness exams. Data even shows that, since establishing coaching visits, patients who received five or more coaching visits have had no hospitalizations.


Because of the startling data mentioned above, the feedback we have received form our patients, and overall outcomes we see in our patients who attend coaching sessions, we have found that it is essential to have health coaches working in collaboration with the care team. This has shown to be the most effective way to deliver lifestyle medicine and to encourage patients on the path toward optimal health.


How does this model work within our Clinic? - Our lifestyle programs have a nurse practitioner or physician, registered dietitian, and health coach working together to help patients make lifestyle changes. The nurse practitioner provides medical guidance and medication management while the registered dietitian focuses on nutrition education and counseling. The health coach helps patients develop skills for behavior change and provides accountability and support. This collaborative approach has been successful in helping our patients overcome barriers to making lifestyle changes. This model of care is also cost-effective, as it reduces unnecessary testing and procedures that are often ordered when patients are managed by a traditional primary care provider.


Our data has shown that health coaching is an incredibly effective tool in helping patients improve their physical and mental health. This collaborative approach drastically encourages patients to make lifestyle changes and has proven to be successful in providing medical guidance as well as nutrition education and counseling. Furthermore, this model of care reduces unnecessary testing and procedures while also being extremely cost-effective. We are proud to provide our clients with the highest quality of healthcare through these innovative approaches involving the use of health coaches!


For more information, contact our clinic! If you are a physician or health professional and would like to collaborate with us, check out our page dedicated to providers!


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