HealthPOWER! Prevention News (Fall 2011)—Feature Article
Transformation in Practice: Innovative Partnership Helps Veterans Walk
With EaseSM and MOVE!®
Marcia Mullis, HPDP Program Manager for the Bay Pines (Florida) VA Health Care
System (VAHCS), knows the statistics all too well. Recent data indicate that 22
percent (50 million) of U.S. adults have arthritis.1 By 2030, this number is
projected to rise to 25 percent (67 million) of adults, of whom 25 million will
report related limitations in physical activity.2 She estimates that
"70 to 80 percent of Veterans who come to the VAHCS have chronic diseases such
as arthritis."
Mullis and Barbara Parker, Bay Pines' Chief of Recreation Therapy Service (RT),
have spent multi-decade VA careers implementing programs to prevent and manage
arthritis and other chronic health problems. This task is particularly
challenging at their HCS, which is located near Tampa Bay and serves a 10-county
area.
As one of the largest facilities in VHA, Bay Pines provides the continuum of
services to the spectrum of Veterans. It accounts for nearly 100,000 outpatient
visits per year through its main facility and eight community-based outpatient
clinics. One of its key missions is to provide evidence-based health care that
promotes population health—a mission that it shares with the Florida Department
of Health (DoH) and has resulted in an innovative collaboration that represents
the vanguard of VA's Transformational Initiatives for the 21st Century.
Outside the Box
In the past, the DoH had provided training and support to Mullis. But she knew
that a deeper partnership between the DoH and Bay Pines was possible, as well as
mutually beneficial. In May 2011, she applied for a grant that would support the
DoH and VHA goal of improving population health, and teamed with Parker to make
it reality. "We felt like 'pioneers' because we were forging a new relationship
with the state, assembling a multi-disciplinary staff for a new clinical
offering, and applying for funding to support a new program, not traditional
research," says Parker.
Novel Partnership, Sizable Grant
In July 2011, Mullis and Parker were thrilled to learn that the DoH's Arthritis
Prevention and Education Program had awarded Bay Pines a grant for $170,000,
which was provided through a cooperative agreement with the Centers for Disease
Control and Prevention (CDC). Lauded as a new model for collaboration by the
DoH, the grant will help meet the health care needs of patients with arthritis.
Mullis and Parker will do this in a novel way: they will use the funding and an
existing VHA program for weight management (MOVE!)® to expand access to and use
of the Arthritis Foundation® (AF) Walk With Ease ProgramSM (WWE).
Walk With Ease
Therapist Stephany LaFlamme signs up Theresa
Torres for WWE
In short, WWE is an evidence-based program that helps adults who have
mobility-limiting arthritis (or chronic health conditions) move. Easily used by
individuals and groups, WWE helps participants gradually increase their walking
time by managing pain, stretching and strengthening muscles, overcoming barriers
to physical activity, and getting and staying motivated. Participants are
provided a handbook that contains self-tests, a diary, stretching and exercise
guides, and motivational tools such as an exercise "contract." Additional
resources are available at the AF's WWE
(http://www.arthritis.org/easy-walking.php) and Let's Move TogetherSM
(http://lmt.arthritis.org/) Web sites.
WWE is backed by research that confirms myriad health benefits that range from
reduced disability to improved balance and overall health. Perhaps as
importantly, it provides patients with the confidence to be more physically
active and lead a healthier lifestyle.
Synergy with MOVE!®
Mullis and Parker believe that WWE is the perfect complement to MOVE!®, which
serves about 150 patients per week at Bay Pines and has helped nearly 300,000 of
the nation's Veterans get healthier by getting active and losing weight. "The
WWE program at Bay Pines is the kind of innovative program that leverages VHA
and community resources to bring healthy physical activity back into our lives,"
says Dr. Ken Jones, National Program Director for Weight Management/MOVE!®.
Although the grant will not directly support MOVE!®, embedding WWE within MOVE!®
will increase both programs' effectiveness, value, success, and reach. By
offering the programs to both Veterans and non-Veterans, Parker estimates that
15,000 new patients will be enrolled in 2011-2012.
Defining Goals and Success
Mullis says that RT and HPDP will jointly coordinate the new offering, which
they initiated in August 2011. About half of the grant money will be used to
acquire re-usable WWE participant handbooks; the remainder will support program
staff and clinical training.
Postgrant, the aim is to have a program that's expandable, sustainable, and a
permanent part of consultation services at Bay Pines. Success will be defined
not only in terms of overall participation, but also in several patient
improvement metrics, because the program is, after all, a treatment tool.
Mullis and Parker have an ambitious, three-stage plan for WWE: (1) MOVE!®
participants will be given the opportunity to sign up for WWE; (2) WWE will be
integrated into Bay Pines' menu for clinician referral; and (3) the Bay Pines
Employee Health Program will offer WWE to employees, volunteers, and family
members. Ultimately, they hope the use of WWE at Bay Pines will provide a
blueprint for the rest of VHA.
The Future of Care
Both Parker and Mullis feel that innovative, sustainable, community-focused, and
infrastructure-building partnerships such as theirs are the future of effective
HPDP efforts in VHA. Emphasizing, combining, and evaluating programs such as WWE
and MOVE!® also fits the current evidence-based focus of Bay Pines’ and VHA's
health care services. "We were just contacted about helping another VAHCS
implement WWE," says Mullis. "We hope other facilities also will want to develop
infrastructure and programs similar to ours."
Sue Diamond, National HPDP Program Manager at NCP, agrees. She thinks that Bay
Pines' ambitious vision and fresh model of collaboration are exactly what's
needed to support the people-centric, results-driven, forward-looking
orientation and ongoing transformation in how VA cares for more than 5.8 million
Veterans. "In spring 2011, NCP launched the Healthy Living Messages campaign to
reinforce healthy behaviors in Veterans," says Diamond. "Physical activity,
weight management, and involvement in one's health care are key healthy living
goals, and programs like WWE and MOVE!®
can help Veterans achieve them."
REFERENCES
1. Cheng YJ, Hootman JM, Murphy LB, Langmaid GA, Helmick CG. Prevalence of
doctor-diagnosed arthritis and arthritis-attributable activity limitation—United
States, 2007–2009. MMWR. 2010;59(39):1261–1265.
2. Hootman JM, Helmick CG. Projections of U.S. prevalence of arthritis and
associated activity limitations. Arthritis Rheum. 2006;54(1):266–229.
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