WellStar Health Systems - Children's Cardiovascular Medicine

Situation

Recognizing that the incidence of pediatric obesity has reached epidemic proportions in the United States, WellStar Health System has partnered with our Pediatric Cardiologists, Children’s Cardiovascular Medicine, in a collaborative effort to provide a targeted multidisciplinary program aimed at having significant reduction of the impact of comorbidities in at risk children ages seven to seventeen.

Statistics show that one in three adults have a condition called insulin resistance, often a precursor to diabetes. In addition, over half of hypertensive adults have insulin resistance. Over 80% of adult diabetics have insulin resistance.

Prevalence of pediatric obesity is at 15% of 6-19 year old population or greater and is on a steady increase. The presence of obesity predisposes the child to insulin resistance, early hypertension and future type 2 diabetes. Four primary risk factors have been identified by the American Diabetes Association and the American Academy of Pediatrics as placing children at increased risk of developing Type 2 diabetes:

1. Overweight
   
2. family history of diabetes
   
3. ethnicity
   
4. the presence of insulin resistance.
   

The focus of the Be Well 101 project is the result of collaboration between the physicians (Children’s Cardiovascular Medicine) managing a high volume of patients with obesity and/or insulin resistance and the resources and expertise of the community health system (WellStar). The hope is to reduce the prevalence of obesity and diabetes in the community’s pediatric population, which in turn will create a healthy community long term. This should then reduce the health care burden of the community.

Solution

A pilot program was designed to test a Health Literacy model felt to have an opportunity to successfully reduce the risk factors and disease burden of children identified to be overweight, hypertensive or insulin resistant. Each screened child meeting criteria was enrolled in Be Well 101 of the WellStar Living Well University, a six month health education program designed to engage the child in better self management of his or her health through intense education and exercise. The program consists of the following components:

1. Health education content provided by a pediatric nurse practitioner designed to allow the child and parents to have a better understanding of the negative impact of overall disease burden;
   
2. Nutritional education by professional diabetes educators including cooking instruction of healthier living snacks;
   
3. Behavioral health education by certified psychologists to improve attitude and self image; and
   
4. Structured exercise classes and at home customized exercise programs.
   

Following a baseline fitness assessment, structured exercise classes moderated by exercise physiologists were offered weekly in Health Place, WellStar’s Wellness Center. Baseline assessments to test health literacy, nutritional insight and behavioral health competency were performed. Monthly, each discipline provided instruction to the children in the three areas of health education, nutritional fitness, and behavioral health fitness. Incentives were provided to encourage goal achievement. Continued care coordination of the underlying disease state was provided by Children’s Cardiovascular Medicine. Clinical followup included sequential outcome measurements of blood pressure, BMI (body mass index), lipid profiles, insulin levels and glucose levels. Clinical measurements were performed at baseline, three and six month periods.

Outcomes to date include significant reductions in clinical markers such as 25% reduction in serum insulin levels, 13% reduction in VLDL cholesterol and 23% reduction in triglyceride levels with a positive improvement in HDL levels of 3%. BMI reductions ranged from 5-10%. Additional improvements in self image and attitude, increased flexibility and strength and nutritional awareness were demonstrated. Parental interaction was positive and testimonials verified an improved ability to self and family manage the disease impact.

The second pilot is planned with modifications to the design based on the initial class feedback. The program is being modified to exercise instruction three times weekly supplemented by an at home exercise program. Educational classes will be combined with these weekly exercise sessions, allowing for better continuous learning versus the initial monthly sessions. Feedback from the participants regarding the new design is encouraging regarding improvement in compliance. The overall duration of the program is being reduced to a twelve week cycle with the intensity of the program compressed. Similar clinical and educational assessments are planned.

Better Health Lower Costs

The program solution is to allow better self management of obesity, hypertension and insulin resistance. The impact of reducing disease burden in this young population has the potential of reversing the negative health condition, resulting in significant long term savings by reduction of co-morbid conditions over the life of the child.