Increasing patient enrollment in the MOVE Program at the VA Medical Center: An evidence-based practice project

Practice Problem: This evidence-based practice project aimed to increase patient referrals to the MOVE program by educating providers about the importance and benefit of the Managing Obesity for Veterans Everywhere (MOVE) Program at the Biloxi, Veterans Affairs (VA) Medical Center. PICOT: In obese, ambulatory care patients, what motivates increased referrals by practitioners to the MOVE Program to decrease BMI compared to the current referral system within two months? Evidence: There was poor participation in the MOVE Program despite the high number of obese patients at the Biloxi, VA Medical Center. According to the data, only sixty of the 18,000 overweight, actively enrolled veterans are currently enrolled in the MOVE Program. Intervention: The project improvement intervention for this project involved implementation of an in-service education for providers about the MOVE Program and the benefit that it can have to the patient regarding weight loss. All primary care providers were encouraged to attend and if unable to do so, they were given the information that was presented to educate them as well. The project was implemented over two months. The expected goal was that there would be a 10% increase in the number of currently enrolled patients. Outcome: Despite the unforeseen consequences of COVID-19, the outcome was still achieved, and the goal was met and at the end of the two-month observation period, MOVE Program referrals increased by more than 10% referrals from the base number of 60 participants. Conclusion: Subsequently, the data reflects that when providers have candid and intimate conversations with their patients regarding obesity and resources that are available to them, they are receptive and willing to participate in the MOVE Program, even during a global pandemic. INCREASING MOVE PARTICIPANTS 3 Increasing Patient Enrollment in the MOVE Program at the VA Medical Center: An EvidenceBased Practice Project The purpose of this project was to increase veteran enrollment in the Veterans Affairs weight management MOVE Program. Often, healthcare providers are burdened by excess workloads and have limited time to spend with the veterans. While the providers are burdened by the complexity of the patients, obesity only magnifies the problem. This project aims at highlighting the growing trend in obesity and the complications that arise, especially in the veteran population. While the Veterans Affairs MOVE Program was created to help patients lose weight, it fails in that there are not enough referrals to the program, and the growing trend of obesity is increasing. Primary care providers play an important role in identifying obese patients that would benefit from a weight loss program (Tseng, Wang, Clark, Appel, & Bennett, 2015). Referring more patients to the MOVE Program helps to determine if patients will have a better chance of weight loss by being exposed to a program they might have not been introduced to in the past. Significance of the Practice Problem Obesity is an ever-growing epidemic that affects many Americans in both the civilian and veteran populations. A significant percentage of the veteran population (77%) are overweight, leading the Veterans Affairs (VA) to create the MOVE Program (Braun, Erickson, Utech, List, & Garcia, 2016). This is a comprehensive program that is geared toward helping veterans lose and keep the weight off. Studies show that long-term commitments result in greater weight loss when using this program for six months or more (Dochat, Godfrey, Golshan, Cuneo, & Afari, 2019). INCREASING MOVE PARTICIPANTS 4 Mental Health Issues Veterans have several issues that they deal with besides physical health problems. Veterans also have social constraints and mental health issues. When these are combined with obesity, the results can be catastrophic. Breland, Donalson, Nevedal, Dinh, and Maguen (2017) performed a study on women veterans and found that the military promoted eating quickly, much like binge-eating due to time constraints. When this pattern of poor eating habits culminated with stressors, veterans tended to overeat as a coping mechanism. The researchers noted that nearly 75% of the veterans that seek care through mental health services reported unhealthy eating habits such as binge-eating. They also found that poor weight loss habits were a trend among veterans due to these eating habits. This behavior was more common in the veteran population than the general population. Adding to these findings, Dorflinger, Ruser, and Masheb (2017) conducted a study and found similarities. They noted that night-eating syndrome (NES) was highest amongst veterans with obesity. Subsequently, veterans seeking weight management reported that one out of ten veterans tested positive for NES. As a result of previous studies, it was found that veterans were more likely to suffer eating disorders and become obese than non-veterans (Santhiveeran, 2019). Researchers found that weight management interventions can improve these stress-related disorders and problematic eating patterns if they are offered. The ability to change eating behaviors and patterns are needed for weight loss; however, the patient needs to be taught these coping skills. Dochat et al. (2019) detailed in their study the importance of creating a weight loss intervention to help these veterans. This project showed the need to offer patients interventions for weight loss so they can learn to diet correctly and lose weight effectively. INCREASING MOVE PARTICIPANTS 5 Effects of Obesity on the Family According to Skelton, Buehler, Irby, and Grzywacz (2012), everyone in the family strata feels the strain when there are issues with obesity within the household. The current guidelines state that family-based treatments are now the option for treating obesity. Unfortunately, familybased dieting and gym memberships can be costly. Often, some veterans are not able to work due to combat-related conditions or illnesses. Many veterans also have service-connected disabilities and rely on that monetary supplement as income. This is often a fixed income that is nominal compared to the working population. With obesity costing the United States 147 billion dollars and individuals paying an estimated additional $1,429 greater annual cost than most non-obese patients, these veterans can feel the economic pressure (Bomberg et al., 2017). Therefore, increasing enrollment in the MOVE Program will not only benefit the patient, but may also benefit the health and wellbeing of the family. Effects of Obesity and Health One of the greatest effects of obesity on a person is related to the deterioration of their health in association with having a BMI greater than 25. Obesity is associated with multiple health issues including diabetes, cardiovascular disease, musculoskeletal issues, depression, and hyperlipidemia (Schwarze et al., 2019). Obesity and Diabetes Week (2016) found a startling trend: as patients’ weight increases, so does their incidence of diabetes, thus leading to the use of insulin. Similar findings were noted in a study by Franklin et al. (2014) that demonstrate that obesity-fueled diabetes can lead to lower limb amputation among veterans with comorbidities. The veteran population depends on The VA for most of their care, regardless if it is dealing with mental health, primary care, or care related to pain management (Maciejewski, ShepherdBanigan, Raffa, & Weidenbacher, 2018). INCREASING MOVE PARTICIPANTS 6 Many veterans suffer from chronic, daily pain (Higgins et al., 2016). According to Dong, Larsson, Levin, Bernfort, and Gerdle (2018), the more obese a patient is, the worse chronic pain they suffer. The culmination of chronic pain in conjunction with obesity can often be more than one’s psyche can handle (Franklin et al., 2014). People with these ailments tend to have exacerbations of arthritis and low back pain. Already plagued with pain from carrying heavy cargo for years, they multiply this ongoing pain by carrying excess weight (Higgins et al., 2016). Another pressing issue that many veterans are diagnosed with is heart conditions that are often worsened by obesity. When combined with diabetes, obese patients have a greater chance of cardiovascular disease and heart failure than those who patients who are of a healthy weight (Rippe & Angelopoulos, 2016). Addressing obesity-related comorbidities can influence their risk for serious health conditions (Higgins et al., 2016). Effects of Obesity on Society Hammond and Levine (2010) noted that healthcare costs are much higher in the obese population. It is estimated that people with obesity have a lifetime medical cost that is 50% greater than those that are considered a healthy weight. Hammond and Levine also stated that nationally 22 million dollars were spent on the overweight population and that 53 million dollars were spent on obese patients due to the compounding medical problems that they have related to their obesity and other comorbidities. Obese patients are more likely to engage in disability claims and payments than those that are of a healthy weight. Lastly, they found that patients who were defined as obese were expected to live 13 years less than those who were not obese, which is a 22% decrease in longevity of life (Hammond & Levine, 2010). INCREASING MOVE PARTICIPANTS 7