Brenner Children's Hospital BrennerFit Program: Can This Innovation Be Scaled?

Uploaded by ahrqinnovations on 15.03.2012

Narrator: Welcome to the AHRQ Innovations Exchange video series,
Can This Innovation Be Scaled?
This video presents innovator and expert exchanges
on the Brenner Children's Hospital BrennerFIT program.
The F-I-T, "fit" stands for "families in training."
The AHRQ Health Care Innovations Exchange works to accelerate the uptake of innovations
to improve health care quality and reduce disparities.
Speeding uptake was also the focus of the Innovations Exchange roundtable on scale-up and spread.
Innovators presented their innovations to experts on health care services.
Experts included Amy Berman of the John A. Hartford Foundation, which focuses on geriatric health care;
Janell Moerer of Via Christi Health, a health care service provider;
Sharon Rising of Centering Healthcare Institute, a community health organization;
Steve Shields of Action Pact Development, a nursing home consulting firm;
Lisa Suennen of the Psilos Group, a health care venture capital firm;
and Adam Zavadil of the Alliance of Community Health Plans, a national association of insurers.
The experts provided input on a number of topics, which included how to develop an innovation;
how to assess its scalability; and how to scale it.
This video will focus on how to develop an innovation and assess its scalability.
It features Dr. Joseph Skelton who directs BrennerFIT.
Let's begin with a brief overview of this innovative program.
BrennerFIT is an intensive program that offers treatment to families of obese children and teens.
A multidisciplinary team of professionals uses evidence-based and family-centered approaches.
Treatment is holistic and addresses influences such as family habits and the home environment.
BrennerFIT uses several measures to assess its outcomes.
For example, evidence indicates that about two-thirds of BrennerFIT patients have lowered their body mass index adjusted for age.
They also reduced their cholesterol levels and resistance to insulin.
BrennerFIT offers a solution that fits the complexity of the problem of childhood obesity.
It treats a diverse group of patients and their families in a way that challenges the notion
that childhood obesity stems from defective families.
Let's take a look as Dr. Skelton and experts talk about developing this innovation and assessing its scalability.
Consider family readiness to participate in program.
Amy Berman: What is your process around readiness for those people either before you're asking them to commit
or those people who have not yet committed?
Dr. Joseph Skelton: Sort of two steps. One is educating our referring physicians or that customer of,
you know, make sure families are ready to do this.
Try to make sure they understand our treatment process
because oftentimes if we don't do a good job explaining our program,
they look at it, it's a clinic, they need to go to the clinic, diagnose the problem, and fix it.
And it's really not that. I mean this is a program.
It's coming in to help this family change from unhealthy habits to healthy habits and that takes a lot of work
and so making sure physicians understand that so they know...
Because they know these families very well.
So they can make a judgment of or at least engage families in the conversation of, "Is this a good time for me to do it?"
Or, maybe not this level but maybe a less intensive level.
Or start with some education or start with something that will support that family.
So part of it is educating our referring physicians.
The second part is the idea that we started with the family navigator
Someone that will call the families and make sure they –- if the physician didn't do it or everything...
We have a saying, "The families need to see it, hear it, and read it."
So we have an orientation video. They read it in a letter.
And they talk to a live person to make sure they understand this is an intensive program.
And it's not to scare them off. It's actually to build a relationship
to make sure that we care for you, we want to help you.
But also it's okay if this isn't the right time.
Narrator: Improve program efficiency.
Adam Zavadil: I think that there is... It seems like it's an innovation that shows some promise of working.
The question is, you know, is there a way to make it more efficient too.
You know, telemedicine sounds very interesting,
figuring out how to facilitate access afterhours that don't make families leave work.
Those types of things where you can sort of increase adherence, decrease costs are very important.
And so innovations that make it more efficient are going to be more compelling to the health insurance industry.
Narrator: Use groups to support behavior change and improve efficiency.
Sharon Schindler Rising: What we have found is that support for behavior change within a group
is more important than the support that can be given by a provider.
You have a very heavy provider team and so I'm wondering what your thoughts have been.
And I would encourage you to really think very carefully about how you can provide care that is more efficient and effective
within the group and track the support for behavior change that then happens.
Dr. Joseph Skelton: They can gain support from others, see other people struggling, pick up tips,
see others living healthy behaviors. And so we're actually integrating and that's sort of the group classes with a twist.
It's not group treatment in the sense of they're working on behavior change, focused on their family with a lot of other people,
but we put the educational aspect in a group as well as integrating that support.
And that's one thing what I mentioned to you is that kids get a lot from seeing other kids struggle.
You know, a 13 year old Hispanic boy, that's the last thing he wants to be doing is sitting there with his mom
talking to me about his weight and his health and that he's about to go on CPAP.
He sees another kid that looks like him, that doesn't play basketball as well as he does,
things like that, that can mean a lot. And so that's sort of the idea.
And I –- I use the context being able to spread it.
Sharon Schindler Rising: There are themes that emerge and there will be strategies
that one family can share with another that will really extend what you're doing.
And perhaps eventually decrease the number of providers that are in that team
because I'm concerned about the long-term sustainability and the cost effectiveness of this model
for a problem that is so multifaceted. And so just some of my thoughts about that.
Narrator: Clarify and communicate program benefits.
Steve Shields: If I was a source of capital for you, whether it was from a foundation or an investor,
I would not feel clear enough about the depth of improvement because I'm not seeing enough stats here that tell me,
you know, that it's been improved and there's satisfaction among families.
Well, does that mean I lost 4 pounds? Does it mean I lost 500 pounds?
Dr. Joseph Skelton: We look at it in two ways when it comes to weight change.
We look at it as what percentage of people are we having success with and then what is overall success,
overall decrease in their weight status and then within those that are successful and not successful.
It's really kind of hard to talk about with kids because kids are growing.
It's actually almost impossible to put in the context of weight, adult weight loss.
But a one pound weight loss in a four year old is more like a 10 to 20 pound weight loss in an adult because kids are always growing.
And so we talk in this very abstract number called the BMI Z-score, which is a big struggle in talking to families and other doctors
even about that 'cause they may talk about decreasing BMI, but oftentimes what they want to see is what's the pound weight loss?
And that's just not an accurate marker of weight loss until you get into the teenage years.
Susan Mende: Thank you very much for this. One potential sound bite on trying to explain this is perhaps
if you can explain for a similar group of children who do not go through this kind of program, what would be their trajectory?
You know, because I understand so that could be one way. And another way would be if you can, you know, hopefully not do it yourself,
but if you can find research that does say that for every, you know, two pounds that the child doesn't gain
or whatever the statistic is, we can demonstrate that, you know, their chance of getting diabetes is reduced by "X" amount
which will translate to "X" amount over the next 20 years.
You know, even those can be... And clearly it's not an exact science,
but these kinds of sound bites I think give people a sense of the impact, you know, of it because as you're saying,
the weight gain or like the weight loss may not be great, but it's what it implies
and what would happen if you didn't do this program.
Foster Gesten: Joe, you're a brave man. You did a great job.
I want to just throw out a few possibilities. One is again in terms of the pitch to payers.
From what I understand from your intervention, my guess is that you're actually doing a family intervention
and it probably relates to the adults as well. And you might want to think about how to describe that
and analyze what impact you're having on the adults where there may be a more immediate impact of obesity.
The second is it's hard to imagine, while you may be taking all comers, it's hard to imagine
if you take kids who are at the upper scale who may have some of the complications that you mentioned,
that you might be able to make a more compelling return on investment for kids who are really at the very steep end
and starting to have some comorbidities. And the other thing to explore is
while folks have a hard time thinking about the long term in terms of investment,
if in fact you can document that people are with insurance,
those plans, for a much longer time than people think and
that's certainly true in some public programs as well as private insurance,
then the argument about this time period and so on may not be so difficult to make.
Narrator: Tailor messages to different audiences.
Marie Schall: In terms of the pitch, a thought that I had was that
I think it's important to identify the different audiences so there isn't like there's one pitch.
But I think in your slide you have like the three key customers:
hospital administrators, referring physicians, and patients and families.
So one of the things I think that we know from looking at spread and dissemination
is that it's important to customize your message to the –- to what's important for the particular customer.
So it may be something that you're aware of,
but I think it's important to point out so there's not just one pitch,
it's customized pitches for your... So I guess it's three elevator speeches, Paul,
depending on who you're in the elevator with.
Narrator: For more information on this and other health care innovations,
please visit the AHRQ Innovations Exchange website at