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Babich JS, McMacken M, Correa L, Polito-Moller K, Chen K, Adams E, Morgenstern S, Katz M, Long TG, Joshi S, Wallach AB, Shah S, Boas R. Advancing Lifestyle Medicine in New York City's Public Health Care System. Mayo Clin Proc Innov Qual Outcomes 2024; 8:279-292. [PMID: 38828080 PMCID: PMC11141270 DOI: 10.1016/j.mayocpiqo.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Chronic diseases are the leading cause of death and disability in the United States, and much of this burden can be attributed to lifestyle and behavioral risk factors. Lifestyle medicine is an approach to preventing and treating lifestyle-related chronic disease using evidence-based lifestyle modification as a primary modality. NYC Health + Hospitals, the largest municipal public health care system in the United States, is a national pioneer in incorporating lifestyle medicine systemwide. In 2019, a pilot lifestyle medicine program was launched at NYC Health + Hospitals/Bellevue to improve cardiometabolic health in high-risk patients through intensive support for evidence-based lifestyle changes. Analyses of program data collected from January 29, 2019 to February 26, 2020 demonstrated feasibility, high demand for services, high patient satisfaction, and clinically and statistically significant improvements in cardiometabolic risk factors. This pilot is being expanded to 6 new NYC Health + Hospitals sites spanning all 5 NYC boroughs. As part of the expansion, many changes have been implemented to enhance the original pilot model, scale services effectively, and generate more interest and incentives in lifestyle medicine for staff and patients across the health care system, including a plant-based default meal program for inpatients. This narrative review describes the pilot model and outcomes, the expansion process, and lessons learned to serve as a guide for other health systems.
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Affiliation(s)
- John S. Babich
- NYC Health + Hospitals/Bellevue, New York, NY
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Michelle McMacken
- NYC Health + Hospitals/Bellevue, New York, NY
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
- NYC Health + Hospitals, New York, NY
| | | | | | - Kevin Chen
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
- NYC Health + Hospitals, New York, NY
| | - Eric Adams
- 110th Mayor of the City of New York, New York, NY
| | - Samantha Morgenstern
- Sodexo, Healthcare, Sodexo USA, Gaithersburg, MD
- Food & Nutrition Services, NYC Health + Hospitals, New York, NY
| | | | - Theodore G. Long
- NYC Health + Hospitals, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Shivam Joshi
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
- Department of Veterans Affairs, Orlando, FL
| | - Andrew B. Wallach
- NYC Health + Hospitals/Bellevue, New York, NY
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
- NYC Health + Hospitals, New York, NY
| | - Sapana Shah
- NYC Health + Hospitals/Bellevue, New York, NY
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Rebecca Boas
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY
- NYC Health + Hospitals, New York, NY
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Albert SL, Massar RE, Kwok L, Correa L, Polito-Moller K, Joshi S, Shah S, McMacken M. Pilot Plant-Based Lifestyle Medicine Program in an Urban Public Healthcare System: Evaluating Demand and Implementation. Am J Lifestyle Med 2024; 18:403-419. [PMID: 38737881 PMCID: PMC11082870 DOI: 10.1177/15598276221113507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Lifestyle interventions that optimize nutrition, physical activity, sleep health, social connections, and stress management, and address substance use, can reduce cardiometabolic risk. Despite substantial evidence that healthful plant-based diets are beneficial for long-term cardiometabolic health and longevity, uncertainty lies in how to implement plant-based lifestyle programs in traditional clinical settings, especially in safety-net contexts with finite resources. In this mixed-methods implementation evaluation of the Plant-Based Lifestyle Medicine Program piloted in a large public healthcare system, we surveyed participants and conducted qualitative interviews and focus groups with stakeholders to assess program demand in the eligible population and feasibility of implementation within the safety-net setting. Program demand was high and exceeded capacity. Participants' main motivations for joining the program included gaining more control over life, reducing medication, and losing weight. The program team, approach, and resources were successful facilitators. However, the program faced administrative and payor-related challenges within the safety-net setting, and participants reported barriers to access. Stakeholders found the program to be valuable, despite challenges in program delivery and access. Findings provide guidance for replication. Future research should focus on randomized controlled trials to assess clinical outcomes as a result of program participation.
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Affiliation(s)
- Stephanie L. Albert
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Rachel E. Massar
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Lorraine Kwok
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Lilian Correa
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Krisann Polito-Moller
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Shivam Joshi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Sapana Shah
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Michelle McMacken
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
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