title: Using Unlicensed Health Coaches to Improve Care for Insured Patients with Diabetes and Hypertension: Patient and Physician Perspectives on Recruitment and Uptake.
abstract: Health coach programs using low-cost unlicensed providers have largely targeted uninsured or underserved populations, raising questions about uptake and effectiveness for insured patients. This observational study evaluated the referral process, uptake, and effectiveness of a health coach program for patients with diabetes and/or hypertension at a multispecialty clinic. Data included appointment observations; interviews with patients, physicians, and health coaches; patient and physician characteristics; and measures of utilization and clinical outcomes. Out of 1313 eligible patients, 308 (23.5%) were referred over a 12-month period and 169 (54.9%) had at least 1 health coach appointment. Although the health coach program did not change patients' biometrics, physicians and patients reported improved care processes and reduced physician workload. Barriers to enrollment included variability in physician referral practices, patient willingness, and scheduling difficulties. Modifications to physician and health coach workflow are needed to determine the program's true effectiveness.
authors.affiliation: 1 Palo Alto Medical Foundation Research Institute , Mountain View, California.
authors.forename: Ellis
authors.initials: E
authors.lastname: Dillon
authors.affiliation: 2 Qualis Health , Seattle, Washington.
authors.forename: Laura
authors.initials: L
authors.lastname: Panattoni
authors.affiliation: 1 Palo Alto Medical Foundation Research Institute , Mountain View, California.
authors.forename: Amy
authors.initials: A
authors.lastname: Meehan
authors.affiliation: 1 Palo Alto Medical Foundation Research Institute , Mountain View, California.
authors.forename: Judith
authors.initials: J
authors.lastname: Chuang
authors.affiliation: 1 Palo Alto Medical Foundation Research Institute , Mountain View, California.
authors.forename: Caroline
authors.initials: C
authors.lastname: Wilson
authors.affiliation: 1 Palo Alto Medical Foundation Research Institute , Mountain View, California.
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D006266:Health Education; D006801:Humans; D006973:Hypertension / Q000628:therapy; D019458:Insurance Coverage; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D019370:Observation; D010353:Patient Education as Topic; D036301:Qualitative Research; D058996:Quality Improvement; D011787:Quality of Health Care / Q000592:standards*; D012017:Referral and Consultation; D012648:Self Care; D011795:Surveys and Questionnaires