9/26/2019 WELLNESS 360: HEALTH AND WELLNESS MODEL FOR THE PHYSICAL THERAPY CLINIC 1 WELLNESS 360: WELLNESS AND LIFESTYLE ENHANCEMENT EDUCATION ▪ Third shift in health care: overview/future of health care ▪ Population Health ▪ Wellness 360! (Research, Wellness Recipe, Patient Examples) 2 THREE MAJOR HEALTHCARE SHIFTS 3 1
9/26/2019 EARLY HEALTHCARE: HEALTHCARE CENTERED AROUND ACUTE MANAGEMENT OF INJURY AND DISEASE. EXAMPLES: WAR INJURIES, SAVING/REMOVING LIMBS, ETC… SECOND SHIFT IN HEALTHCARE: ACUTE INJURY TREATMENT AND DISEASE MANAGEMENT. EXAMPLES: INFECTION, TRAUMA, DISEASE. 4 1900 THE MAIN CAUSES OF PREMATURE DEATH: PNEUMONIA INFLUENZA TB DIARRHEA 2015 THE MAIN CAUSES OF PREMATURE DEATH: HEART DISEASE CANCER COPD STROKE DIABETES 5 THE THIRD AND CURRENT SHIFT IN HEALTHCARE POPULATION HEALTH 6 2
9/26/2019 A HEALTHCARE SHIFT IS CHARACTERIZED BY A SHIFT IN WHERE “HEALTHCARE” DOLLARS ARE SPENT. WHERE HAVE OUR HEALTHCARE DOLLARS BEEN GOING?? 7 ACCORDING TO THE CDC: $327 BILLION HEALTH CARE DOLLARS SPENT ON DIABETES, $237 BILLION ON DIRECT COSTS, $90 BILLION ON INDIRECT COSTS. 90‐95% IS TYPE 2 DM. TOTAL COST OF OBESITY TO BE ESTIMATED AT $147 BILLION ANNUALLY. STROKE AND HEART DISEASE COST THE HEALTHCARE SYSTEM $199 BILLION PER YEAR AND $131 BILLION IN LOST PRODUCTIVITY. ESTIMATES $117 BILLION RELATED TO INACTIVITY HEALTHCARE COSTS. SMOKING: $170 BILLION IN DIRECT MEDICAL COSTS. EXCESSIVE ALCOHOL CONSUMPTION: $249 BILLION IN 2010. 8 WHAT IS DRIVING THIS THIRD SHIFT?? POPULATION HEALTH 9 3
9/26/2019 POPULATION HEALTH FRAMEWORK 10 AN INDIVIDUALS HEALTH OUTCOMES MEASURED VIA “LENGTH OF LIFE” AND “QUALITY OF LIFE.” HEALTH FACTORS. ONLY 20% OF AN INDIVIDUALS HEALTH CAN BE ATTRIBUTED TO THEIR “CLINICAL CARE.” THIS INCLUDES ACCESS AND QUALITY OF CARE. 11 CHILDHOOD OBESITY AND PROXIMITY TO URBAN PARKS AND RECREATIONAL RESOURCES: A LONGITUDINAL COHORT STUDY HEALTH PLACE. AUTHOR MANUSCRIPT; AVAILABLE IN PMC 2015 MAR 31. PUBLISHED IN FINAL EDITED FORM AS: HEALTH PLACE. 2011 JAN; 17(1): 207–214. PUBLISHED ONLINE 2010 OCT 15. DOI: 10.1016/J.HEALTHPLACE.2010.10.001 PMCID: PMC4380517 NIHMSID: NIHMS253636 PMID: 21075670 CHILDHOOD OBESITY AND PROXIMITY TO URBAN PARKS AND RECREATIONAL RESOURCES: A LONGITUDINAL COHORT STUDY JENNIFER WOLCH, A,* MICHAEL JERRETT, B KIM REYNOLDS, C ROB MCCONNELL, D ROGER CHANG, D NICHOLAS DAHMANN, D KIRBY BRADY, E FRANK GILLILAND, D JASON G. SU, B AND KIROS BERHANE D 12 4
9/26/2019 STUDY FINDINGS • 3173 STUDENTS 9‐10 YO FROM 12 COMMUNITIES IN SOUTHERN CALIFORNIA • SUBJECTS OBSERVED FOR 8 YEARS. • PARK ACRES WITHIN A 500 METER DISTANCE FROM CHILDREN’S HOMES • SIGNIFICANT ASSOCIATION WITH ATTAINED BMI AT AGE 18. • SIGNIFICANT ASSOCIATION WITH RECREATION PROGRAM WITHIN 10 KM. 13 THE IMPACT OF INTERVENTIONS TO PROMOTE PHYSICAL ACTIVITY IN URBAN GREEN SPACE: A SYSTEMATIC REVIEW AND RECOMMENDATIONS FOR FUTURE RESEARCH. SOC SCI MED. 2015 JAN;124:246‐56. DOI: 10.1016/J.SOCSCIMED.2014.11.051. EPUB 2014 NOV 26. THE IMPACT OF INTERVENTIONS TO PROMOTE PHYSICAL ACTIVITY IN URBAN GREEN SPACE: A SYSTEMATIC REVIEW AND RECOMMENDATIONS FOR FUTURE RESEARCH. HUNTER RF 1 , CHRISTIAN H 2 , VEITCH J 3 , ASTELL‐BURT T 4 , HIPP JA 5 , SCHIPPERIJN J 6 . 14 STUDY FINDINGS • PHYSICAL ACTIVITY PROGRAMS AND PHYSICAL ACTIVITY BUILT SPACES SUCH AS GREEN SPACES PROMOTE INCREASED ACTIVITY LEVELS 15 5
9/26/2019 EFFECTIVENESS OF PHYSICAL ACTIVITY INTERVENTIONS IN ACHIEVING BEHAVIOURCHANGE MAINTENANCE IN YOUNG AND MIDDLE AGED ADULTS: A SYSTEMATIC REVIEWAND META‐ ANALYSIS. SOC SCI MED. 2017 NOV;192:125‐133. DOI: 10.1016/J.SOCSCIMED.2017.09.021. EPUB 2017 SEP 19. EFFECTIVENESS OF PHYSICAL ACTIVITY INTERVENTIONS IN ACHIEVING BEHAVIOUR CHANGE MAINTENANCE IN YOUNG AND MIDDLE AGED ADULTS: A SYSTEMATIC REVIEW AND META‐ ANALYSIS. MURRAY JM 1 , BRENNAN SF 2 , FRENCH DP 3 , PATTERSON CC 4 , KEE F 5 , HUNTER RF 6 . 16 STUDY FINDINGS PHYSICAL ACTIVITY INTERVENTIONS HAVE BEEN PROVEN TO INCREASE ACTIVITY LEVEL PARTICULARLY WHEN COMBINED WITH “BEHAVIORAL CHANGE TECHNIQUES.” 17 BACK TO OUR EARLIER QUESTION: WHAT DO WE SPEND OUR HEALTHCARE DOLLARS ON?? CURRENTLY THE MAJORITY OF OUR HEALTHCARE DOLLARS GO TO “CLINICAL CARE!” 18 6
9/26/2019 ACCORDING TO THE PATIENT‐CENTERED PRIMARY CARE COLLABORATIVE: ONLY 5.8 – 7.7% OF HEALTHCARE DOLLARS SPENT ON PRIMARY CARE (OR “PREVENTATIVE CARE”) 19 CURRENTLY WE ARE STILL SPENDING THE MAJORITY OF HEALTHCARE DOLLARS ON SECONDARY AND TERTIARY HEALTHCARE. RECALL, ONLY 20% OF OUR HEALTH CAN BE ATTRIBUTED TO CLINICAL CARE WHICH INCLUDES TERTIARY AND SECONDARY HEALTHCARE. THIS MEANS THAT 92.3‐94.2% OF OUR HEALTHCARE DOLLARS ARE GOING TO SOMETHING THAT ONLY IMPROVES OUR HEALTH BY ABOUT 20%. ACCORDING TO MEDICALECONOMICS.COM: “ DELIVERING VALUE IN HEALTHCARE STARTS WITH INCREASED PRIMARY CARE INVESTMENT” GLEN STREAM, MD, FAAFP, MBI. MICHAEL TUGGY, MD. AUG 6, 2018. HTTP://WWW.MEDICALECONOMICS.COM/HEALTH‐LAW‐AND‐POLICY/DELIVERING‐VALUE‐HEALTHCARE‐STARTS‐INCREASED‐ PRIMARY‐CARE‐INVESTMENT: “EVERY $1 INVESTED IN PRIMARY CARE, $13 IS SAVED IN DOWNSTREAM COSTS.” (EXAMPLE: HUMANA PAYS YOU FOR MAKING IT TO THE GYM “X” NUMBER OF DAYS/MONTH, WILL PAY FOR GYM MEMBERSHIP, AND WILL PAY YOU FOR GETTING YOUR ROUTINE CHECK UP) 20 RECALL, ONLY 20% OF OUR HEALTH CAN BE ATTRIBUTED TO CLINICAL CARE WHICH INCLUDES TERTIARY AND SECONDARY HEALTHCARE. TODAY WE FIGHT TOOTH AND NAIL TO MAINTAIN THE STATUS CUE: LEGISLATION AND LEGAL BATTLES TO MAINTAIN OUR REIMBURSEMENT AND ARGUE OUR WORTH. THIS RESEARCH IS WHY IT MAY SEEM AT TIMES WE ARE FIGHTING AN UPHILL BATTLE. 21 7
9/26/2019 REIMBURSEMENT WHERE WE ARE TODAY COST OF DELIVERING CARE 22 WHERE ARE THE HEALTHCARE DOLLARS GOING?? TODAY WE VALUE OUR HEALTH MORE THAN EVER, SO WHY THE REDUCTION IN REIMBURSEMENT FOR HEALTH SERVICES?? SHIFT FROM “FEE‐FOR‐SERVICE” TO “VALUE‐BASED” REIMBURSEMENT. SOCIETY DEMANDING A BIGGER BANG FOR THE HEALTHCARE BUCK. 23 BUT THE HEALTHCARE DOLLARS MUST BE GOING SOMEWHERE…. MISSOULA, MT 24 8
9/26/2019 25 WE’VE SEEN HOW SOME INSURANCE COMPANIES ARE ADDRESSING PRIMARY CARE, WE’VE SEEN HOW CITY PLANNERS AND DESIGN ARE ADDRESSING PRIMARY CARE… …AND IN THE WORLD OF PHYSICAL THERAPY! WELLNESS 360: WELLNESS AND LIFESTYLE ENHANCEMENT EDUCATION 26 TRADITIONAL PHYSICAL THERAPY: 27 9
9/26/2019 FOR MOST PEOPLE SEEKING PHYSICAL THERAPY, A SINGLE JOINT OR MUSCULOSKELETAL CONDITION IS ONLY A MINOR PIECE OF THE PUZZLE: 28 LET’S TAKE OBESITY FOR EXAMPLE: ACCORDING TO THE CDC: “71.4% OVERWEIGHT OR OBESE!” 29 ACCORDING TO THE US CENSUS BUREAU: TOTAL POPULATION 2018: 327,167,434 TOTAL ADULT: 253,227,594 OVERWEIGHT OR OBESE ADULTS: 181,310,957 30 10
9/26/2019 SIGNIFICANT LINK BETWEEN PERSISTENT PAIN IN OBESITY NOT ONLY IN ADULTS BUT CHILDREN AND ADOLESCENTS AS WELL: 1) PERSISTENT PAIN AND COMORBIDITY AMONG OPERATION ENDURING FREEDOM/OPERATION IRAQI FREEDOM/OPERATION NEW DAWN VETERANS. HIGGINS DM, KERNS RD, BRANDT CA, HASKELL SG, BATHULAPALLI H, GILLIAM W, GOULET JL PAIN MED. 2014 MAY; 15(5):782‐90 2) MUSCULOSKELETAL PAIN IN OVERWEIGHT AND OBESE CHILDREN. SMITH SM, SUMAR B, DIXON KA INT J OBES (LOND). 2014 JAN; 38(1):11‐5. 3) OBESITY IS A RISK FACTOR FOR MUSCULOSKELETAL PAIN IN ADOLESCENTS: FINDINGS FROM A POPULATION‐BASED COHORT. DEERE KC, CLINCH J, HOLLIDAY K, MCBETH J, CRAWLEY EM, SAYERS A, PALMER S, DOERNER R, CLARK EM, TOBIAS JH PAIN. 2012 SEP; 153(9):1932‐8. 31 INCREMENTAL INCREASES IN PAIN IN CONJUNCTION WITH INCREASES IN BMI (ALSO SHOWS A FOUR‐FOLD HIGHER COMPLAINT OF PAIN IN OBESE COMPARED TO NON‐OBESE: COMORBIDITY OF OBESITY AND PAIN IN A GENERAL POPULATION: RESULTS FROM THE SOUTHERN PAIN PREVALENCE STUDY. HITT HC, MCMILLEN RC, THORNTON‐NEAVES T, KOCH K, COSBY AG J PAIN. 2007 MAY; 8(5):430‐6. 32 SUBSTANTIAL EVIDENCE TO DESCRIBE LINK BETWEEN OBESITY AND LOW BACK PAIN, HEADACHES, FIBROMYALGIA/CHRONIC WIDESPREAD PAIN, AND ABDOMINAL PAIN: CHRONIC PAIN, OVERWEIGHT, AND OBESITY: FINDINGS FROM A COMMUNITY‐BASED TWIN REGISTRY. WRIGHT LJ, SCHUR E, NOONAN C, AHUMADA S, BUCHWALD D, AFARI N J PAIN. 2010 JUL; 11(7):628‐35. 33 11
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