Integrating Primary Care Practices and Community-based Resources to Manage Obesity

A Bridge-building Toolkit for Rural Primary Care Practices


This toolkit has been developed for primary care practices to manage obesity. It provides tools and concepts that have been informed by the real world of six primary care practices in three rural Oregon communities.


Prepared by

Paul McGinnis, M.P.A., Oregon Rural Practice-based Research Network, Oregon Health & Science University
Melinda M. Davis, Ph.D., Oregon Rural Practice-based Research Network (ORPRN); Department of Family Medicine, Oregon Health & Science University
Sonya Howk, M.P.A.:H.A., Oregon Rural Practice-based Research Network, Oregon Health & Science University
Molly DeSordi, B.A., Oregon Rural Practice-based Research Network, Oregon Health & Science University
Michelle Thomas, M.S.W., Oregon Rural Practice-based Research Network, Oregon Health & Science University

Prepared for the Agency for Healthcare Research and Quality (AHRQ) under Contract No: HHSA290 2007 10016i 4, Task Order #21; Grant No. UL1 RR024140 01 to Oregon Clinical and Translational Research Institute, from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

Contents

Acknowledgements
Support
Foreword
Oregon Rural Practice-based Research Network (ORPRN)
Why Was This Guide Developed?
Quick Start Guide
Introduction
Chapter 1: Attaining Zoning and Building Permits
   Assessing Clinic Readiness for Change and Leadership Support
   Developing Strategies to Support Process Leadership for Change
   Building Clinic-wide Engagement (Bridge Building Planning Meeting)
Chapter 2: Building and Assessing the Clinic Foundation
   Chart Reviews or Audits
   Observations of Practice Flow and Organizational Behaviors
   Patient Survey
Chapter 3: Getting Patients Excited About Crossing the Bridge
   Obesity Screening
   Documenting Weight Status and Addressing It with Patients
   The Five (or Six) A's. The Five A's are: Ask, Advise, Assess, Assist, and Arrange
   Motivational Interviewing
   Documenting Brief Counseling and Patient Goals
Chapter 4: Building the Community Foundation
   Identify Community Resources
   A Step-By-Step Process to Learn About "the Other Side of the Ravine"
Chapter 5: Crossing the Bridge and Returning
   Get Patients Ready to Use Community Resources
   Receiving Feedback from the Resource
Chapter 6: Reflections on the Critical Elements for Successful Bridge Building
References
Resources
Tool 1. Staff Meeting Discussion Guide
Tool 2. Chart Audit Form and Instructions
Tool 3. Clinical Care Observation Guide
Tool 4. Patient Waiting Room Survey
Tool 5. BMI Protocol Template
Tool 6. Worksheet: Establishing Protocols for BMI Screening
Tool 7. Documenting the Conversation in Your Charts
Tool 8. Sample Community Inventory Form
Tool 9. Sample Prescription Pad
Tool 10. Sample Brochure
Tool 11. Sample Poster
Tool 12. Sample Punch Card

Current as of May 2014
Internet Citation: Integrating Primary Care Practices and Community-based Resources to Manage Obesity : A Bridge-building Toolkit for Rural Primary Care Practices. May 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/community/obesity-pcpresources/index.html