Health Health Promotion and Promotion and

Wellness:Wellness:Relevance and Relevance and

Implementation Implementation StrategiesStrategies

Circle of LifeCircle of Life

www.CircleofLife.netwww.CircleofLife.net

The Circle of LifeThe Circle of Life

Self-Inquiry Assessment FormSelf-Inquiry Assessment Form

Trends in Health Trends in Health CareCare

Wellness and health Wellness and health promotionpromotion

Disease managementDisease management Complementary medicineComplementary medicine Parish nursingParish nursing Cluster servicesCluster services

MethodologyMethodology Provide opportunities that are: Provide opportunities that are:

– ExperientialExperiential– RelevantRelevant– Life inspiringLife inspiring– Community buildingCommunity building

Leverage practical, applied spirituality:Leverage practical, applied spirituality:– ToolsTools– SupportSupport– Assistive AccountabilityAssistive Accountability

Utilization Frequency Utilization Frequency and Costand Cost

Medical Care

Self Careand Citizen Self Reliance

Prevention and Health Enhancement Programming

FREQUENCY

COST

What are the most important What are the most important complementary services?complementary services?

Those that are safe, effective at a minimal Those that are safe, effective at a minimal cost:cost:

• • Group health improvement activities -Group health improvement activities -- group education- group education- support group, study group- support group, study group- exercise- exercise- mind/body - Yoga, Tai Chi, Qigong, - mind/body - Yoga, Tai Chi, Qigong,

meditationmeditation• • Counseling or coaching - Counseling or coaching - nutrition, informed nutrition, informed

choicechoice

• • Proactive triage - Proactive triage - nurse on phone, demand nurse on phone, demand managementmanagement

Medical visits - 75% could be handled Medical visits - 75% could be handled through self-care, 25% require contact through self-care, 25% require contact with a provider (no visit), 10% require an with a provider (no visit), 10% require an office visit (physician or office visit (physician or nurse practitioner). nurse practitioner).

Health Decisions, Demand ManagementHealth Decisions, Demand Management Donald Vickery, MD Donald Vickery, MD

Of the $1 trillion in annual Of the $1 trillion in annual expenditures 33% is spent on care expenditures 33% is spent on care deemed to be avoidable.deemed to be avoidable.

Piper Jaffray Research, Piper Jaffray Research,

Health Care Information Systems Industry, 6/97Health Care Information Systems Industry, 6/97

Pressures in the SystemPressures in the System Challenge of Chronic IllnessChallenge of Chronic Illness Negative Drug ReactionsNegative Drug Reactions Iatrogenic IncidencesIatrogenic Incidences Major % of disease is behavioralMajor % of disease is behavioral Immense media attentionImmense media attention Anti-aging and longevityAnti-aging and longevity Alternative and complementary medicineAlternative and complementary medicine

Chronic IllnessChronic IllnessJAMA, C. Hoffman, et al, November, 1996JAMA, C. Hoffman, et al, November, 1996

1970 - 21 family caregivers/85 year old1970 - 21 family caregivers/85 year old 1987 - 76% of direct medical expenses1987 - 76% of direct medical expenses 1996 - 7 of 10 admissions are for chronic illness1996 - 7 of 10 admissions are for chronic illness 1996 - 99 million, 45% of population, $470 billion 1996 - 99 million, 45% of population, $470 billion 2020 - 134 million, 60% of population, $685 billion2020 - 134 million, 60% of population, $685 billion 2030 - 6 family caregivers/ 85 year old 2030 - 6 family caregivers/ 85 year old

Integration of complementary services that Integration of complementary services that

are safe and effective may help to resolve are safe and effective may help to resolve some of this challengesome of this challenge..

Adverse Drug Adverse Drug ReactionsReactions

JAMA April, 1998, Lazarou, et JAMA April, 1998, Lazarou, et alal

1998 Major Causes of Death -1998 Major Causes of Death -– Heart diseaseHeart disease– CancerCancer– Adverse drug reactionsAdverse drug reactions

5,000,000 drug 5,000,000 drug complications/yearcomplications/year

200,000 deaths/year200,000 deaths/year $4 Billion in medical costs $4 Billion in medical costs

per yearper year

Medical Error -Medical Error - Iatrogenic Illness Iatrogenic Illness

1988 Rand Corporation - 1988 Rand Corporation - – 25% of heart, stroke, pneumonia deaths25% of heart, stroke, pneumonia deaths

1991 Time Corp- 1991 Time Corp- – 80,000/year = 2x annual auto deaths80,000/year = 2x annual auto deaths

1994 JAMA, 1994 JAMA, 272:1851-1857 - Leape, et al272:1851-1857 - Leape, et al

– 180,000 deaths per year180,000 deaths per year 1997 Harris Poll - 100 million have 1997 Harris Poll - 100 million have

experienced or know someone who experienced or know someone who hashas

1999 - 2000 1999 - 2000 Congressional HearingCongressional Hearing

Medical ErrorMedical ErrorInstitute of MedicineInstitute of Medicine

• • At least 44K to 98K deaths per At least 44K to 98K deaths per year due to adverse medical eventsyear due to adverse medical events

• • More iatrogenic deaths than More iatrogenic deaths than motor vehicle accidents, breast motor vehicle accidents, breast cancer, or AIDScancer, or AIDS

• • Medical mistakes cost between Medical mistakes cost between $17 billion and $29 billion per year$17 billion and $29 billion per year

An Act of Congress An Act of Congress Created Created

The Office of Alternative The Office of Alternative Medicine (OAM)Medicine (OAM)

It was then upgraded It was then upgraded to to

The National Center The National Center for Complementary for Complementary

and Alternative and Alternative MedicineMedicine

CComplementary and omplementary and

AAlternative lternative MMedicine - edicine - CAMCAMThe Economics:The Economics:• • $13 Billion, 1991$13 Billion, 1991

• • $ 54 Billion, $ 54 Billion, 19971997

Between 1990 and Between 1990 and 20002000

The budget of The budget of NCCAM was NCCAM was

increased 3000%increased 3000%

White House Commission on White House Commission on Complementary and Complementary and

Alternative Medicine PolicyAlternative Medicine Policy

Added a new area to its Added a new area to its investigation on self-care and self-investigation on self-care and self-healing because a strong theme healing because a strong theme

in their testimony regarded in their testimony regarded personal health improvement personal health improvement

through personal action.through personal action.

The House Task Force on The House Task Force on Guiding Principles Guiding Principles

for Health Carefor Health Care

Two Key principles:Two Key principles:• • Health CreationHealth Creation

• • Self-Healing and Self- Managed Self-Healing and Self- Managed CareCare

Health FuturistsHealth Futurists• • Strongest move:Strongest move:Health Improvement as a key to Health Improvement as a key to Integrative or Complementary MedicineIntegrative or Complementary Medicine

• • Cost Pressures:Cost Pressures:Alternative Therapies are Cost ShiftingAlternative Therapies are Cost Shifting

Self-Care is Cost CuttingSelf-Care is Cost Cutting

70%70%of disease is of disease is preventablepreventable

Healthy People 2000, Healthy People 2000, DHHS, 1991, #91-50213DHHS, 1991, #91-50213

National Center For Health Statistics, National Center For Health Statistics, DHHS, 1992, # 92-1232DHHS, 1992, # 92-1232

8 of 98 of 9causes of disease arecauses of disease are

preventablepreventable

New England Journal of Medicine, Fries, Koop, et New England Journal of Medicine, Fries, Koop, et al, 329:321-325, 7/93al, 329:321-325, 7/93

Chain of Chain of CausationCausation10 Leading Causes of Death 10 Leading Causes of Death 9 Actual Causes of Death9 Actual Causes of Death

Root Causes of DeathRoot Causes of Death

1. Heart Disease1. Heart Disease TobaccoTobacco Lack of Lack of

informationinformation

2. Cancer2. Cancer Diet/activity patternsDiet/activity patterns Lack of life skillsLack of life skills

3. Cerebrovascular disease3. Cerebrovascular disease AlcoholAlcohol Lack of Lack of

connectionconnection

4. Accidents4. Accidents Microbial agentsMicrobial agents External External

& internal stress& internal stress

5. COPD5. COPD Toxic agentsToxic agents Low self-esteemLow self-esteem

6. Pneumonia6. Pneumonia FirearmsFirearms

HopelessnessHopelessness

7. Diabetes7. Diabetes Sexual behaviorSexual behavior Anger Anger

and frustrationand frustration

8.. Suicide8.. Suicide Motor vehiclesMotor vehicles Powerlessness and fearPowerlessness and fear

8. Liver disease and cirrhosis8. Liver disease and cirrhosis Illicit use of drugsIllicit use of drugs Economic Economic

despair despair

10. HIV/AIDS10. HIV/AIDS Meaningless Meaningless

existenceexistence

Columns 1 & 2 -- Journal of the American Medical Association, McGinnis and Foege, 270:2207-Columns 1 & 2 -- Journal of the American Medical Association, McGinnis and Foege, 270:2207-2212, 11/932212, 11/93

Column 3 - Health ActionColumn 3 - Health Action

Heart diseaseHeart disease CancerCancer Cerebro-vascular Cerebro-vascular

diseasedisease Negative drug Negative drug

interactionsinteractions AccidentsAccidents Medical errorMedical error COPD, Pneumonia & fluCOPD, Pneumonia & flu DiabetesDiabetes SuicideSuicide Liver diseaseLiver disease

1010

LeadingLeading

Causes Causes

of of

DeathDeath

TobaccoTobacco Diet/activity Diet/activity

patternspatterns AlcoholAlcohol Microbial agentsMicrobial agents Toxic agentsToxic agents FirearmsFirearms Sexual behaviorSexual behavior Motor vehiclesMotor vehicles Illicit use of drugsIllicit use of drugs

99

ActualActual

Causes Causes

of of

DeathDeath

Lack of information Lack of information Lack of lifestyle skillsLack of lifestyle skills Lack of connectionLack of connection External & internal External & internal

stressstress Economic despairEconomic despair Meaningless existenceMeaningless existence Low self-esteemLow self-esteem HopelessnessHopelessness Anger and frustrationAnger and frustration Powerlessness and fearPowerlessness and fear

RootRoot

Causes Causes

of of

DeathDeath

In 1990 and 97, In 1990 and 97, Eisenburg, 1Eisenburg, 1

34%/56% of Americans used 34%/56% of Americans used unconventional health care methodsunconventional health care methods

400/800 million visits to 400/800 million visits to unconventional providers$13.7 unconventional providers$13.7 billion was spentbillion was spent

72%/35% of respondents did not 72%/35% of respondents did not inform their medical doctorinform their medical doctor

New England Journal of Medicine, Eisenburg et al, 1/93New England Journal of Medicine, Eisenburg et al, 1/93

JAMA, Eisenburg, et al, 11/97JAMA, Eisenburg, et al, 11/97

In 1990 and 97, In 1990 and 97, Eisenburg, 2Eisenburg, 2Some of the therapies studied:Some of the therapies studied: Relaxation & meditation practicesRelaxation & meditation practices

Weight-loss programsWeight-loss programs Mega-vitamin and herbal supplementsMega-vitamin and herbal supplements Self-help and support groupsSelf-help and support groups Therapeutic imagery & spiritual healingTherapeutic imagery & spiritual healing Bio-feedback and hypnosisBio-feedback and hypnosis ChiropracticChiropractic AcupunctureAcupuncture MassageMassageNew England Journal of Medicine, Eisenburg et al, 328:246-252, 1/93New England Journal of Medicine, Eisenburg et al, 328:246-252, 1/93

In 1990 and 97, In 1990 and 97, Eisenburg, 3Eisenburg, 3The less frequently discussed points:The less frequently discussed points:

Only 10% of respondents used Only 10% of respondents used actual treatment provided by actual treatment provided by medical or licensed providers medical or licensed providers (Chiropractic, Acupuncture, Massage)(Chiropractic, Acupuncture, Massage)

Most utilized unconventional Most utilized unconventional methods were health improvement methods were health improvement activities - Yoga, Tai Chi, activities - Yoga, Tai Chi, meditation, support groups, etcmeditation, support groups, etc

New England Journal of Medicine, Eisenburg et al, 328:246-252, 1/93 New England Journal of Medicine, Eisenburg et al, 328:246-252, 1/93 and 97and 97

Archives of Archives of Internal MedicineInternal Medicine

Stress & Heart DiseaseStress & Heart DiseaseBlumenthal, et al, October, 1997Blumenthal, et al, October, 1997Duke, National Heart Lung and BloodDuke, National Heart Lung and Blood

Current annual stats, 13.5 million, $117billionCurrent annual stats, 13.5 million, $117billion 107 patients - 3 groups - 107 patients - 3 groups - Standard tx, + exercise, + supportStandard tx, + exercise, + support

– 33 in group support and stress management33 in group support and stress management 74% reduction in risk for second cardiac event74% reduction in risk for second cardiac event

– Standard tx - 30% second eventStandard tx - 30% second event– Standard tx plus exercise - 21% second eventStandard tx plus exercise - 21% second event– Standard tx plus group support -9% second eventStandard tx plus group support -9% second event

Ornish ProgramOrnish Programfor Recovery from Heart for Recovery from Heart

Disease, Prostate Cancer, etc.Disease, Prostate Cancer, etc.• • NutritionNutrition

• • ExerciseExercise

• • Stress MasteryStress Mastery

• • Group SupportGroup Support

• • 88% avoided future procedures, no additional adverse event 88% avoided future procedures, no additional adverse event rates compared to controls = safe/effective.rates compared to controls = safe/effective.

• • Cost to franchise $30K to $100K+, cost per participant $3K to Cost to franchise $30K to $100K+, cost per participant $3K to $15.$15.

How?How?

• • The Circle of Life The Circle of Life programprogram

- Personal Health - Personal Health AssessmentAssessment

Self-EnhancementSelf-Enhancement System (PHASES)System (PHASES)

The Circle of LifeThe Circle of LifePersonal Health Assessment & Personal Health Assessment & Self-Energizing SystemSelf-Energizing System

The Circle of Life system has 7 The Circle of Life system has 7 phases:phases:

1. Assess, self inquiry, data capture1. Assess, self inquiry, data capture •Assessment •Assessment PhasePhase

2. Evaluate, discuss findings2. Evaluate, discuss findings •Exploration •Exploration PhasePhase

3. Develop healthy living program3. Develop healthy living program •Personal •Personal Planning PhasePlanning Phase

4. Individual implementation4. Individual implementation •Action Phase•Action Phase5. Support and accountability5. Support and accountability •Support •Support

PhasePhase6. Re-evaluation, measure outcome6. Re-evaluation, measure outcome •Re-•Re-

evaluation Phaseevaluation Phase7. Course correction7. Course correction •Re-design Phase•Re-design Phase

Health educatorsHealth educators Parish nursesParish nurses Ministry professionalsMinistry professionals Social servicesSocial services Counselors, therapistsCounselors, therapists Occupational Occupational

therapiststherapists Physical therapistsPhysical therapists Human resources staffHuman resources staff Health consultantsHealth consultants Citizens, lay-personsCitizens, lay-persons

Who Who providesprovidescoachingcoaching &&SupportSupportGroupGroupfacilitatiofacilitationn

Diet & nutritionDiet & nutrition Exercise & fitnessExercise & fitness Stress masteryStress mastery Health care & self-careHealth care & self-care Relationships & familyRelationships & family Work and careerWork and career Financial healthFinancial health Humor, play & Humor, play &

creativitycreativity Environment & natureEnvironment & nature Emotions & self-esteemEmotions & self-esteem Life purpose & serviceLife purpose & service Spirituality & intuitionSpirituality & intuition

Circle:Circle:AssessesAssesses&&SupportsSupportsAction inAction in12 Areas12 Areas

Rich opportunities Rich opportunities are already in most are already in most hospitals:hospitals:1. Physical therapy 1. Physical therapy departmentdepartment

2. Health education 2. Health education departmentdepartment

3. Comprehensive cancer3. Comprehensive cancer4. Cardiac rehabilitation4. Cardiac rehabilitation5. Diabetes services5. Diabetes services6. Rehabilitation medicine6. Rehabilitation medicine

Comprehensive Comprehensive DeliveryDelivery

The PublicThe Public

ConsultationConsultation

DiagnosisDiagnosis

TreatmentTreatment

ComplementComplementaryary

MedicineMedicine

Self Self InquiryInquiry

Personal PlanPersonal Plan

Personal ActionPersonal Action

Group SupportGroup Support

HealthHealthPromotionPromotion

ConsultationConsultation

DiagnosisDiagnosis

TreatmeTreatmentnt

ConventionalConventionalMedicineMedicine

Monday MorningMonday Morning Begin to craft, from resources Begin to craft, from resources

within within the organization, programs and the organization, programs and

delivery pathways that maximize delivery pathways that maximize health improvement and health improvement and complement already agreed upon complement already agreed upon clinical protocols.clinical protocols.

If necessary target this strategy in If necessary target this strategy in just one or two departments or at just one or two departments or at one or two diagnostic categories.one or two diagnostic categories.