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Partnering for personal care
Frank Delrio has a lot to live for. The 54-year-old has two daughters, two grandsons and other loved ones who care about him. But earlier this year, he lost his only son and found himself in the hospital with health complications.
That’s where he was approached by Shannon Care Coordination nurse coordinator Sandra
“When Sandra approached me in the hospital, I had already made up my mind I didn’t want to participate,” Delrio says. “Looking back now, I’m so glad I did.”
Each week, Delrio gets a home visit from his health coach, Peyton LaBauve, a senior biology student at Angelo State University (ASU). They spend a couple hours openly discussing how Delrio is feeling, what he has accomplished that week and areas where he can improve. La- Bauve talks to him about his medications and pain management, and he also accompanies Delrio to his doctor appointments.
“I’m the type that doesn’t let anyone into my personal life,” Delrio says. “I wouldn’t dare tell anyone if something is wrong except for my doctor and my immediate family, but Peyton helps me bring it out. It helps me when he is at the appointment with me. We talk before we go into my appointment and go over what I need to talk about with Dr. Burgess—things I want to remember to ask him, concerns I have. It makes it much easier for me; I’m telling the doctor more instead of holding back.”
An innovative program
The Shannon Care Coordination program, a partnership between Shannon and ASU and the first program of its kind in Texas, helps patients like Delrio by pairing him with a student health coach. It is modeled after a concept introduced by Barry Bittman, MD, chief innovation officer at Meadville Medical Center in Pennsylvania, and is designed to benefit the patients, students, community and hospital.
Irv Zeitler, DO, vice president of medical a? airs at Shannon and course director for the program, and Bryan Horner, Shannon Medical Center CEO and president, caught wind of Dr. Bittman’s successful, innovative program and approached ASU about partnering to begin a program locally.
“ASU was looking for an outreach program and Shannon has always been great to let our students shadow and give back to the community,” says Russell Wilke, PhD, professor and department of biology chair at ASU. “?The program was a perfect ?fit because it aligned our mission with Shannon’s—to provide quality health care to our community.”
Before they can become health coaches, the students must complete the “Community Healthcare from Theory to Practice” seminar course at ASU. Students are eligible to apply to the program during their sophomore year. ?They must be pre-med majors and meet a list of predetermined criteria.
The program involves pre-med students in the business side of health care while also giving them experience with patients. From the beginning, the patient’s physician agrees that the patient would benefit from participation in the program, and the physician continues to make all the clinical decisions regarding the patient. Students bolster their medical school applications while patients gain trained health coaches, who help manage their care outside the walls of the hospital or clinic.
?Throughout the semester, students listen to presentations from the course directors as well as Shannon nursing professionals, physicians, dietitians, case managers and health care attorneys. They are presented case studies, and open, thought-provoking discussion ensues to further prepare them for effectively serving as health coaches in the community. Upon completion of the seminar, students begin the internship phase where they visit patients in the home, under the supervision of a multidisciplinary committee.
“The goal of this program is to help be more accountable for population health,” Dr. Zeitler says. “We want to keep patients from being readmitted to the hospital for an existing issue by taking another step to help them manage their health. That requires us to step outside of the clinic or hospital setting and into their homes. The research has shown going to patients in their homes helps us grasp a better understanding of their social and health issues. We are changing the delivery of care while better managing health care costs for all parties involved.”
Another component of the program that helps with patient success is that patients are never discharged. ?Their visits may decrease to once a month, or whenever the patient feels like he or she needs a visit, but the relationship is not stopped unless the patient requests so.
“If for some reason they are readmitted to the hospital, we will pick back up with weekly meetings,” Morales says. “It’s similar to the relationship they keep with their doctors. It’s just a little extra help.”
And, after the first semester, it’s safe to say the program is working.
Lillian Brown was also approached by Morales while recovering from open-heart surgery in the hospital.
During the first few months of her recovery, Brown’s daughter stayed with her. After she returned home, Brown resumed living by herself while continuing on the path to recovery, but she was on her own when it came to remembering to take her medications or what time her appointments were. “Lillian is no stranger to cardiac events,” Morales says. “Her first heart surgery was in 2005. Therefore, she has medical knowledge of her condition, but we partnered her with health coach and ASU senior Michael Kyrouac to help her better manage medications and keep a record of the progress of her health.”
A special medication box, supplied through the program, reminds Brown to take her daily meds. The box blinks as a first reminder and beeps ? minutes a?fter if it has not been opened. If Brown still has not taken her medication after that time, an alert is sent to Morales. Brown says the box, and Kyrouac, have helped her a lot.
“We sit down, fill my medication box and make sure my meds are correct,” Brown says. “We fill out my daily record for weight and blood pressure, go over all the numbers, and make sure everything is looking good. Michael taught me how to log information in my phone and make a memo. It reminds me an hour or 30 minutes before my appointment, which is really helpful.”
Kyrouac works with Brown’s physicians and obtains information from them on topics such as cholesterol and nutrition, which he then passes on to Brown.
“I asked him to teach me more about reading food labels, and he helped me with that,” Brown says. “I also have Michael’s phone number, and I can text or call him whenever I need him. I’ve had to text him on several occasions about my appointments, and he has asked me about my medications. It’s nice to have that personal line of communication.”
Meaningful patient relationships
Both LaBauve and Kyrouac’s health coaching experiences have been more than just reinforcement for their medical school applications. The students have relished the experience of communicating and developing relationships with the patients.
“I think I’ve learned more about communication since starting this program than I have in my life,” LaBauve says. “I’ve learned the technical aspects of how health care functions, but I’ve also learned how powerful human relationships are. Patients might not need ‘special’ treatment, just ‘specialized.’ It may be required of the physician to do something unorthodox like having a student visit the patient’s home. Aside from all that, I’ve learned so much from Frank. He is very wise. I’ve learned how to communicate in a genuine and real way, which exceeds medicine and affects other parts of my life as well. I’m excited to see where the program goes. I think this is going to change the culture of medicine and how we interact with future patients and just people in general.”
Kyrouac echoes LaBauve’s enjoyment with participating in the program.
“I’ve seen Lillian improve through diet and through other means than just medication, and her organization has also improved,” he says. “I’ve enjoyed seeing people benefit from my efforts. A lot of undergraduate education is just learning and studying, and with this program, we are actually able to apply what we’re learning while helping someone improve their life. I’ve also realized how much of medicine I don’t know and how much there is still to learn.”
After the completion of their internship, the students no longer receive formal credit from participation in the program. But they do have the option to continue their work with patients until they leave San Angelo for medical school. Both LaBauve and Kyrouac plan to continue visiting their patients, and Delrio is looking forward to continued visits from his health coach.
“?This program is the greatest thing,” Delrio says. “I just hope that people will open up and realize there is help and people who care. I hope this program goes further and grows bigger. There’s still a lot for me to learn and for Peyton and I to do. This is helping me overcome grief. I hope no one has to go through what I’ve gone through to be a part of this program, but it helps. It’s helped me realize I need to be healthy, and I’m passing that on to my family.”