Nutrition Education Program

The NEP has been part of SCC’s primary services since September 2013. Implementation of its services is ongoing throughout the year. The NEP is led by Maria Paz Quiroga, M.S., R.D., Nutritionist, and available at all three of SCC’s sites, name the Beverly Health Center, S. Mark Taper Foundation Health Center, and Wallis Annenberg Children and Family Health Center at Hollywood Wilshire Health Center (WAC). The Pre-Diabetic and Fitness classes will be a new component to the NEP. Ms. Quiroga has already begun developing the curriculum for the Pre-Diabetic and Fitness classes. One-on-one and group education session will be held at all sites and classes will be held at WAC. Education session will be provided during regular business hours and each class will be offered on a bi-monthly basis every Saturday in one hour sessions. Each class will have between 20-30 students and will be provided throughout the year.

The Pre-Diabetic class will covers topics such as identifying and defining diabetes and obesity, the effect of diabetes, how nutrition is linked to chronic disease, the importance of exercise, and more. Fitness classes will comprise of circuit training which incorporates a breadth of exercises such as strength training, cardio, and stretching. An education component will also be included to help participants perform the exercises at home. Participants will receive a diet journal to monitor food intake and utilize measuring tapes and calipers to evaluate progress.

Upon notification of funds, Ms. Quiroga will purchase the necessary equipment and hire a contracted co-trainer to begin classes. SCC will use in-reach efforts to inform medical staff and providers of the services available as well outreach efforts to publicize NEP and its additional services.

SCC’s in-reach efforts include posting posters at medical exam rooms and front desk as well as distributing informational flyers at the registration and discharge rooms. In terms of outreach efforts, SCC’s Managed Care Manager leads a team of Outreach Specialists to promote SCC’s various programs and services, including the NEP. The Managed Care Manager coordinates and leads culturally-sensitive and linguistically-appropriate outreach activities such as maintaining contact with agencies, initiating collaborations and partnerships, and participating in community events. The Outreach Specialists visit schools, local community and faith-based organizations, and other service centers.

The NEP will make LA the healthiest place to live by providing access to quality and affordable health care, health education, and fitness classes to those most in need. According to the County of Los Angeles’s Key Indicators of Health by Service Planning Area report (2013), 19% of adults in SPA 4 live in neighborhoods that do not have walking paths, parks, playgrounds, or sports fields, thus limiting spaces to exercise. Further, 25% of adults reported their health to be fair or poor, and only 17% of adults say they consume five or more servings of fruits and vegetables a day. These statistics are amongst the highest of the eight LA County SPAs and shows the potential impact the NEP’s services can make.

One-on-one and group education sessions and the Pre-Diabetic class will teach individuals how to eat healthier, how to maximize their limited funds to purchase healthy foods, appropriate portion control, and much more. Fitness classes will provide individuals a free space to exercise as well as lessons on proper fitness regimens and exercise routines.

As participants gain more knowledge about nutrition and fitness through the NEP, they will be able to utilize and share them with their friends and family to promote a healthier and more active lifestyle. By 2050, SCC hopes that the network of persons reached will be great enough to have a significant impact on the Los Angeles community. SCC is confident that the NEP will have a positive effect on the communities it serves. SCC has already received positive remarks from patients on how the current NEP and its services have transformed different areas of their health including weight loss, eating habits, blood pressure, and medication intake.

The NEP will benefit both SCC’s current patients and individuals in SPA 4 who are at risk for or suffering from chronic disease.

Over 7,000 patients at SCC are currently at risk for and or suffering from chronic disease. In Fiscal Year 2012-2013, 27,188 patient visits were related to chronic disease, accounting for more than a quarter (27%) of SCC’s total number of patient visits. SCC saw 5,653 patients for hypertension and 3,039 for diabetes. Most if not all of these patient can greatly benefit from the NEP and its free services.

Chronic disease is also prevalent within SPA 4. According to the County of Los Angeles’s Key Indicators of Health by Service Planning Area report (2013), major chronic health concerns prevalent among SPA 4 residents include hypertension and high cholesterol. The percentage of hypertension in SPA 4 has increased from 14% in 1997 to 20% in 2011, and the percentage of high cholesterol has increased from 15% in 1999 to 24% in 2011 according to the same report. Diabetes in SPA 4 is also a health concern according to Kaiser Foundation Hospital - Los Angeles’s 2013 Community Health Needs Assessment. In SPA 4, the prevalence of diabetes is 17% and the hospitalization rate is 186 per 100,000 persons. Furthermore, uncontrolled hospitalizations is 22 per 100,000 persons. These statistics are amongst the highest of the eight SPAs. As such, it is clear that many individuals in SCC’s service area can benefit from the NEP.

Yes. The Nutritionist is currently researching and contacting local food banks and researching local grocery stores to provide a list of healthy and affordable food. Local food banks in SCC’s service area include the Greater West Hollywood Food Coalition, World Harvest Food Bank, Los Angeles Regional Food Bank, Project Angel Food, and more.

Three factors critical to a successful collaboration are the following:

1. Large Capacity. SCC and local food banks and local grocery stores must have reasonably sized resources to accommodate the need for healthy food.

2. Trustworthiness. SCC and local food banks will need the trust of the community, including those serves, for retaining patients in the NEP.

3. Locality. All partnerships and collaborations must be local and accessible and in proximity of patients.

Healthcare access

Obesity rates

Percentage of residents receiving coordinated healthcare services (Dream Metric)

Health care access: SCC is committed to serving anyone in need of health care regardless of their insurance or income status. SCC offers services at three sites, namely the Beverly Health Center, S. Mark Taper Foundation Health Center, and Wallis Annenberg Children and Family Health Center at Hollywood Wilshire Health Center. Multiple entry points across Los Angeles allows patients to access health care easier and more conveniently.

SCC will engage in outreach and enrollment activities to ensure its patients and the surrounding communities are knowledgeable of its services. Overseen by the Managed Care Manager and Chief Operations Officer, SCC will engage in multiple in-reach and outreach efforts including signage throughout all three sites, health fairs, schools, and more information about SCC’s services, including the NEP.

Obesity rates: As mentioned earlier, the NEP will encourage patients to have a change in lifestyle through education sessions and Pre-Diabetic and Fitness classes. Key changes include healthier eating and regular exercise. The knowledge gained from participating in the NEP will benefit participants as well as their families and friends.

Percentage of residents receiving coordinated health care services: SCC utilizes a Care Team Coordination Model, allowing cross-department referrals during a patients visit. SCC offers medical, dental, behavioral health, and non-primary care, including the NEP. Patients are able to be treated appropriately for any health ailments and referred to appropriate services to best fit their health needs. The Care Team Coordination Model enables all-inclusive, integrative care that allows for problems to be addressed quickly and efficiently. This also brings SCC closer to a Patient Centered Medical Home, giving residents more coordinated health care services.

Fund will assist SCC in meeting the following goals in a 12 month period:

1. SCC will provide at least 150 unduplicated patients nutrition education services, including primary nutrition services as well as Pre-Diabetic and Fitness classes.

2. SCC will receive positive feedback from at least 90% of patients when asked if they recommend SCC as a place to come for care to a friend or relative in Patient Satisfaction Surveys.

3. SCC will reach a minimum of 2,500 outreach and health education encounters in its in-reach and outreach effort while promoting the NEP.

SCC tracks quantitative measures, such as the number of patients served, patient visits, outreach contacts, service referrals and demographic data utilizing Electronic Health Records, i2i Tracks, and other health information systems. SCC also tracks qualitative measures such as patient feedback and program quality through Patient Satisfaction Surveys, its Community Advisory Council, and staff feedback. Data tracked are used to guide and evaluate SCC’s operations, giving SCC an idea of where funds need to be allocated, which programs need more staffing, which programs are reaching their goals, and which are not.

Patient Satisfaction Surveys are distributed on a quarterly basis and measure patient satisfaction as well as the quality of other activities. Factors utilized in tracking patient satisfaction include appointment scheduling, registration staff at the front desk, medical/dental assistants, wait time, medical providers, dispensary/medication staff, discharge, facility, and patient safety.

SCC also utilizes its Corporate Quality Management Program (CQMP) to ensure that it is managing all of its projects and services efficiently, effectively, and with the highest possible quality. The CQMP is fully integrated into SCC’s ongoing operations through participation of various committees which consist of members from all departments, disciplines, and cross functional groups/teams. The Program consists of multiple committees that evaluate different service delivery indicators including education/skills of employees, compliance and information dissemination, internal data management, policy adherence, appointment wait time, customer service, and more.

SCC learned the significant need for the NEP through its 2013 Community Health Needs Assessment (CHNA). SCC has utilized this report to learn about the growing health concerns of its communities in its service area as well as in Los Angeles County, as a whole. The CHNA indicated that 14% of SCC’s adult population is diagnosed with diabetes and 26% with hypertension. Further, 8% of SCC’s adult population is obese (BMI is greater than 30). SCC aims to address these issues through preventative health care services and education, both of which the NEP provides.

SCC also learned that it needed to have a more comprehensive NEP in order to be an effective Patient Centered Medical Home (PCMH). SCC aims to transform its practice closer to a PCMH; it looks to develop its delivery of services in conjunction with the five pillars of a PCMH: 1) a patient-centered orientation, 2) comprehensive, team-based care, 3) care that is coordinated, 4) superb access to care, and 5) a systems-based approach to quality and safety. SCC has already taken the first steps by hiring a Nutritionist and implementing a NEP. SCC is currently looking to expand the NEP’s services in order to provide more comprehensive and accessible nutrition services.

As stated, the NEP has been a part of SCC’s primary services since September 2013. With the exception of the Pre-Diabetic and Fitness classes, all services have already been implemented. Since January 2014, Ms. Quiroga has been developing the curriculum for the two classes. Space at WAC has already been reserved and potential instructors have already been identified. From internal surveys and community assessment, SCC has also identified a large amount of individuals interested in participating in the two classes.

SCC has significant experience in successfully piloting new projects. Previous projects include integrating HIV screening into primary care, outreaching to and enrolling individuals into a health care plan for the Affordable Care Act, delivering primary and therapeutic oral services to patients 0-5 years old, offering Spanish-speaking and domestic violence couple therapy group, and many others. All of these projects were successful and have been incorporated into SCC’s regular practice.

SCC is in the process of implementing Electronic Health Records (EHR). EHR implementation will significantly improve delivery of services in addition to quality improvement efforts. However, SCC anticipates a loss in productivity during the initial onset of EHR as staff is trained and familiarized with the system. This anticipated loss in productivity may limit the number of patients the NEP can serve. In order to accommodate patient access during this period, SCC has extended its hours of operation with evening and weekend medical and dental sessions.

Another challenge is that the Pre-Diabetic and Fitness classes is a pilot project. As with all pilot projects, SCC anticipates to experience numerous learning opportunities. SCC is, however, prepared to identify and address any issues that may come up in a timely manner. It has a Corporate Quality Management Program that was created to ensure clinical/program challenges are address and discussed on a regular basis. The Corporate Quality Management Program is led by the Quality Performance Improvement Manager, who works closely with the Chief Medical Officer, managers, and development staff to ensure programs are meetings goals and deliverables.