1995-2005

Executive Summary 2004-2005

Community Need:

The practicing clinicians at Bread for the City were surveyed by our ISCOPES team as a method of identifying major health concerns for their patients. The results of the surveys overwhelmingly identified the prevalence of obesity as a serious health concern and care was taken to recognize the increased risk of developing obesity due to low socioeconomic status. Due to the prevalence and long-term health affects of obesity including hypertension, type II diabetes mellitus, heart disease, and stroke, the George Washington University ISCOPES Team selected obesity as their topic for the 2004-2005 project.

Purpose(s) of Project: 

In an attempt to decrease the prevalence of obesity in the Bread for the City population, the ISCOPES team intends to increase the awareness of obesity within the patient population and encourage providers to consistently weigh patients, calculate Body Mass Index (BMI) and discuss control measures for the disease.

GOAL: We expect to increase the conversation between patient and provider about patient's weight.

Short term goals

1. Placement of a poster for the waiting room to engage patients in thinking about their weight

2. Patient survey

3. Patient card with their current weight and the date on it.

 Long Term Goals-Measurement of an "increase in conversation" through chart review

1. Is there an increase in documentation of patient weight?

2. Is there an increase in the documentation of BMI?

3. Is there an increase in the documentation of a conversation about the patient's weight?

Team Activities and Accomplishments

Phase I: Planning

Our team Bread for the City (BFTC) started the year by brainstorming on various projects and avenues that were possibly needed. These ranged from a continuation of last year’s project of group needle exchange to posting educational material in each of the exam rooms. We decided as a group that we needed to have feedback from the participating clinicians at BFTC about what they thought was the most required aspect for patient education. Our Community Preceptor delivered our detailed survey to the attending physicians with an 86% return rate. There was an overwhelming majority that ranked obesity as the most important health topic that needed to be addressed. After getting such great feedback, we decided to do a chart review of random charts looking for properly filled out charts regarding: patients’ BMI, weight, height, and if there was documented discussion between the provider and patient. We used this initial chart review to gain first hand knowledge of the problem. Overall, the chart review told us that  patients’ weights were not properly documented in the chart. Only 50% of the charts reviewed actually showed the patient being weighed; of those, only 12% actually had documented discussions about weight. We then decided as a group to focus on a project that would include patient education, a physician reminder, and a better way to involve patients with regards to obesity.

Phase II: Implementation

After deciding about which project to pursue, we designated the various tasks that needed to be completed before our project was successful. Our project centered around a low literacy obesity awareness poster which prompts patients to know if they are overweight and to talk to their primary care physician about their weight. Along with this poster, we made wallet sized self-tracking weight management cards with body mass index scales on the back. This same scale was made into a larger version and placed in each of the six exam rooms. We also made patient survey cards that prompted the patient to examine 5 questions regarding being overweight and personal indicators (ie. Does your weight affect your health?). These surveys are intended to initiate awareness of eating and behavioral factors, which may lead to overweight and obesity and to prompt discussion between provider and patient. All materials developed were of appropriate literacy levels, culturally sensitive and available in English and Spanish. The poster was placed in the waiting area for all patients to view, along with pockets for holding extra patient surveys and weight management cards.

Phase III: Observation

Our group decided that it was too early to perform a statistical analysis and compare the results with our initial chart assessment. We did, however, want to evaluate our process and make sure that all the patients were able to understand our goal and find it easy to participate.  Our observations consisted of several questions: (Of the many patients that came through the waiting area, how many actually approached and read the poster?, How many took a weight management card or survey?, How many patients actually filled out their surveys?).   With these results, we were hoping to make any adjustments necessary to the poster, weight cards or surveys so that they would be more user-friendly for the patient population.  To date we have been unable to ascertain the true value of the poster and patient education.

We feel that this would be a great ISCOPES project for next year’s group to continue. We hope that they begin with a chart comparison before and after the campaign since it will be approximately 6 months after the project implementation. 

Community Benefit

Since obesity has become an epidemic in the United States, it is important to educate the population about the health risks of obesity.  Many do not know that obesity may lead to life-threatening illnesses such as heart disease and diabetes.  Our project was based around educating the patients of Bread for the City’s free medical clinic about the correlation between weight management and health and the providers about checking and documenting obesity status.  Our poster hanging in the waiting room encourages patients to consider how their weight affects their health.  In addition, the patient surveys we provided further motivate the patients to consider regulating their weight as part of healthy living and also motivates them to discuss with their provider how their weight affects their health. 

Our patient materials act as a method to facilitate this important discussion  between patient and provider about weight and obesity.  Our provider materials- the scales and BMI index cards--serve as a reminder for the provider to inform the patients about weight control as a part of their visit.  Therefore, our project was designed to teach the Bread for the City clinic community about healthy living by addressing the issue of obesity.  By providing information and incentives to learn about healthy eating and exercise habits, we aided in the fight against obesity.  As a consequence, patients of Bread for the City also will receive a more complete check-up and health evaluation from providers.   Through our efforts, the Bread for the City community knows more about healthy living habits in the form of weight management.

Interdisciplinary Teamwork

The multi-disciplinary approach to this project worked to our advantage.  Each team member brought different ideas and approaches to the group.  Having team members from all different backgrounds helped foster creativity.  Most of the time a group member would suggestion something and other members would build on that point.  A major take home point is that it is crucial to have patience and be respectful when dealing with people from different backgrounds.  Each person sees a situation differently, and it is important to be respectful and open to each opinion.  Also, each member had different strengths that were useful at different times in the process.  It is important to be patient with group members and realize that if someone had less to contribute to one part of the project they most likely excelled in another area. 

Cultural Competence

Cultural competence is an increasingly important skill in health care in the United States.  New immigrants arrive frequently, bringing their own languages and cultures to add to the country’s already rich diversity of cultures.  Many cultures have different beliefs about health, sickness, and medicine than the traditional Western concepts; it is important to understand these differences in order to effectively treat or prevent illness and promote health.  Language also can be a major barrier; medical jargon is difficult for many native English speakers, so imagine how much more difficult it would be for somebody whose first language is not English.  Bilingual staff or interpreters are necessary for meaningful communication.

Our team often considered issues of cultural competence while planning our intervention.  One notable example was in designing a questionnaire, which was intended to be used by patients to examine their exercise and eating habits.  Since the patients would be answering this questionnaire on their own, it needed to be very accessible.  We had extensive discussion regarding appropriate wording for questions, considering using non-medical jargon terms and everyday language that would be easy to understand, such as referring to weight rather than Body Mass Index.  We also translated the questionnaire into Spanish, which allows it to be understandable to a much larger percentage of Bread for the City clients.  Since the intervention is for the patients, we endeavored to consider the issues of cultural competency at every point in the planning process, so our intervention would have the maximum effect possible.

As part of the Bread of the City team, we wanted our intervention to meet several goals:  1) to have a long-term effect, 2) to encourage more patient-doctor conversation, and 3) to meet the needs of the client population, as well as help support the providers.  These three goals, though few, were not easy to accomplish.  In planning our intervention, we had to put ourselves “in their shoes” and assume their roles and situations, in order to find a set of solutions that would encourage the practitioners, as well as the clientele, in participating in our intervention.  The largest challenge was meeting the large range of issues that we would have to accommodate:

1        Practitioners are available on a volunteer basis and do not have a regular fixed schedule. It is impractical to implement changes and expect that all the practitioners will be aware and immediately adjust to our intervention.

2        The clientele of Bread for the City is low-income, limited in literacy and comprehension and has limited health knowledge. There also are many immigrant patients who speak very little or no English.

3        Bread for the City is limited in its resources, so we had to be cost-efficient and sensitive to its resources for our long-term intervention.

In retrospect, we realized that we were limited in our interactions with the community, mainly because our team met to plan for our intervention away from the community site.  We hope that future teams will consider the possibility of meeting at Bread for the City when planning for the next intervention, thereby getting a deeper sense of what the community needs are from direct observation, instead of relying on creativity and imagination of what their needs may be.

Our team worked well together and easily decided on a project that we felt could be completed in the time given and also provide a needed service to the clinic.  The feedback from team members regarding the value of community service learning versus volunteering was mixed.  There was a consensus that our project, although seemingly productive, did not necessarily provide as fulfilling or gratifying of an experience as the students hoped.  We find it challenging to compare community service learning with volunteering because our project is not completed and we hope that it will have a lasting impact on the Bread for the City Clinic.  We cannot at this point evaluate whether or not our project will be effective, which is important for the team to feel fulfilled and that our time was well spent.

Some team members felt the multi-disciplinary approach to ISCOPES is very important because it teaches all of us how to work with one another as a team.  This is unique to community service learning because ISCOPES allows students the time to discuss issues that arise and listen to all participants’ opinions.  We feel that our ISCOPES experience will allow us to be receptive to multi-disciplinary teamwork as healthcare professionals.

Overall, we felt that the value of community service learning would be best appreciated if we were more involved with the Bread for the City community.  We hope that future teams take advantage of the central location of bread for the city and become more engaged with members of the community and gain a better understanding of the services needed.