Evidence-based health and well-being for entire populations.

Pro-Change’s Smoking Cessation Program Also Effective for Psychiatric Patients

South Kingstown, RI – August 21, 2013. HealthDay News recently reported the results of a new study from the American Journal of Public Health (http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301403). The study showed that psychiatric patients who participated in Pro-Change Behavior System’s individually tailored smoking cessation program while they were hospitalized for treatment of a mental illness were more likely to quit smoking and less likely to be re-hospitalized.

The findings challenge a common misperception among mental health experts that smoking is a useful tool in treating psychiatric patients. The study’s lead author, Judith J. Prochaska, PhD, an associate professor at the Stanford University School of Medicine, reported that cigarettes are still used as part of a reward system on some units and that doctors may sometimes smoke with patients as a way of creating a connection.

The study conducted by Prochaska and her colleagues included 224 inpatients at a smoke-free psychiatric hospital in California who smoked at least five cigarettes a day prior to being admitted to the hospital. The patients had a range of mental health conditions, including depression, bipolar disorder, and schizophrenia. Three-quarters were suicidal. The patients were randomized into two groups. Patients randomized to the treatment group participated in Pro-Change’s Smoking Cessation program. Those randomized to the control group received usual care–which included a pamphlet about the hazards of smoking and information on how to quit.

The Pro-Change Smoking Cessation program included a computer-tailored intervention with individualized feedback and a stage-matched print manual. Patients in the treatment group also met for 15 to 30 minutes with a counselor and were offered a 10-week supply of nicotine patches when they were ready to quit smoking. The computer-tailored intervention was repeated at 3- and 6-months post-hospitalization to provide ongoing behavior change guidance through the quitting process. Patient’s outpatient providers received a copy of the patient’s report.

At the 18 month follow-up, 20% of those in the treatment group had quit smoking, compared to just 7.7% of those in the control group. Furthermore, fewer patients (44%) in the treatment group had been re-hospitalized (44% vs. 56%). The findings indicated that helping patients quit smoking did not harm their mental health recovery and may have even improved it, Prochaska said. “I think some of the therapeutic contact that addressed participants’ tobacco dependence, and supported them with this major health goal, may have generalized to them feeling better about their mental health condition,” Prochaska said in a Stanford news release.

Sara Johnson, PhD, Senior Vice President of Research and Product Development at Pro-Change Behavior Systems said, “Given that almost half of the cigarettes in the United States are sold to those with psychiatric or addictive disorders, we commend Dr. Prochaska and her colleagues for their ongoing efforts to make our population-based tailored Smoking Cessation program available to inpatients with mental illness and to rigorously evaluate its impact in this historically under-served group.”

Pro-Change’s CEO Given Achievement Award by Providence Business News

1-JanProchaska-2013-PBNAward

South Kingstown, RI – August 8, 2013. Janice M. Prochaska, PhD, President and CEO of Pro-Change Behavior Systems, Inc., was one of twelve women who received an Achievement Award at the 5th Annual Providence Business News Business Women’s Awards luncheon.

The event spotlighted twelve talented and dedicated women working in southeastern New England. Prochaska was recognized for being well ahead of the curve in establishing disease prevention and wellness programs and evaluating their effectiveness. Pro-Change is recognized for being on the cutting edge of changing people’s behavior to help improve their health and well-being. To do so, Pro-Change applies the best that the science of behavior change has to offer to produce high-impact solutions.

Pro-Change’s Drs. Prochaska Featured in Health Literacy’s 100th Podcast

Click here for full Podcast.

Transcript

South Kingstown, RI – August 1, 2013. Health Literacy Out Loud’s 100th podcast, titled “Stages of Change and Health Communication,” went live July 30, 2013. In the podcast, James O. Prochaska, PhD, Founder of Pro-Change and Janice M. Prochaska, President & CEO talk with Helen Osborne about:

  • What the Stages of Change model is and how it got started
  • Why the Stages of Change model is relevant to health literacy and health communication, including its role in informed decision making
  • How listeners can use the Stages of Change model when communicating about health and communicating about health literacy

Recognized for her expertise in health literacy, Helen Osborne, M.Ed., helps professionals communicate health information in ways that patients, caregivers, and the public can understand. Among Helen’s many “hats,” she produces and hosts the podcast interview series, Health Literacy Out Loud (HLOL). In honor of the 100th episode of HLOL, Helen chose to interview James and Janice Prochaska on the Stages of Change behavior theory. Helen wanted to honor the Prochaskas this way, saying that “The Stages of Change model has meant so much to me and everyone else who strives to communicate health information in ways others can understand, accept, and act upon.” To hear the podcast, go to www.healthliteracy.com/hlol-stages-of-change.

Pro-Change’s Comments on the Rand Study “Do Wellness Programs Work?”

South Kingstown, RI – June 27, 2013. A growing number of sources are suggesting that wellness programs do not work. Can we answer in the affirmative that wellness programs do work? The Rand Report
(http://www.rand.org/pubs/research_reports/RR254.html) clearly indicates that such a sweeping claim cannot be supported. But why would one assume that such a heterogeneous field – filled all too often with fads, fashions, and far too few facts – would be found to have much impact?

The more critical question is: Can wellness programs work? Here we can respond affirmatively and with confidence. A national Task Force for Community Preventive Services (CHES) has been developing bodies of evidence for recommendations, predictions, evaluations, and innovations for population-based health promotion or wellness programs (Zaa et al., 2005; Soler et al., 2010). The Task Force relies on an impressive range of criteria on which confidence can be based. These include the number of studies, the consistency of results in the same direction, the magnitude of the effects and the consistency of the magnitude, the type of study design, the quality of the study implementation, and length of follow-up. To these criteria, we have added the number of replications across different types of populations, diverse sub-populations and multiple health risk behaviors, and the percentage of participants in programs. We also added strength of outcome measures. Simply measuring improvement is not as strong as the percentage of participants who progress from being at-risk at baseline to not-at-risk at long-term follow-up (e.g., from smoking to not smoking).

A Task Force team applied their original criteria to employee health promotion programs that included HRA assessments with feedback reported at least twice plus at least one additional health promotion program. Across 51 studies, they found average participation rates of about 50% and average follow-ups of about 2 ¾ years. They had confidence in concluding that these wellness programs can produce important effects with exercise (a median success rate of 15.3% from 15 arms from 12 studies) and smoking cessation (a median abstinence rate of 17.8% from 30 arms from 24 studies). Smaller effects were found with high-fat diets (median decrease of 5.4%) and no effects for fruit and vegetable consumption).

Building on the Task Force’s body of evidence, we found much higher impacts for all four of these behaviors with results from 26 arms of population-based RCTs. These results are included in a paper that will be published soon
(http://online.liebertpub.com/doi/abs/10.1089/pop.2012.0094). Unfortunately, the Rand Study did not build on the CHES body of evidence nor did it include the range or rigor of criteria that were used in their review of wellness programs. It is well known that the easiest way to prove the null hypothesis (e.g., wellness programs do not work) is to rely on weak studies. The poorer the studies, the more error and noise is produced, preventing the likelihood of detecting adequate signals of significant effects. The companies reviewed by Rand were as small as 50 employees. As with any program, product or service, there are various levels of quality and one cannot conclude that wellness programs don’t work because the “average” results aren’t impressive. Employers need to use best practices to increase the probability their efforts will reap positive outcomes. One best practice is to use programs that have been scientifically tested and shown to work and not fall to marketing claims that lack peer-reviewed evidence of their offerings.

The Rand review reports that “employers are using incentives” to increase employee engagement in wellness programs. We have been using plan design incentives with our clients for more than a decade and have been able to consistently achieve over 80% of participation rates.

What we can conclude from the Rand Report is that employers need such growing bodies of evidence, based on a broad range of rigorous criteria, in order to benchmark alternative wellness programs. With such benchmarking tools, employers will be able to predict whether they are providing high impact programs, average impact programs, or programs that will produce minor impacts and major disappointments.

Pro-Change, Care New England, and VAL Health to Pilot an Innovative Smoking Cessation Program

South Kingstown, RI – June 12, 2013. This month, Care New England will launch a pilot of an innovative smoking cessation program for its health plan members. The program integrates Pro-Change’s evidence-based behavior change program, including individually tailored text messages with VAL Health’s unique approach to incentives.

Pro-Change’s Smoking Cessation Program (www.prochange.com/smoking-cessation-program) is built for smokers who are not ready to quit, getting ready to quit, ready to quit, in the process of quitting, and staying quit. The URAC award-winning program has an impressive cessation rate of 25%-30%. Recent research indicates that adding individually tailored text messages to the program increased effectiveness by 10 percentage points.

The 6-month pilot with Care New England health plan members will be integrated with VAL Health Rewards, an innovative program that applies the principles of behavioral economics to improve the impact and efficiency of incentive programs.

All Care New England’s benefit-eligible employees and their spouses and dependents who smoke will be eligible to participate in the program. A special bonus award is available if more than one member in a household participates.

“We are very excited to be working with Pro-Change and VAL Health Rewards on this new program. Unlike many other smoking cessation programs, this pilot helps to assess how ready a person is to quit and then provides tailored support based upon that assessment. Many, but not all, participants will quit. However, the research shows that most who complete the program will be better prepared to quit” said Domenic Delmonico, Senior Vice President and executive sponsor of the program for CNE.

About VAL Health
VAL Health is a leading behavioral economics consulting firm. Its health related incentive solutions are derived from team members’ rigorous scientific studies that demonstrate how one offers incentives is often more important than the size of the incentive. VAL Health applies behavioral economic science into practice to develop high impact wellness programs for employers and health plans, and customized incentive programs for health-related technology companies to increase participation and engagement. For more information, please visit www.valhealth.com.

About Care New England
Care New England Health System is positioned to transition into the new era of health care delivery with a high quality continuum of care. Its strength are based on complementary programs and distinctive competencies of partner hospitals and agencies including Kent, Butler, and Women and Infants Hospitals, the VNA and the Care New England Wellness Center. For more information, please visit www.carenewengland.org.

Pro-Change’s Lessons Learned on Patient Engagement

South Kingstown, RI – May 31, 2013. From research gleaned through 30 population-based randomized clinical trials, Pro-Change has found that there are six phases and five factors on a continuum of patient engagement.

The six phases of patient engagement are:

REACH → RECRUIT → RETAIN → PROGRESS → SUCCESS → SUSTAIN

The five factors that drive those phases are: proactivity, stage of change, communications, incentives, tailoring, and transforming.

Most health professionals have been trained to passively wait for patients to reach out to them for help with high-risk and high-cost behaviors like smoking, unhealthy diets, and sedentary lifestyles. Unfortunately, few patients reached out because they were not experiencing pain, illness, or distress from these “silent killers.” Now, with Accountable Care Organizations and pay for performance models, health professionals need to be trained to proactively reach out to entire populations, not just those ready to change.

Once recruited, retention is the next challenge. Historically, discontinuation or drop-out from action-oriented interventions ranged from 70% to 80% for weight management and addictive behaviors, and about 50% for use of prescribed medications. The number one factor that predicted who was recruited and who was retained was stage of change. This factor needs to drive the design of behavior change programs and the health communications used to engage patients.

The historic model for behavior change of large percentages of patients (and of professionals) has been an action model, in which individuals are seen as changing when they quit smoking or start taking their medications as prescribed. If professionals are trying to engage them in a disease prevention or management program, patients assume it is action oriented. Why should patients agree to participate in a program for which they are not prepared? Programs need to be appropriate for patients in all stages of change.

Patient communications needs to convey that “Wherever you are at, we can work with that!”TM Using a traffic light as an icon for readiness to change, communications can let patients know “red light = not ready, yellow light = getting ready, green light = ready. Ready or not, we can be of help.” Of course, the program must actually be designed to respect wherever the patients are at.

Incentives are an increasingly important factor to engage populations. Employers particularly rely heavily on such extrinsic motivations, because most employees are not prepared to participate but they are prepared to trade time for money. The problem is that populations can simply go through the motions for money, without putting in the effort. Transforming from extrinsic to intrinsic motivation is the next driving factor. This begins the progress phase, as individuals advance from one stage to the next as a result of having received tailored feedback. Once patients progress, it means they are engaged not just in the treatment process but also in the change process. Historically, we equated treatment with change, but many people can remain in treatment and not progress. Programs need valid, brief measures that assess progress that would not be observable to participants. For example, the sooner patients receive feedback that their cholesterol is decreasing, the more likely they will continue to adhere to cholesterol lowering drugs.

Over time, progress leads to success as patients change their health status for costly behaviors. To maximize success, programs need to sustain engagement from one year to the next. The greater the percentage of populations engaging in treatment and change processes over time, the more programs can reduce risks and costs, and increase health, well-being and productivity.

The bottom line: It’s time to use the lessons we have learned from the science of behavior change to increase patient engagement, rather than repeating history.

Pro-Change At Cutting Edge of Multiple Behavior Change Research: Plays Key Role in Translational Behavioral Medicine Journal’s Special Section

South Kingstown, RI – May 1, 2013. Kerry E. Evers, PhD, Senior Vice President at Pro-Change Behavior Systems, Inc. is the Co-Editor of the Special Section Multiple Health Behavior Change in the latest issue (March 2013) of the Translational Behavioral Medicine Journal: Practice, Policy, and Research. In her editorial, Dr. Evers comments on the “Advances in Multiple Health Behavior Change Research” and describes the Special Section as “spanning different populations (e.g., adults and adolescents, employees, health clinic patients), methods (e.g., quantitative and qualitative), and modalities (e.g., survey and intervention research).”

Two of the eight peer-reviewed papers published in the Special Section highlight Pro-Change’s programs, one on youth obesity prevention, and the other on adult stress management, weight management, and smoking cessation.

The article by Yin et al., titled “Treatment-enhanced Paired Action Contributes Substantially to Change Across Multiple Behaviors: Secondary Analyses of Five Randomized Trials,” explores different analytical methods to determine the consistency, robustness, and synergy in patterns of multiple concurrent behavior change outcomes. Data from five randomized trials of computer-tailored interventions that simultaneously treated multiple health behaviors were analyzed. Three of those five trials used Pro-Change programs. Yin et al. found that paired action (changes on both behaviors in a pair) contributed substantially more to the treatment related outcomes than changes in just one of the behaviors in a pair. These results help us to understand how Pro-Change programs can increase impacts on multiple behaviors and populations.

The Bottom Line Statement in the Policy Brief by Amy A. Eyler, PhD, of Washington University, states that Pro-Change’s Health in Motion youth program “was not only effective in initiating and maintaining energy balance behaviors, but also in reducing smoking and alcohol acquisition in early adolescents.” Eyler is highlighting Velicer’s et al’s study “Multiple Behavior Interventions to Prevent Substance Abuse and Increase Energy Balance Behaviors in Middle School Students.” Health in Motion has been used by middle and high schools, by dependents of employees, and YMCAs, and could be used by Accountable Care Organizations for families and communities.

About Translational Behavioral Medicine Journal
Translational Behavioral Medicine: Practice, Policy, and Research (TBM) is an official international peer-reviewed publication of the Society of Behavioral Medicine. TBM’s mission is to engage, inform, and dialogue between research, practice, and policy. TBM features original empirical studies on the effectiveness or implementation of interventions which explicitly state the impact of the findings for researchers, practitioners, and policy makers. For more information, please go to
www.springer.com/medicine/journal/13142.

Pro-Change to Develop a Program for the Interstitial Cystitis Association

South Kingstown, RI – April 10, 2013. The Interstitial Cystitis Association (ICA) has subcontracted Pro-Change Behavior Systems, Inc. to develop a Transtheoretical Model-based computer-tailored intervention for patients experiencing interstitial cystitis (IC) (painful bladder syndrome).

The online program will be designed to encourage patients with IC to use a range of healthy strategies to manage or minimize their pain, and to cope with pain that does occur. Healthy strategies will include first-line treatments recommended in the American Urological Association’s treatment guidelines (e.g., education, stress management, pain management, self-care, and behavior modifications), and any second-line and third-line treatments prescribed by their care providers.

The intervention will be accessed via the ICA’s website, ichelp.org, and will:

  1. Assess and give feedback on level of IC pain and the benefits of using healthy strategies to manage that pain;
  2. Assess and give feedback on current stage of change for using healthy strategies to manage IC pain;
  3. Assess and give feedback on current use of each of the healthy strategies for managing IC pain;
  4. Facilitate use of up to seven stage-matched Transtheoretical Model principles and processes of change shown empirically to facilitate transition to the next stage of change for making positive behavioral changes;
  5. End with a report that contains all the feedback received during the session, and links to stage-matched information and resources on the ICA website. The report can be printed or accessed online using private login information.

Lee Claassen, Executive Director of the ICA stated, “We are pleased to have the opportunity to have a strong theory-based intervention built for IC patients to help empower them in managing their condition and live the fullest life possible.”

The development of this computer-based self-management tool for IC patients is supported by the Interstitial Cystitis Association’s Cooperative Agreement number 5U58DP002936-02 from The Center for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of The Centers for Disease Control and Prevention.

About ICA
The Interstitial Cystitis Association (ICA) is the only non-profit health association dedicated to improving the quality of healthcare and lives of people living with IC. The ICA provides advocacy, research funding, and education to ensure early diagnosis and optimal care with dignity for people affected by IC. For more information, please visit ichelp.org.

Pro-Change has the Tools to Promote Patient Engagement

South Kingstown, RI – February 27, 2013. The February 2013 thematic issue of Health Affairs entitled, “New Era of Patient Engagement,” has over 25 articles exploring aspects of patient engagement from the evidence and potential of patient engagement, to the role of clinicians and shared decision making.

According to Susan Dentzer, Health Affairs editor-in-chief, “wherever engagement takes place, the emerging evidence is that patients who are actively involved in their health and health care achieve better health outcomes, and have lower health costs, than those who aren’t… The challenge is to encourage patients and providers alike to embrace engagement and achieve its full potential to improve health and health care.” Pro-Change has designed two solutions to do just that.

Proactive Health Consumer (PHC) is a mobile-optimized, individually tailored behavior change program designed to increase patient engagement in health and health care by encouraging informed decision making; shared decision making; financially responsible use of health services; and engagement in ongoing wellness activities among patients. Like all Transtheoretical Model-based programs, PHC is for all patients – those who are not ready, those who are getting ready, and those who are already proactive consumers. The program includes a dynamic web portal containing interactive activities that build patients’ skills and confidence to be an active participant in their care. To read more about the PHC program, please read this article from Art and Science of Health Promotion.

Pro-Change’s new health care Provider Dashboard helps primary care providers to be experts in behavior change without extensive training. The dashboard is populated with a patient’s data from our Health Risk Intervention (HRI). Once a patient has completed the HRI, clinicians can see a graphic representation of the patient’s self-reported health status, as well as behavior change challenges and priorities on a single screen. The dashboard provides brief, evidence-based, tailored behavior change messages the clinician can deliver to engage the patient in the behavior change process. The inclusion of a patient’s behavior change priorities can promote shared decision making and improve outcomes. The dashboard also allows clinicians to prescribe Pro-Change’s award-winning behavior change programs and follow their patients’ progress over time.

About Health Affairs
Health Affairs is the leading journal of health policy, thought, and research. The peer-reviewed journal was founded in 1981 under the aegis of Project HOPE, a nonprofit international health education organization. Health Affairs explores health policy issues of current concern in both domestic and international spheres. To learn more about Health Affairs, visit their website at www.healthaffairs.org.

About Pro-Change Behavior Systems, Inc.
Pro-Change Behavior Systems, Inc., a certified Women’s Business Enterprise, is a research and development company providing wellness partners with computer- and coaching-based programs for changing health risk behaviors. Based on the Transtheoretical Model developed by founder Dr. James O. Prochaska, Pro-Change programs are for entire populations and are uniquely tailored to each individual. Pro-Change programs have produced unprecedented impacts on multiple behaviors to enhance health and reduce health care costs. In 2009, Pro-Change LifeStyle Management Programs for Stress Management, Depression Prevention, Weight Management, Exercising Regularly, Smoking Cessation, and Medication Adherence won the URAC Gold Award for Best Practices in Health Management. In 2012, the LifeStyle programs were featured on AHRQ’s Innovation Exchange website. For more information, please visit www.innovations.ahrq.gov. For more information about Pro-Change, please visit www.prochange.com.

Pro-Change and Krames StayWell to Collaborate on ACO Patient Engagement Solution

Krames StayWell ACO 360 Suite to include Pro-Change LifeStyle Management Suite featuring Health Risk Intervention, Online Coaching Programs, and New Provider Dashboard

South Kingstown, RI – February 13, 2013. Pro-Change Behavior Systems, Inc. and Krames Staywell (KSW) have reached an agreement to incorporate a special version of the Pro-Change LifeStyle Management Suite into Krames Staywell’s comprehensive communication and engagement package created for accountable care organizations, ACO 360°. ACO 360° meets the outreach, acute patient education, and health management needs of an accountable care organization and is designed to foster patient engagement in the care coordination activities of an ACO by promoting health self-management.

“ACO 360° is a powerful program that includes print and digital newsletters, a patient resource guidebook, multimedia website libraries, and a comprehensive database of over 5,500 patient education articles in English and Spanish that can be integrated into virtually any Health IT system and delivered through the EHR and Patient Portal via the Infobutton Standard,” explained John George, Executive Vice President Krames StayWell. “However, we felt there was a gap in providing solutions to enable ACOs to better manage the overall health of their patient population. The LifeStyle Management Suite, created by the Pro-Change team using a leading behavior change methodology, is uniquely designed to serve the needs of an ACO model.”

Pro-Change was founded by James O. Prochaska, PhD who developed the Transtheoretical Model of Behavior Change (TTM) more commonly referred to as the Stages of Change Model. The LifeStyle Management Suite incorporates the TTM into a Health Risk Intervention that not only assesses risk but also addresses a person’s readiness to make a behavior change and guides the user with stage matched strategies. The Suite includes nine online coaching programs such as smoking cessation, weight management, exercise, nutrition, and stress management that dynamically reassess where a person is on the continuum of making a behavior change and provides tailored guidance strategies to best help the user reduce their health risks. The version of the LifeStyle Management Suite incorporated into ACO 360° also includes an innovative provider dashboard designed to better coordinate and encourage health management interventions and promote communication between the patient and the care team.

“We are excited to be partnering with Krames Staywell,” added Janice M. Prochaska, PhD, President and CEO, Pro-Change. “The combination of our scientifically validated behavior change programs and KSW’s proven patient and consumer engagement tools coming together in ACO 360° creates a powerful lever for any accountable care organization looking to drive success of their efforts via effective patient engagement and accountability in personal health management.”

To find out more about this new program for accountable care organizations please visit www.kramesstaywell.com/aco-360.

About Krames StayWell
Krames StayWell is the largest provider of patient education, consumer health information, and population health management communications in the country. Combining extensive technology and content assets with vast consumer insights and a strategic approach, Krames StayWell is uniquely qualified to engage consumers across the entire spectrum of their health care experience. Our best-in-class health communication solutions integrate print, interactive, and mobile formats at multiple touch points to attract and retain consumers, improve health outcomes, and lower costs. We deliver measurable results for hospitals, health care professionals, health plans, employers, retail pharmacies, government agencies, and association clients with world-class design, commitment to health literacy principles, and a focus on custom development. For more information, please visit www.kramesstaywell.com.