By Melinda Young

EXECUTIVE SUMMARY

Hospitals and colleges can collaborate to give undergraduate students experience working with patients in a case management-style model.

  • Students are health coaches and meet with at-risk patients once a week.
  • Health coaches get to know patients and provide them with friendly companionship, and promote improving healthy habits.
  • The health coaching model benefits all stakeholders, including students, patients, the hospital, the college, and the community.

Some small-town hospitals and colleges have found a way to provide pre-med, nursing, and allied health undergraduate students with hands-on medical experience that benefits the community. The student health coaches perform case management-type services for at-risk patients.

Called health coaches, these students learn skills years ahead of their peers. They receive college course credit and volunteer or internship experience. And, they contribute to positive health outcomes, including keeping patients out of hospitals and EDs.

“The patients love it because they love the students, and we can find out so much more about what’s going on with patients because of the students being there in their homes,” says AlexSandra Davis, RN, BSN, MPA, director of home health services/Community Care Network at Wooster Community Hospital in Ohio.

The program is successful with patients and students, Davis says.

For instance, Wooster’s private internal data show that patients with diabetes improved their hemoglobin A1c levels, and reduced ED visits and hospitalizations. For all diseases, ED visits declined 38% and hospitalizations dropped by 36%.

Wooster Community Hospital collaborates with the College of Wooster to run the program, which started in 2013 after nearly a year of preparation. The idea came from a care management-style program implemented in 2012 by Meadville Medical Center and Allegheny College in Meadville, PA.

“Our program has been in place for seven years and has had over 14 semesters worth of students that have cared for patients,” says Tracy Meure, BSN, director of the Community Care Network at Meadville Medical Center.

About 40 students work with patients each semester, she says.

“They develop relationships with the patients and start to break down those barriers between the healthcare community and patient,” Meure says.

The students visit patients weekly and learn to observe changes, including small things that could signal a major health issue.

For example, one Allegheny College health coach noticed a patient would cough when drinking water. The student reported this change to the health coaching team at a weekly meeting, and the team sent a healthcare professional to examine the patient for swallowing problems, Meure says. It turned out the patient experienced difficulty drinking water. The patient needed therapy to improve swallowing and prevent pneumonia or another respiratory disease, she adds.

“The student reported something she noted that was out of the ordinary for that patient, but didn’t know the relevance of what she was reporting,” Meure says. “We, as a clinical team, could identify the problem.”

In another example, a student health coach worked with a patient who had visited the ED 23 times in the year after her husband died, Meure recalls.

“All of her visits were in the evening, and some of them involved random symptoms that could have been because she was lonely,” Meure says. “We put a health coach in place, and once the woman knew there was something to look forward to — a weekly visit — she was only in the emergency room once.”

Finding college professors and volunteers from the hospital to help with the Wooster program was fairly easy, Davis notes.

“We had so many volunteers from the hospital, who were willing to teach, and we had so many partners,” Davis says.

The timing of the program coincided with the rise of accountable care organizations (ACOs), as population health/care management models were gaining acceptance across the healthcare spectrum.

“How to manage really sick patients was a priority for many physicians because they were under the gun to manage their patients better,” Davis says.

The health coaching model was born when a Meadville Medical Center doctor observed a disturbing trend of patients returning to the ED multiple times at an enormous cost, says Steven Farrelly-Jackson, DPhil, associate professor of philosophy and global health studies and coordinating professor of the Health Coaching Program at Allegheny College.

“The idea was to extend care into the community to prevent readmissions and to prevent people from having catastrophic health breakdowns,” Farrelly-Jackson says. Meadville Medical Center and Allegheny College officials met and discussed a plan for the internship program.

The Health Coaching Program typically has 20 students in the seminar portion and 20 in the health coaching portion in a given semester. Students begin with the seminar to learn about community healthcare before they launch into real-world experience, Farrelly-Jackson says.

“We have a lot of students who are pre-health,” he says. “They are biology, biochemistry, global health studies, pre-health track majors planning to go to medical school, physician assistant school, or go into nursing.”

There up to 100 health coaches at Wooster, working with about 120 patients, Davis says. Students who enroll in the program are entering the healthcare field, including professions in medicine, dentistry, and dietetics.

“I’ve had several students who just graduated from medical school, and they say this program really prepared them for medical school,” Davis says. “They were so far ahead of other students — already knowing how to take care of patients, document care, and present their cases.”

One former health coach now is working in a hospital training to be a neurologist, she adds.

Student health coaches often develop a special bond with the patients they serve, says Kirsten Peterson, MA, director of pre-professional studies and global health studies at Allegheny College. Peterson also works with health coaches.

“Patients tell students things they would never tell their doctor and nurse,” Peterson says. “They get to know them and trust them.”

Students also learn hard lessons about how difficult it is to help people change their behaviors. Peterson learned from one student that his client was a man who needed to lose weight and exercise. The student devised an exercise schedule and envisioned the patient walking one mile several times a week by the end of the semester.

“Then he got in there, meeting with the man, and realized that his schedule would not work,” Peterson recalls. “By the end of the semester, the patient was able to leave his house and walk out to the sidewalk, which was very different from walking a mile every day.”

However, the health coach helped the patient reach the program’s goals. The man was able to get out of his house, stay healthy enough to continue living at home, and to achieve the highest quality of life possible under the conditions, she adds.

“Particularly with these older folks and with patients with low mental capacity and all sorts of mental health problems, you don’t make these huge scale changes,” Peterson says. “They come in increments, and that’s an incredibly important lesson for students to learn. It gives them a much more realistic view of conditions, diseases, and what can be done.”