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Put me in, health coach!

October 12, 2006 - Today The San Diego Union Tribune ran a fair piece by Associated Press science writer Alicia Chang about "health coaches." Insurers increasingly rely on such coaches to help patients with chronic conditions manage their health at home and stay out of the hospital, thereby cutting costs and improving outcomes. The piece barely manages to note that most of the coaches are nurses, so it fails to discuss why nurses are uniquely qualified to play such key patient education and health management roles, which they have long done without the label "health coach." The piece credits a Colorado physician for the specific care "model" it discusses, which may imply that this kind of work is a recent physician innovation. The piece does provide a good quick snapshot of the work of one nurse/health coach. It occurred to us that nurses--whose professional name is so problematic that some have wondered whether it should be changed--could do worse than to be called "health coaches." Of course, "health coach" does not convey the range of nurses' advanced, life-saving skills, nor their central role in bedside care. In any case, we thank Ms. Chang and the above media entities for reporting on health coaches.

The Union Tribune headline is "Health coaches helping patients avoid return trips to hospital." The piece is built around 79-year-old Los Angeles emphysema patient William Jones. After Jones started seeing a health coach provided by his insurer, SCAN Health Plan, his "once-a-month" visits to the ED have become much less frequent. Jones lives with a caregiver, breathes with an oxygen machine, and has often been hospitalized for pneumonia. The piece notes that the coach counsels him about drugs, health appointments, and other issues. Jones's daughter describes the change as "an amazing turnaround." The piece notes that insurers are increasingly using such coaches to help discharged patients "navigate the daunting transition" to home care and stay out of the hospital, potentially improving their conditions and saving the insurers money.

he 12th paragraph of the piece gives readers the minor detail that "[m]ost health coaches are registered nurses hired by insurers to make regular house visits or talk to patients on the telephone." It explains that coaches may "role-play" with patients to teach them about prescriptions and follow-up care. The piece notes that such aftercare is especially important for the growing ranks of elderly patients. It does not mention that it could also be critical in an era of declining reimbursement and denursification, which often means hospital patients are discharged before they are ready to function well at home.

The piece reports that Medicare is currently doing a three-year pilot study of health coaching for 115,000 of its patients who "tend to suffer from heart failure or diabetes." The program will apparently require participating providers to show a 5% cost savings as a result of the coaching. Results are not yet in, though a Medicare program official says that "anecdotal evidence" suggests that at least some patients have improved.

The article describes a recent study by University of Colorado physicians which found that patients who received coaching were significantly less likely to return to the ED within six months, reducing annual hospital costs by about $845 for every patient enrolled. It notes that one of these physicians, Eric Coleman, has developed a "model" for such programs that is being used in eight states, and is the basis for the program in which patient Jones participates. The piece quotes Coleman as saying the program is about consumers taking an active role in their care.

There have been other recent press pieces about such nurse-based community health initiatives, which are now addressing health issues ranging from those of poor young mothers to urban heart failure patients. Like most of those pieces, this one includes no larger historic context to let readers know that nurses have been doing just this kind of work for many decades, and that they are experts in this area. Indeed, the holistic approach and focus on education that such patients need have long been key elements of the overall nursing care "model." However, no nursing policy expert is consulted here. Instead, the sense is that this is a promising idea that physicians recently had. As we have noted in the past, it is unfortunate that nursing ideas and practices often seem to get attention and respect only when adopted by physicians. Of course, one factor in this situation is nurses' own reluctance to speak up about their work.

Fortunately, the nurse who is coaching Jones did speak with this reporter, and near the end of the long piece, readers are introduced to her. Ann Chan-Verdugo says her patient is a perfect candidate for coaching because of his frequent hospitalizations. The reporter notes that during a two week period, Chan-Verdugo "regularly chatted" with Jones, his caregiver, and his daughter about his drugs, organizing his health information for "doctor visits," and what might indicate a worsening condition. Chan-Verdugo says program patients are (in the piece's words) "more savvy and proactive about their care." She also notes that they "don't think of the hospital as a place to get better." This seems to mean that the coached patients know their health is in their own hands, that they need to work to stay out of the hospital, although we couldn't help think of it as a comment on the troubled state of hospitals today. We could quibble with the piece's use of the word "chatted;" we doubt it would have described Jones' "doctor visits" as "chatting." But on the whole this is not a bad brief look at Chan-Verdugo's work.

Would "health coach" be a good alternate name for nurses? Some have suggested that the name "nurse" may be a liability, noting that the name's connotations of unskilled care and breastfeeding may undermine nurses' efforts to be seen as a modern scientific profession for both genders. As we have noted, the title "nurse" remains so elastic that many unskilled caregivers clearly feel justified in using it, and the media regularly refers to health care robots as "nurses."

"Health coach" would certainly resolve some of these problems, since it is not a gendered term and implies expertise, strength, and an educational focus. Indeed, we wonder if this article would have come out any differently, or been received any differently, if the nurses were not called "coaches." On the other hand, "health coach" probably does not convey important parts of nursing, including nurses' bedside and patient advocacy roles, and their scientific training and skills. See our FAQ on the name nurse and add your thoughts about potential name changes on our discussion board.

We thank Ms. Chang and the AP for this story.

See Alicia Chang's AP article "Health coaches helping patients avoid return trips to hospital," published in the San Diego Union-Tribune on October 12, 2006.

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