Tyler Hemmingson

Healthcare worker burnout is pervasive and negatively impacts practitioner and patient health. Lifestyle medicine (LM) is a burgeoning field that uses ther

This chapter outlines foundational concepts, tools, and resources designed to establish or enhance the clinical delivery of team-based, patient-centered whole person lifestyle medicine while cultivating patient engagement and improving the management of chronic conditions within primary care. Spanning the gamut of chronic disease prevention, treatment, and remission, the chapter describes the establishment of lifestyle medicine practice. It outlines key clinical practice tools that are already in use across a variety of established primary care settings. Select tools and resources include clinical guidelines, patient assessments, evidence-based recommendations, video resources, patient education tools, professional development opportunities, training, cost-effectiveness resources, implementation toolkits, and more that can 1) support health care team members in achieving better health outcomes at a lower cost, 2) boost patient and provider satisfaction, and 3) enhance efforts aimed to improve education, access, and equity. The chapter equips primary care clinicians with evidence-based information and decision-making support to enhance the delivery and scalability of lifestyle therapy into the care they provide for their patients and their communities.

Background: Lifestyle medicine (LM) is an evidence-based field of medicine that is effective in treating and preventing leading causes of morbidity and mortality. Despite demonstrated impact, few physicians and other healthcare professionals regularly implement LM. Continuing education may be an effective avenue for improving practitioner knowledge, confidence, and practice of LM, but there is a gap in the understanding of how educational content and strategies can be utilized to effectively increase LM adoption. The purpose of this study is to identify educational strategies that facilitate the implementation of LM in health systems (HS). Methods: Eight US HSs participated in this multiple case study. We conducted in-depth, semi-structured interviews (n = 68 total; 6–8 within each HS) with HS employees leading and delivering LM programs. Interviews included questions about LM implementation and educational strategies. Transcripts were analyzed following the framework analysis approach. Strength of endorsement was assessed through quantitative and qualitative analysis. Results: Four topic areas were identified as critical content for effective continuing education in LM. The need for further education in behavior change counseling received the strongest endorsement. Other topics included LM definition and evidence, referral opportunities, and business development skills. Ten types of continuing educational strategies were identified that facilitate LM. There was the strongest endorsement for pilot programs, employee wellness, and interpersonal educational activities, including peer-learning, communities-of-practice, and supervisor-learning/mentorship. Conclusion: Continuing education can facilitate LM implementation in HSs. Educational strategies should emphasize training that builds skills in behavior change counseling, leverages employee wellness pilot programs, and nurtures interpersonal learning.

Background: Lifestyle medicine (LM) is the use of therapeutic lifestyle changes (including a whole-food, plant-predominant eating pattern; regular physical activity; restorative sleep; stress management; avoidance of risky substances; and positive social connection) to prevent and treat chronic illness. Despite growing evidence, LM is still not widely implemented in health care settings. Potential challenges to LM implementation include lack of clinician training, staffing concerns, and misalignment of LM services with fee-for-service reimbursement, but the full range of factors facilitating or obstructing its implementation and long-term success are not yet understood. To learn important lessons for success and failure, it is crucial to understand the experiences of different LM programs. Objective: This study aims to describe in depth the protocol used to identify barriers and facilitators impacting the implementation of LM in health systems. Methods: The study team comprises team members at the American College of Lifestyle Medicine (ACLM), including staff and researchers with expertise in public health, LM, and qualitative research. We recruited health systems that were members of the ACLM Health Systems Council. From among 15 self-nominating health systems, we selected 7 to represent a diversity of geographic location, type, size, expertise, funding, patients, and LM services. Partway through the study, we recruited 1 additional contrasting health system to serve as a negative case. For each case, we conducted in-depth interviews, document reviews, site visits (limited due to the COVID-19 pandemic), and study team debriefs. Interviews lasted 45-90 minutes and followed a semistructured interview guide, loosely based on the Consolidated Framework for Implementation Research (CFIR) model. We are constructing detailed case narrative reports for each health system that are subsequently used in cross-case analyses to develop a contextually rich and detailed understanding of various predetermined and emergent topics. Cross-case analyses will draw on a variety of methodologies, including in-depth case familiarization, inductive or deductive coding, and thematic analysis, to identify cross-cutting themes. Results: The study team has completed data collection for all 8 participating health systems, including 68 interviews and 1 site visit. We are currently drafting descriptive case narratives, which will be disseminated to participating health systems for member checking and shared broadly as applied vignettes. We are also conducting cross-case analyses to identify critical facilitators and barriers, explore clinician training strategies to facilitate LM implementation, and develop an explanatory model connecting practitioner adoption of LM and experiences of burnout. Conclusions: This protocol paper offers real-world insights into research methods and practices to identify barriers and facilitators to the implementation of LM in health systems. Findings can advise LM implementation across various health system contexts. Methodological limitations and lessons learned can guide the execution of other studies with similar methodologies. International Registered Report Identifier (IRRID): DERR1-10.2196/51562

BACKGROUND Lifestyle medicine (LM) is the use of therapeutic lifestyle changes (including a whole-food, plant-predominant eating pattern; regular physical activity; restorative sleep; stress management; avoidance of risky substances; and positive social connection) to prevent and treat chronic illness. Despite growing evidence, LM is still not widely implemented in health care settings. Potential challenges to LM implementation include lack of clinician training, staffing concerns, and misalignment of LM services with fee-for-service reimbursement, but the full range of factors facilitating or obstructing its implementation and long-term success are not yet understood. To learn important lessons for success and failure, it is crucial to understand the experiences of different LM programs. OBJECTIVE This study aims to describe in depth the protocol used to identify barriers and facilitators impacting the implementation of LM in health systems. METHODS The study team comprises team members at the American College of Lifestyle Medicine (ACLM), including staff and researchers with expertise in public health, LM, and qualitative research. We recruited health systems that were members of the ACLM Health Systems Council. From among 15 self-nominating health systems, we selected 7 to represent a diversity of geographic location, type, size, expertise, funding, patients, and LM services. Partway through the study, we recruited 1 additional contrasting health system to serve as a negative case. For each case, we conducted in-depth interviews, document reviews, site visits (limited due to the COVID-19 pandemic), and study team debriefs. Interviews lasted 45-90 minutes and followed a semistructured interview guide, loosely based on the Consolidated Framework for Implementation Research (CFIR) model. We are constructing detailed case narrative reports for each health system that are subsequently used in cross-case analyses to develop a contextually rich and detailed understanding of various predetermined and emergent topics. Cross-case analyses will draw on a variety of methodologies, including in-depth case familiarization, inductive or deductive coding, and thematic analysis, to identify cross-cutting themes. RESULTS The study team has completed data collection for all 8 participating health systems, including 68 interviews and 1 site visit. We are currently drafting descriptive case narratives, which will be disseminated to participating health systems for member checking and shared broadly as applied vignettes. We are also conducting cross-case analyses to identify critical facilitators and barriers, explore clinician training strategies to facilitate LM implementation, and develop an explanatory model connecting practitioner adoption of LM and experiences of burnout. CONCLUSIONS This protocol paper offers real-world insights into research methods and practices to identify barriers and facilitators to the implementation of LM in health systems. Findings can advise LM implementation across various health system contexts. Methodological limitations and lessons learned can guide the execution of other studies with similar methodologies. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/51562