Successful Implementation of Lifestyle Medicine: Lessons Learned from Eight Health Systems

Presentation Summary: This session will address what is known about the implementation of lifestyle medicine in health systems, present learnings from the qualitative research studied conducted through ACLM “Lifestyle Medicine Integration in Health Systems: A Case Study Project” and finally outline next steps in understanding factors that support or detract from lifestyle medicine implementation. The bulk of the presentation will center on ACLM’s research study, emergent themes, and implications for practice. Lifestyle medicine is an evidence-based field of medicine that has been shown to be effective in treating and preventing leading causes of morbidity and mortality. Individual practitioners demonstrate enthusiasm for lifestyle-based approaches to treatment and data on a variety of innovative clinical models has been published. However, a gap exists in comprehensive understanding of how implementation of lifestyle medicine can successfully grow within health systems.

The purpose of lifestyle medicine Integration in health systems: A Case Study Project was to identify facilitators and barriers that influence the implementation of lifestyle medicine in health systems. To address this question, the research team recruited health systems that were members of the ACLM Health Systems Council. We used a case study approach; a qualitative design that uses multiple data sources and goes in-depth to understand decision-making and processes while maintaining context. From among 15 self-nominating health systems, we selected seven to represent a diversity of geographic location, type, size, expertise, funding, patients, and lifestyle medicine services. Partway through the study, we recruited one additional health system to serve as a contrasting case, where lifestyle medicine programming had initially expanded, then retracted. 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 semi-structured interview guide, loosely based on the Consolidated Framework for Implementation Research (CFIR) model. Detailed case narrative reports for each health system were used in cross-case analyses to develop a contextually rich and detailed understanding of various predetermined and emergent topics. Implications related to the emergent themes, including topics of site champions, clinician training, workplace culture, and provider well-being/burnout will be discussed.

Investigation of the factors that support lifestyle medicine have led to deeper understanding of how to support health systems interested in the initiation and growth of lifestyle medicine programming in their setting. To translate these findings into practice tools, we are developing systems science models at the health system, clinician and individual/patient levels to identify leverage points and resulting outcomes for patients, practitioners, and health systems. These models can provide real-world insight and guidance as health systems plan their investments in lifestyle medicine.