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Exercise as a vital sign: a quasi-experimental analysis of a health system intervention to collect patient-reported exercise levels.

Abstract：

BACKGROUND:Lack of regular physical activity is highly prevalent in U.S. adults and significantly increases mortality risk. OBJECTIVE:To examine the clinical impact of a newly implemented program ("Exercise as a Vital Sign" [EVS]) designed to systematically ascertain patient-reported exercise levels at the beginning of each outpatient visit. DESIGN AND PARTICIPANTS:The EVS program was implemented in four of 11 medical centers between April 2010 and October 2011 within a single health delivery system (Kaiser Permanente Northern California). We used a quasi-experimental analysis approach to compare visit-level and patient-level outcomes among practices with and without the EVS program. Our longitudinal observational cohort included over 1.5 million visits by 696,267 adults to 1,196 primary care providers. MAIN MEASURES:Exercise documentation in physician progress notes; lifestyle-related referrals (e.g. exercise programs, nutrition and weight loss consultation); patient report of physician exercise counseling; weight change among overweight/obese patients; and HbA1c changes among patients with diabetes. KEY RESULTS:EVS implementation was associated with greater exercise-related progress note documentation (26.2 % vs 23.7 % of visits, aOR 1.12 [95 % CI: 1.11-1.13], p < 0.001) and referrals (2.1 % vs 1.7 %; aOR 1.14 [1.11-1.18], p < 0.001) compared to visits without EVS. Surveyed patients (n = 6,880) were more likely to report physician exercise counseling (88 % vs. 76 %, p < 0.001). Overweight patients (BMI 25-29 kg/m(2), n = 230,326) had greater relative weight loss (0.20 [0.12 - 0.28] lbs, p < 0.001) and patients with diabetes and baseline HbA1c > 7.0 % (n = 30,487) had greater relative HbA1c decline (0.1 % [0.07 %-0.13 %], p < 0.001) in EVS practices compared to non-EVS practices. CONCLUSIONS:Systematically collecting exercise information during outpatient visits is associated with small but significant changes in exercise-related clinical processes and outcomes, and represents a valuable first step towards addressing the problem of inadequate physical activity.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Grant RW,Schmittdiel JA,Neugebauer RS,Uratsu CS,Sternfeld B

doi

10.1007/s11606-013-2693-9

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

341-8

issue

eissn

0884-8734

issn

1525-1497

journal_volume

pub_type

杂志文章,多中心研究

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Exercise as a vital sign: a quasi-experimental analysis of a health system intervention to collect patient-reported exercise levels.