Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system  

作　　者：John Kevin Ong Dayao Caroline E L Duffy Amalia M Cristiano Gene'Rusty'Kallenberg Sarah E Linke 

机构地区：[1]University of California San Diego School of Medicine,La Jolla,California,USA [2]Milken Institute of Public Health,The George Washington University,Washington,District of Columbia,USA [3]The University of Texas Medical Branch at Galveston School of Medicine,Galveston,Texas,USA [4]Scripps Family Medicine Residency,Scripps Mercy Hospital Chula Vista,Chula Vista,California,USA [5]Herbert Wertheim School of Public Health&Human Longevity Science,University of California San Diego,La Jolla,California,USA [6]Department of Family Medicine,University of California San Diego,La Jolla,California,USA [7]Omada Health,San Francisco,California,USA

出　　处：《Family Medicine and Community Health》2024年第1期16-27,共12页家庭医学与社区卫生（英文）

基　　金：funded by the Agency for Health Care Research and Quality(K08HS026517(PI:SEL));funded by two internal grants:a UC San Diego Department of FMPH Pilot Award(PI:SEL);an Academic Senate Award(PI:SEL).

摘　　要：Objective Exercise is Medicine(EIM)is a global initiative encouraging healthcare providers to routinely assess and promote physical activity(PA)among patients.The objective of this study was to evaluate the feasibility,adoption,implementation and effectiveness of EIM from patient,clinician and healthcare staff perspectives using a combination of electronic health record(EHR),survey and interview data.Design This study used a combination of the Practical Robust Implementation and Sustainability Model(PRISM)and the Learning Evaluation model to implement EIM.Data captured from the EHR,including Physical Activity Vital Sign(PAVS)scores,and data collected from qualitative surveys and interviews were used to evaluate the programme’s Reach,Effectiveness,Adoption,Implementation,Maintenance(RE-AIM,which is embedded within PRISM)from provider,staff and patient perspectives.Setting Five primary care clinics within a large academic health system.Participants A total of 24443 patients from all participating clinics had at least one PAVS score during the study period.A total of 17 clinicians completed surveys,and 4 clinicians,8 medical assistants and 9 patients completed interviews.Results Implementation fidelity metrics varied widely between components and across clinics but were generally consistent over time,indicating a high degree of programme maintenance.Fidelity was highest during the first 6 months of the COVID-19 pandemic when most visits were virtual.Mean PAVS scores increased from 57.7(95%CI:56 to 59.4)to 95.2(95%CI:91.6 to 98.8)min per week at 6 months for patients not meeting PA guidelines at baseline and decreased from 253.84(95%CI:252 to 255.7)to 208.3(95%CI:204.2 to 212.4)min per week at 6 months for patients meeting PA guidelines at baseline.After EIM implementation,clinician-estimated time spent discussing PA with patients increased for 35%of providers and stayed the same for 53%.Conclusion Overall,this study established EIM’s feasibility,adoption,implementation and maintenance in routine primary care pra

关 键 词：ROUTINE qualitative completed 

分 类 号：R197.1[医药卫生—卫生事业管理]