This post is the fifth in a seven-part series that explores Exercise as a Vital Sign (EVS), a clinical initiative designed to systematically ascertain patient-reported exercise levels at the beginning of each outpatient visit. By focusing on frontline clinical experience, policies and organizational practice, I intend to shed light on an important clinical strategy to address obesity and physical inactivity.
Over the past several weeks, I’ve talked with physicians, medical assistants, researchers, clinic champions, and health coaches about Exercise as a Vital Sign. Most recently, I learned about a new initiative designed to support EVS, Project Move, from staff at Kaiser Permanente’s Innovation Consultancy — a small, multidisciplinary team within Kaiser Permanente whose very cool job is to develop, design and implement novel ideas to creatively improve health care delivery and management.
I met up with Dana Ragouzeos, a design researcher for the team working closely with the Exercise as a Vital Sign (EVS) initiative. In 2012, her group was tasked with transforming exercise vitals from just another number in a member’s chart, into an actionable item that health care providers could use to encourage healthy behavior change. They called the mission Project Move. The goal of the project was to better understand patients’ barriers and motivations regarding exercise. With that knowledge, providers could better use EVS to connect patients to resources and help them improve their physical activity.
The team went to Kaiser Permanente clinics in Southern California, Oregon and Washington state where they interviewed members, shadowed providers, and reviewed the scientific literature to gain a better understanding of physical activity promotion and behavior change theory. They found that members aren’t active because their busy lifestyles make it challenging, and providers often fail to address inactivity during patient visits because they lack the time and established resources to make a difference.
The group came up with several ideas to make Exercise as a Vital Sign more actionable for both the providers and patients:
- Exercise Vitals: Under the current practice, the medical assistant (MA) or licensed vocational nurse (LVN) asks the patient about his or her weekly exercise levels, according to the region’s guidelines.
- Exercise Vitals 2.0: With the addition of Project Move, if the member exercises fewer than 150 minutes a week, they also are asked: “What keeps you from being more active?” Responses can vary from time and ability to finances and family priorities, and this information, plus tips to overcome these barriers is entered into the patient’s After Visit Summary. The MA/LVN enters a diagnosis code for exercise counseling for the provider to review with the patient. (In the Northwest region, a “Smartset” is activated, comprising a specific follow-up question, a referral to a health and wellness coach, and other helpful prompts.)
- Provider Action: The provider reviews the activity levels and challenges to regular activity with the member, and provides additional counseling.
Quantitative and qualitative impact measures of the Project Move pilot study are still being collected, but primary results appear promising. The Innovation Consultancy is currently working on a pilot that offers the doctor a Kaiser Permanente-developed website, or resource locator, that helps members find available resources for physical activity in his or her community.
For Exercise as a Vital Sign to be truly successful in shaping and improving patients’ health, it will take the creative ideas, discoveries, and designs of health care thought leaders and innovators. The possibilities are endless.
Do you have an idea, outlandish or otherwise, on how health care providers can help integrate physical activity into patients’ lives?
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Latifat T. Apatira, MD, MPH is a fourth year Internal Medicine and Preventive Medicine Resident at Kaiser Permanente San Francisco Medical Center