Implementing and Evaluating the Comprehensive Integration of Physical Activity into a Major Health System and Connecting Patients to Community-Based Physical Activity Programs

实施和评估将体育活动全面纳入主要卫生系统并将患者与基于社区的体育活动计划联系起来

• 批准号: 10705363
• 负责人: Mark Stoutenberg
• 金额: $ 64.07万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10705363
• 关键词: Adopted; Adoption; American; Attention; Blood Pressure; Body Weight; Centers for Disease Control and Prevention (U.S.); Chronic; Chronic Disease; Clinic; Clinical; Cluster randomized trial; Communities; Credentialing; Development; Diabetes Mellitus; Dimensions; Education; Effectiveness; Electronic Health Record; Exercise; Fibrinogen; Future; Glycosylated hemoglobin A; Health; Health Care Sector; Health Expenditures; Health Status; Health system; Healthcare Systems; Heart Diseases; Hypertension; Impairment; Lipids; Malignant Neoplasms; Medicine; Mental Health; Methodology; Methods; Modeling; Obesity; Outcome; Patient Care; Patient Representative; Patient Self-Report; Patients; Physical activity; Prevention program; Primary Health Care; Process; Promoting Action on Research Implementation in Health Services framework; Provider; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Resources; Role; Rural; Savings; South Carolina; Sports Medicine; Standardization; Training; Universities; Variant; Work; base; behavior change; clinical practice; college; community organizations; community setting; contextual factors; cost; cost effectiveness; cost estimate; cost outcomes; design; disorder prevention; effectiveness evaluation; evidence base; exercise intervention; future implementation; health care service utilization; health care settings; health equity; health management; implementation barriers; implementation outcomes; implementation strategy; improved; incremental cost-effectiveness; medical schools; patient engagement; physical inactivity; population health; prevent; prisma; programs; provider adoption; public health priorities; response; scale up; standard care; standard of care; tool

The U.S. healthcare sector has great potential for promoting physical activity (PA) for chronic disease prevention and treatment; however, implementation barriers exist, ranging from practice integration to information flow. In 2016, the first multi-organizational partnership between a large academic healthcare system and a national PA organization launched Exercise is Medicine Greenville (EIMG®), a comprehensive clinic-to-community approach that involves PA assessment, prescription, and referral of patients with chronic diseases to tailored, community-based PA programs. Since 2016, EIMG® has grown to include 18 provider clinics covering 342 urban/rural miles2 and 6 community PA centers covering 213 urban/rural miles2. However, great variability across participating clinics exists in correctly identifying eligible patients, providing referrals, and engaging patients in the community-based PA programs. A pragmatic, stepped wedge, cluster randomized trial using a mixed methods approach will examine the implementation and reach of EIMG® across newly onboarded primary care clinics (i.e., clinic workflow, referral process), ultimately leading to patient engagement in community-based, evidence-informed PA programs. The RE-AIM framework will inform the assessment of implementation outcomes, while the i-PARIHS framework will be used to more fully understand contextual factors (i.e., determinants) influencing patient and clinic level outcomes. Our specific aims are to: (1) to determine differences in provider-level adoption (i.e., proportion of providers that initiate use), implementation (i.e., delivery fidelity), and reach (i.e., number, proportion, and representativeness of patients) of EIMG® at newly onboarded primary health clinics; (2) assess the effectiveness of patient engagement in the evidence- informed, 12-week PA programs at the community PA centers on patient self-reported PA levels and health outcomes (i.e., body weight, blood pressure, hemoglobin A1c, lipid profiles) captured in their electronic health records, and (3) evaluate the cost of implementing EIMG® and the cost-effectiveness (i.e., changes in PA levels and improvements in health outcomes versus health care utilization costs) of patients participating in EIMG® vs. standard of care (i.e., no engagement in EIMG®). As an exploratory aim, we will evaluate long-term adaptations to the implementation and sustainability of EIMG® in the primary care clinics. Finally, we will pay careful attention to issues of health equity across all RE-AIM dimensions. This study has the potential to significantly change clinical practice and improve population health outcomes by informing future strategies on optimizing and scaling up the integration of comprehensive PA models into U.S. health systems. This study also will provide information on cost estimates of potential savings to health systems that may implement PA as a population health management tool through the use of clinical-community linkages.

美国医疗保健行业在促进身体活动（PA）治疗慢性病方面具有巨大潜力 预防和治疗；然而，实施障碍存在，从实践整合到 2016 年，大型学术医疗保健机构之间建立了首个多组织合作伙伴关系。 系统和国家 PA 组织发起了“运动是医学格林维尔”(EIMG®)，这是一个综合性的 临床到社区的方法，包括慢性病患者的 PA 评估、处方和转诊 自 2016 年以来，EIMG® 已拥有 18 家提供者。 诊所覆盖 342 英里的城市/乡村2，6 个社区 PA 中心覆盖 213 英里的城市/乡村2。 参与诊所在正确识别符合条件的患者、提供转诊、 并让患者参与以社区为基础的 PA 计划。 使用混合方法的试验将检查 EIMG® 在新领域的实施情况和影响范围 加入初级保健诊所（即诊所工作流程、转诊流程），最终提高患者参与度 RE-AIM 框架将为基于社区的、基于证据的 PA 计划的评估提供信息。 实施成果，而 i-PARIHS 框架将用于更全面地了解背景 影响患者和临床水平结果的因素（即决定因素）是：(1) 确定提供商级别采用的差异（即发起使用的提供商的比例）、实施 EIMG®（即交付保真度）和覆盖范围（即患者数量、比例和代表性） 新成立的初级卫生诊所；(2) 评估患者参与证据的有效性 在社区 PA 中心开展为期 12 周的知情 PA 计划，了解患者自我报告的 PA 水平和健康状况 电子健康记录中捕获的结果（即体重、血压、糖化血红蛋白、血脂谱） 记录，以及 (3) 评估实施 EIMG® 的成本和成本效益（即 PA 的变化） 参与的患者的健康结果与医疗保健利用成本的水平和改善 EIMG® 与护理标准（即不参与 EIMG®） 作为探索性目标，我们将评估长期。 适应 EIMG® 在初级保健诊所的实施和可持续性 最后，我们将支付费用。 认真关注 RE-AIM 所有维度的公平健康问题。 临床改变实践并通过告知未来策略来显着改善人口健康结果 优化和扩大综合 PA 模型与美国卫生系统的整合。 还将提供可能实施 PA 的卫生系统潜在节省的成本估算信息 通过利用临床与社区的联系作为人口健康管理工具。