Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States (2019) / Chapter Skim
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3 Health Care
3 Health Care
Pages 45-62
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From page 45... ...
. These visits provide valuable opportunities to assess physical activity levels and advise patients to be physically active.
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STRATEGIES AND ACTIONS FOR IMPLEMENTATION OF PHYSICAL ACTIVITY SURVEILLANCE IN HEALTH CARE Strategy 7 Develop surveillance systems to monitor the prevalence of physi cal activity assessment in adults through expanded integration of a standard physical activity vital sign (PAVS) in health care delivery.
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As a vital sign, physical activity level can be measured and monitored over time, facilitating more comprehensive and personalized counseling initiatives. Widespread adoption of the PAVS will require multiple stakeholders to come together, including health care organizations, EHR vendors and information technology professionals, and quality assurance organizations (e.g., National Committee for Quality Assurance [NCQA]
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Strategy 8 Develop surveillance systems to monitor the prevalence of physical activity assessment and promotion among children through integra tion of a standard pediatric physical activity vital sign ( edsPAVS) P in health care delivery.
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. This likely reflects a variety of factors that include physician training and self-efficacy for physical activity counseling, clinical workflow and tools to aid in physical activity assessment, and the inherent challenge of asking a child how many minutes of MVPA he or she engaged in over a given time frame.
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Supporting Action 8.3: Health care systems and EHR vendors should integrate PedsPAVS and documentation of physical activity counseling into the EHR. The primary role of the PedsPAVS is to prompt health care provid ers to discuss the importance of physical activity in child health and wellness.
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could also benefit from surveillance of physical activity levels in an effort to improve health and reduce injury and disease; reduction in the higher health care costs associated with these conditions might be realized as well. Studies have demonstrated acceptance of wearable physical activity devices in atrisk populations (e.g., older adults, adults with chronic illness)
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Such scenarios can also evaluate patient acceptance and experience with objective physical activity assessment in health care settings, and learning on the use of these data for surveillance purposes. Supporting Action 9.2: An expert panel of stakeholders represent ing EHR vendors, health care system leaders, CDC, and patients should determine the patient populations that would benefit the most from the use of wearable physical activity devices to better
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. Emerging research has demonstrated that grip strength and the 6MWT combined are highly predictive of frailty, and can be successfully implemented in primary care settings (Lee et al., 2017)
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Supporting Actions for Implementation The committee recommends the following actions to support this strategy: Supporting Action 10.1: The Centers for Medicare & Medicaid Services (CMS) should partner with health care systems to develop and implement protocols using grip strength and the 6MWT in primary care settings as part of the Medicare Annual Wellness Visit as a fitness surveillance strategy among adults 65 years of age and older.
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Strategy 11 Ensure that national health care delivery surveys include questions about physical activity assessment and counseling in health care settings. Background National health care delivery surveys provide data on the proportion of patients or patient visits where counseling for exercise is provided.
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Background A strong predictor of lifestyle counseling is a health care provider's personal engagement in health promotion activities. Medical students and practicing physicians who are more physically active are also more likely to counsel their patients regarding physical activity (Oberg and Frank, 2009)
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. An examination of physical activity counseling training programs in family medicine residency training found improvements in knowledge, but inconsistent improvements in self-efficacy to perform physical activity counseling (Wattanapisit et al., 2018)
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, should develop and regularly implement a survey to query medical students, residents, fellows, advanced practice clinician students, nursing students, and physical therapy students about their per sonal lifestyle behaviors, and use the results to inform development of programs aimed at promoting regular physical activity among health care providers in training. Supporting Action 12.3: CDC, in partnership with medical edu cational organizations (e.g., American College of Graduate Medi cal Education, American Nurses Association, American Physical Therapy Association, Association of American Medical Colleges)
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Furthermore, patients may be particularly motivated to adopt or increase physical activity behaviors to help manage a health condition and/or to prevent adverse health outcomes for which they may be at risk. The 6 strategies and 16 implementation actions recommended in this chapter can help improve the low rates of health care provider physical activity assessment and advice by providing relatively simple solutions that are integrated with existing EHRs and clinical workflows.
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2014. Physical activity counseling in medical school education: A systematic review.
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2018. Routine assessment and promotion of physical activity in healthcare settings: A scientific statement from the American Heart Associa tion.
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2018. Physical activity counseling in primary care and family medicine residency training: A systematic review.
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