Nurs Res. 2024;73(3):216-223. doi: 10.1097/NNR.0000000000000714. Epub 2024 Jan 11.
Currently, only about half of U.S. adults achieve current physical activity guidelines. Routine physical activity is not regularly assessed, nor are patients routinely counseled by their healthcare provider on achieving recommended levels. The three-question physical activity vital sign (PAVS) was developed to assess physical activity duration and intensity and identify adults not meeting physical activity guidelines. Clinical decision support provided via a best practice advisory in an electronic health record (EHR) system can be triggered as a prompt, reminding healthcare providers to implement the best practice intervention when appropriate. Remote patient monitoring of physical activity can provide objective data in the EHR.
This study aimed to evaluate the feasibility and clinical utility of embedding the PAVS and a triggered best practice advisor into the EHR in an ambulatory preventive cardiology practice setting to alert providers to patients reporting low physical activity and prompt healthcare providers to counsel these patients as needed.
Three components based in the EHR were integrated for the purpose of this study: Patients completed the PAVS through their electronic patient portal prior to an office visit, a best practice advisory was created to prompt providers to counsel patients who reported low levels of physical activity, and remote patient monitoring via Fitbit synced to the EHR provided objective physical activity data. The intervention was pilot-tested in the Epic EHR for 1 year (July 1, 2021 to June 30, 2022). Qualitative feedback on the intervention from both providers and patients was obtained at the completion of the study.
Monthly assessments of the use of the PAVS and best practice advisory and remote patient monitoring were completed. Patients' completion of the PAVS varied from 35% to 48% per month. The best practice advisory was signed by providers between 2% and 65% and was acknowledged by 2%-22% per month. The majority (58%) of patients were able to sync a Fitbit device to their EHR for remote monitoring.
Although uptake of each component needs improvement, this pilot demonstrated the feasibility of incorporating a physical activity promotion intervention into the EHR. Qualitative feedback provided guidance for future implementation.
目前，只有大约一半的美国成年人达到了当前的身体活动指南。常规的身体活动没有得到定期评估，患者也没有定期接受医疗保健提供者关于达到推荐水平的咨询。三问身体活动生命体征（PAVS）是为了评估身体活动的持续时间和强度，并确定不符合身体活动指南的成年人而开发的。临床决策支持可以通过电子健康记录（EHR）系统中的最佳实践咨询提供，作为提示，提醒医疗保健提供者在适当的情况下实施最佳实践干预。身体活动的远程患者监测可以在 EHR 中提供客观数据。
本研究旨在评估在门诊预防心脏病学实践环境中嵌入 PAVS 和触发最佳实践顾问到 EHR 中的可行性和临床实用性，以提醒提供者注意报告低身体活动的患者，并在需要时提醒医疗保健提供者对这些患者进行咨询。
为了本研究的目的，整合了基于 EHR 的三个组件：患者在就诊前通过电子患者门户完成 PAVS，创建最佳实践咨询以提示提供者对报告低身体活动水平的患者进行咨询，以及通过与 EHR 同步的 Fitbit 进行远程患者监测提供客观的身体活动数据。该干预措施在 Epic EHR 中进行了为期一年的试点测试（2021 年 7 月 1 日至 2022 年 6 月 30 日）。在研究结束时，从提供者和患者那里获得了对干预措施的定性反馈。
每月评估 PAVS 和最佳实践咨询以及远程患者监测的使用情况。患者完成 PAVS 的比例每月从 35%到 48%不等。最佳实践咨询的签署率在提供者之间为 2%至 65%，每月的知晓率为 2%至 22%。大多数（58%）患者能够将 Fitbit 设备与他们的 EHR 进行同步，以便进行远程监测。
尽管每个组件的采用都需要改进，但本试点表明将身体活动促进干预措施纳入 EHR 的可行性。定性反馈为未来的实施提供了指导。
