Opening soonNot applicableInterventional
What this study is about
A public health priority exists for the U.S. healthcare sector to integrate physical activity (PA) as a part of the patient care model. This research will provide valuable information on facilitating optimal implementation of a clinic-to-community model that identifies, refers, and enrolls physically inactive patients to community-based PA programs for the prevention and treatment of chronic diseases. Further, this work will provide evidence on the cost-effectiveness of integrating PA in healthcare systems as a population health management strategy.
A promising-looking record is not the same as confirmed eligibility. The study team must review the full criteria and current recruitment status.
Basic eligibility
AgeNot listed to Not listed
SexAll
Healthy volunteersAccepted
ConditionPhysical Inactivity, Dyslipidemia, Obesity and Overweight, Hypertension, Diabetes, Health Care Delivery, Patients, Chronic Disease, Exercise, Physical Activity, Implementation Science
Full registry criteria
The primary aim of this study is implementation facilitation at the clinic level. The secondary aim of this study is at the patient level. Therefore we have divided our inclusion/exclusion eligibility criteria by primary and secondary aim. 1\. Clinic (primary aim) Inclusion criteria * Currently EIMG-activated Prisma Health-Upstate Primary Care clinic (family or internal medicine) * Adopted EIMG \>= 6 months prior to the beginning of this study Exclusion criteria * Not EIMG-activated * Adopted EIMG \< 6 months prior to the beginning of this study * Greater than 15 miles from the nearest YMCA 1\. Primary care clinic staff (primary aim) Inclusion criteria * At least 18 years of age * Has worked at the Prisma Health-Upstate clinic since the start date of the intervention in the respective wave, i.e., Pre-IF start date for each wave * Has clinical encounters with a minimum of 25 patients per month * Study clinic is their primary clinic (\>50% of their working time) * Able to understand and communicate in English Exclusion criteria * Less than 18 years of age * Work at the Prisma Health-Upstate clinic started after the Pre-IF phase began * Has clinical encounters with \<25 patients per month * Unable to speak or understand English * Adults unable to provide consent 2\. Patient (secondary aim) Inclusion criteria (must meet all of below) * Age \>= 18 and \<= 80 years * Clinically eligible (diagnosis of hypertension, dyslipidemia, obesity, diabetes, or physical inactivity) to receive an EIMG referral * A healthcare visit with an eligible encounter type (evaluation, telemedicine, consult, office visit, e-visit, follow-up, appointment, education, multidisciplinary visit, nutrition, occupational medicine-office visit) * A healthcare visit at a participating clinic Exclusion criteria * Age \< 18 or \> 80 years * Current referral to Physical therapy or occupational therapy * Current referral to cardiac, pulmonary, or oncology rehab * One of the following visit diagnoses listed below: * Alzheimer's disease * Amyotrophic lateral sclerosis * angina or chest pain * congenital stenosis of aortic valve * congenital insufficiency of aortic valve * moderate or severe persistent asthma * typical or atypical atrial flutter * autonomic dysreflexia * acute bronchitis * cerebral infarction * encounter for chemotherapy * chronic kidney disease (stage 3-5) * end stage renal disease * coma * acute chronic obstructive pulmonary disease * unspecified dementia * dependence on renal dialysis * trisomy 21 * pulmonary embolism * venous embolism and thrombosis * history of falling * acute fracture * left ventricular failure * congestive heart failure * hypertensive urgency, emergency or crisis * diabetes with ketoacidosis * chronic respiratory failure * dependence on supplemental oxygen * myocardial infarction * osteoporosis with current fracture * encounter for palliative care * paraplegia or quadriplegia * Parkinson disease * pneumonia * encounter for supervision of pregnancy * encounter for radiation therapy * serious mental illness (schizophrenia, psychotic disorder) * homicidal or suicidal ideations * sepsis * injury of spinal cord * presence of coronary stent * dependence on wheelchair or ambulatory aid For patients completing accelerometry data collection, the additional inclusion/exclusion criteria apply: Inclusion criteria: * Received an EIMG referral and scheduled for orientation * Attending orientation at two pre-determined community PA facilities (these sites were selected due to each being the largest urban and rural YMCA referral sites in the study) Exclusion criteria: * Unable to provide verbal informed consent * Planning on travel or vacation during data collection, as patient PA behavior is anticipated to differ from 'everyday' PA behavior at home * Unable to wear a watch during work hours due to employment restrictions e.g., food service, healthcare, operating heavy machinery/construction, laboratory-based work etc. In addition, for patients completing interviews, the additional inclusion/exclusion criteria apply: Inclusion criteria: \- Received an EIMG referral Exclusion criteria: * Unable to provide verbal informed consent * Unable to speak or understand English * \<18 years of age
Primary outcomes
Clinic-level differences in implementation of EIMG and reach of patients receiving EIMG referrals pre- and post-implementation facilitationFrom Wave 1 start in pre-implementation facilitation activities to the end of Wave 4 post-implementation facilitation. Time frame for Wave 1 = 39 months, Wave 2 = 33 months, Wave 3 = 27 months, Wave 4 = 21 months.Reach (primary study outcome measure) will be assessed by estimating the number and proportion of eligible patient visits engaged in EIMG by providers. A patient's visit will be considered 'engaged' if they receive an EIMG referral. The proportion is estimated by dividing patient visits with an EIMG referral by all eligible patient visits. Reach will be calculated by provider and aggregated at the clinic level. Adoption will be assessed at the provider level by determining the number, proportion, and representativeness (i.e., sex, age, specialty) of providers that utilize any EIMG component in their practice compared to peers that do not use EIMG. Implementation will be assessed by determining the extent to which all three steps of EIMG (i.e., assessment, prescription, patient referral) are conducted with each eligible patient at the provider level, aggregated at the clinic level.
