TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video
-
Upload
trever-j-ball -
Category
Documents
-
view
78 -
download
0
Transcript of TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video
![Page 1: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/1.jpg)
1
Methods for Evaluating Effectiveness of Promoting Physical Activity in Healthcare
Trever J. Ball, PhD, MPH Senior Outcomes AnalystHealth Promotion & Wellness Institute for Healthcare Delivery Research Intermountain [email protected]
World Congress on Exercise is MedicineMay 31, 2016Boston, MA
![Page 2: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/2.jpg)
2
Background
Intermountain Healthcare• Not-for-profit health system• Based in Salt Lake City, UT• 22 hospitals• 185 clinics
![Page 3: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/3.jpg)
3
![Page 4: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/4.jpg)
4
QI: Role in Driving Evidence Base
Outcomes Research
Program Evaluation
Clinical Effectiveness
Implementation Science
Quasi-Experimental
Intervention Studies
Quality Improvement
Courtesy of L. SavitzInstitute of Medicine (IOM). “Health System Leaders Working Toward High-Value Care through Integration of Care and Research,” The National Academies, Workshop in Brief, June, 2014.
Driving the science of change/innovation…
![Page 5: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/5.jpg)
5
Role of Research at Intermountain
Priorities:
1. High operational utility2. Of interest to clinical investigators3. Of interest to close partners4. Of interest to external investigators/entities
![Page 6: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/6.jpg)
6
Quality Improvement Foundational Leaders
Homer Warner, MD, PhD– Medical informatics founder– 1950s – computer assisted CV
decision support– 1970s – HELP system
developed
Dr. Brent James, MD, MStat– CQI - Standardization of clinical
care through data analysis
![Page 7: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/7.jpg)
7
Institute for Healthcare Delivery Research
Clinical Programs
Data Analysts
Delivery System Science
Data Analysts
Health Promotion & WellnessCommunity Health
ImprovementOutcomes Analyst
![Page 8: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/8.jpg)
8
VP Community Benefit
Community Health
Improvement
Health Promotion &
Wellness
Behavioral Health Reporting
Outcomes Analyst
![Page 9: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/9.jpg)
9
Health Promotion & Wellness
Insurance Members
Patients & Providers
Intermountain Employees Community Comm. Business
Development
![Page 10: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/10.jpg)
10
Physical Activity “Vital Sign” (PAVS)
1. Ball TJ, Joy EA, Gren LH, Shaw JM. Concurrent Validity of a Self-Reported Physical Activity "Vital Sign" Questionnaire With Adult Primary Care Patients. Prev Chronic Dis. 2016;13:E16.
2. Ball TJ, Joy EA, Gren LH, Cunningham R, Shaw JM. Predictive Validity of an Adult Physical Activity "Vital Sign" Recorded in Electronic Health Records. J Phys Act Health. 2015.
3. Ball T, Joy E, Goh T, Hannon J, Gren L, Shaw J. Validity of two brief primary care physical activity questionnaires with accelerometry in clinic staff. Prim Health Care Res Dev. 2014;28:1-9.
4. Greenwood JLJ, Joy EA, Stanford JB. The Physical Activity Vital Sign: A Primary Care Tool to Guide Counseling for Obesity. Journal of Physical Activity & Health. 2010;7(5):571-576.
![Page 11: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/11.jpg)
11
Physical Activity “Vital Sign”
![Page 12: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/12.jpg)
12
![Page 13: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/13.jpg)
13
![Page 14: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/14.jpg)
14
Reasons to Evaluate
• Ensure efforts produce desired results
• Justifies need• Monitor goals• Facilitates accountability
![Page 15: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/15.jpg)
15
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 16: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/16.jpg)
16
Team Structure
Guidance Team
Project Team
Front Line Workers
Process
Health Promotion & WellnessPatient & Provider Development Team
Lead: Trever Ball, PhD, MPH
Clinic Receptionists MAs Physicians
Scott Hansen, MD Locke Ettinger, PT, PhD Tamara Sheffield, MD Roger Peterson, PT
Laurel Newman, RN Liz Joy MD, MPH Clinic Manager
Direction, control
Participation, ownership
Reports monthly
Fundamental knowledge
![Page 17: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/17.jpg)
17
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 18: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/18.jpg)
18
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 19: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/19.jpg)
19
Engage Stakeholders
Describe projects
Focus evaluation
plans
Gather credible evidence
Justify conclusions
Ensure use and
disseminate
RE-AIM Framework: www.re-aim.org CDC Evaluation Framework. http://www.cdc.gov/eval/framework/index.htm
StandardsUtility
FeasibilityProprietyAccuracy
RE-AIM
![Page 20: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/20.jpg)
20
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 21: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/21.jpg)
21
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 22: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/22.jpg)
22
Mission
Increase proportion of primary care visits for which physical activity levels of patients are asked
advised
![Page 23: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/23.jpg)
23
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 24: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/24.jpg)
24
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 25: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/25.jpg)
25
Logic Modeling (“Outcomes Roadmap”)
![Page 26: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/26.jpg)
26
Purposes of Logic Models
• Graphic depiction of relationship between activities and intended outcomes.
• Helps focus evaluation on most central and important questions.
CDC Evaluation Framework. http://www.cdc.gov/eval/framework/index.htm
![Page 27: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/27.jpg)
27
Activities Outcomes
Early Later
![Page 28: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/28.jpg)
28
Activities Outcomes
Early Later
Contact with Clinical Program Leads
Identify Champions Identify areas that health promotion fits into their workflow
Engage Intermountain Clinicians with tools Engage Clinician in their own health:
Nursing Study (Liz) LiVe Well for Employees (see Employee) Design engagement opportunities for physicians, nurses and other clinicians to improve their personal wellness habits.
Execute care processes for healthy behaviors
PAVS DPP Hypertension CHF – With CV Clinical Program Weigh to Health Falls – Stepping On (this may be in CB community) Potential Partners that are being considered
DATU Omada Takada
Determine a Behavior Change Framework Carry out research and development on “best practices” for achieving healthy lifestyles. Study and expand application of integrative wellness services.
Identify CP LiVe Well champion(s) Identify Health Pathway(s) to include tools from the Lifestyle CPM Build healthy lifestyles into High Blood Pressure CPM Nursing intern student study results (Liz) Health pathways include assessment and management of prevention and wellness Meet with each CP to prioritize efforts aimed at prevention and wellness Clinical wellness champions identified and trained on LWM CPM in relevant CPs Dissemination & implementation of DPP to relevant CPs Priorities identified within each CP for implementation in 2015-2016 # of CPs with identified and trained clinical champion # of CP that have implemented
Orient and engage the champion to LiVe Well programs and tools Education event, or online resource for clinicians Measure patient participation in exercise a d wt loss. BMI CPM include assessment and management of prevention and wellness strategies Number of patients not converting to Diabetes Number of patients not progressing to CHF Number of patients increasing or maintaining PA. Number of patients with controlled BP Obesity Rates in adults and children PA rates in Children and adults Other population health measures
![Page 29: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/29.jpg)
29
Activities Outputs Outcomes
Early Later
Early Later
Contact with Clinical Program Leads
Identify Champions
Identify areas that health promotion fits into their workflow Engage Intermountain Clinicians with tools
Identify clinical wellness champions and train on LWM CPM in relevant CPs Meet with each CP to prioritize efforts aimed at prevention and wellness
Identify Health Pathway(s) to include tools from the Lifestyle CPM Build healthy lifestyles into High Blood Pressure CPM Dissemination & implementation of DPP to relevant CPs Identify priorities within each CP for implementation in 2015-2016 Orient and engage the champion to LiVe Well programs and tools
Education event, or online resource for clinicians
Execute care processes for healthy behaviors
PAVS
DPP
Hypertension
CPM include assessment and management of prevention and wellness strategies Patient participation in exercise and wt loss # of CPs with identified and trained clinical champion # of CP that have implemented operational workflow to refer patients into DPP # of new CPMs with measureable and evidence based wellness and prevention strategies
Culture of Wellness Health pathways include assessment and management of prevention and wellness # of patients adhering to recommendation for CHF lifestyle Clinical Values Lifestyle measures Rate of physicians recording and counseling on PAVS Rate of physicians counseling on BP compliance that includes lifestyle
BMI Patient rate not converting to Diabetes Patient rate not progressing to CHF Patient rate increasing or maintaining PA. Patients rate with controlled BP Obesity rates in adults and children PA rates in adults and children Other population health measures Lifestyle measures
![Page 30: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/30.jpg)
30
ReachAdoptionImplementationMaintenance Effectiveness
Glasgow, Vogt et al. 1999; Gaglio, Shoup et al. 2013; Yeh, Chang et al. 2014; Thomas, Krevers et al. 2015
RE-AIMFramework
![Page 31: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/31.jpg)
31
Example Central Evaluation Question:
Do efforts to adopt and implement care
processes related to the Physical Activity Vital Sign improve patient
physical activity?
![Page 32: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/32.jpg)
32
Example Central Evaluation Question:
Do efforts to adopt and implement care
processes related to the Physical Activity Vital Sign improve patient
physical activity?
![Page 33: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/33.jpg)
33
![Page 34: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/34.jpg)
34
Detailed health promotion
strategies for patients and
providers
![Page 35: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/35.jpg)
35
Physical Activity “Value Chain”
Activities Outcomes
Adapted from: Program Measurement & Evaluation Guide: Core Metrics for Employee Health Management, 2015. HERO & PHA
![Page 36: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/36.jpg)
36
Physical Activity “Value Chain”
Activities Outcomes
Ask AssessAdvise
AssistArrange
PA Behavior
Clinical Outcomes
Financial Outcomes
Adapted from: Program Measurement & Evaluation Guide: Core Metrics for Employee Health Management, 2015. HERO & PHA
![Page 37: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/37.jpg)
37
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 38: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/38.jpg)
38
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 39: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/39.jpg)
39
Aim
Increase the proportion of patient visits at the (choose clinic) that have mins/week of physical activity recorded from __% to __% by (date).
![Page 40: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/40.jpg)
40
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 41: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/41.jpg)
41
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 42: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/42.jpg)
42
Quality Improvement Tools
• RE-AIM framework• Cause & effect diagrams• Driver diagrams• Pareto charts• Flow charts/logic modeling• Run charts• SPC charts
![Page 43: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/43.jpg)
43
Why is physical activity not asked and recorded?
Staff Factors
Health ITOperations
Patient Factors
Healthy staff
Care Manager
MAs
Clinicians
Research Findings
Age disparity
BMI disparity
Data Architecture
Decision Support
New EHR integration
Activating team
Educating teams benefits of PA
![Page 44: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/44.jpg)
44
Odds of Treatment for Physical Activity by Patient Demographic
Female Male
18-29
30-39
40-49
50-64 >6
4<1
8.5
18.5-
24.9
25.0-
29.9
30.0-
34.9
35.0-
39.9
≥40.0
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
Standard PAVS Only PA Advice Only PAVS + PA Advice
n=257,869
![Page 45: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/45.jpg)
45
Odds of Treatment for Physical Activity by Patient Demographic
Female Male
18-29
30-39
40-49
50-64 >6
4<1
8.5
18.5-
24.9
25.0-
29.9
30.0-
34.9
35.0-
39.9
≥40.0
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
Standard PAVS Only PA Advice Only PAVS + PA Advice
n=257,869
![Page 46: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/46.jpg)
46
Odds of Treatment for Physical Activity by Patient Demographic
Female Male
18-29
30-39
40-49
50-64 >6
4<1
8.5
18.5-
24.9
25.0-
29.9
30.0-
34.9
35.0-
39.9
≥40.0
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
1.33
3.30
5.23
7.24
1.84 1.831.32
2.58
Standard PAVS Only PA Advice Only PAVS + PA Advice
n=257,869
![Page 47: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/47.jpg)
47
Why is physical activity not asked and recorded?
Staff Factors
Health ITOperations
Patient Factors
Self-complete formsHealthy staff
Care Manager
MAs
Clinicians
Research Findings
Age disparity
BMI disparity
Tools
Clinic support for process
Assessment & operations of clinic education needs
Support for feedback/reporting
Data Architecture
Decision Support
New EHR integration
Explanation of terms
Activating team
Educating teams benefits of PA
![Page 48: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/48.jpg)
48
Quality Improvement Tools
• RE-AIM framework• Cause & effect diagrams• Driver diagrams• Pareto charts• Flow charts/logic modeling• Run charts• SPC charts
![Page 49: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/49.jpg)
49
Quality Improvement Tools
• RE-AIM framework• Cause & effect diagrams• Driver diagrams• Pareto charts• Flow charts/logic modeling• Run charts• SPC charts
![Page 50: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/50.jpg)
50
Aim Key Drivers Strategies
Increase proportion of patient adult visits at the _____ clinic that have PA recorded from __ % to __ % by [date]
Clinical Champion
Clinical excellence goal part of value recognition program
Health IT
Academic detailing our LWM CPM; presentations
Maintain work with PCCP
Work with new EHR team to ensure PAVS is there and easy to complete
![Page 51: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/51.jpg)
51
Framework Aim Key Drivers Strategies
Ask
Increase the proportion of patient visits at the _____ (clinic/region) that have physical activity recorded (minutes/week) from __% to __% by (date).
Clinical championAcademic detailing our LWM CPMs to cliniciansPresentations
Clinical excellence goal Maintain work with PCCPWork with IMG
Health ITWork with iCentra team to ensure PAVS is there, is easy to complete, and is visible to clinicians
Assess & Advise
Increase the proportion of patient visits at the ______ (clinic/region) that have physical activity advice recorded from __% to __% by (date).
iCentraWork with iCentra development team to make sure product is placed well for iCentra workflow for clinician
Clinical excellence goal Maintain work with PCCP Work with IMG
iCentra +Manipulate patient activity graph to serve as a prompt for clinician, including if patient meets or does not meet PA guidelines
Assist & Arrange
Increase the proportion of SH MA members that access the fitness benefit from __% to __% by (date).
Referral networkSee Greenville, SC model (EIM slides)Member educationDevelop referral network
Increase the reimbursement/member for the fitness benefit (mean & median) from $__ to $__ by (date).
Payer factors for referral network
Member education
Develop referral network
![Page 52: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/52.jpg)
52
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 53: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/53.jpg)
53
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 54: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/54.jpg)
54
DATA ANALYTICS 101
![Page 55: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/55.jpg)
55
![Page 56: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/56.jpg)
56
Intermountain Healthcare EDW
![Page 57: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/57.jpg)
57
Query & Track Outcomes
TrackAnalyze
Disseminate
Interpret
Graphical presentation
Stratifications
VisualizeWrite & QA
query
QueryAgree on
evaluation question
Identify data elements
Consult
![Page 58: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/58.jpg)
58
Query & Track OutcomesPatient_id
Patient_sex
Appt_st_dt
Ob_NCID
Encounter_num
001002003004005
Facility_ncid
Encounter_facility_id
Encounter_num
Primary_provider
Unit_num
Unit_num
Encounter_facility_id
Encounter_num
Primary_provider
Unit_num
![Page 59: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/59.jpg)
59
Query & Track Outcomes
Patient_id
APPOINTMENT_START_DTTM
APPOINTMENT_STATUS_NCID
APPOINTMENT_STOP_DTTM
APPOINTMENT_TYPE_NCID
ENCOUNTER_FACILITY_NCID
ENCOUNTER_NUMBER
LAST_UPDATE_DT
MED_RECORD_FACILITY_NCID
MEDICAL_RECORD_NUMBER NOTE
PATIENT_BIRTHDATE
PATIENT_HOME_PHONE
PATIENT_NAME
PATIENT_SEX
PATIENT_WORK_PHONE
PROVIDER_NAME
PROVIDER_NCID
REASON
REFERRING_PROVIDER_NAME
REFERRING_PROVIDER_NCID
RESPONSIBLE_PARTY
SCHEDULED_DTTM
SCHEDULED_FACILITY_NCID
SCHEDULED_LOCATION_NCID
SCHEDULER_NCID
UNIT_NUMBER
00001
00002
00003
00004
00005
00006
00007
00008
00009
00010
![Page 60: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/60.jpg)
60
Query & Track Outcomes
• 25,422 tables• 2,197,993,362 Queries/month• 157,797,141,557 Rows• 467,789 Columns
Courtesy of Dallin Rogers, Intermountain EDW Team
![Page 61: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/61.jpg)
![Page 62: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/62.jpg)
62
Query & Track Outcomes
![Page 63: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/63.jpg)
![Page 64: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/64.jpg)
64
Physical Activity “Value Chain”
Activities Outcomes
Ask AssessAdvise
AssistArrange
PA Behavior
Clinical Outcomes
Financial Outcomes
Adapted from: Program Measurement & Evaluation Guide: Core Metrics for Employee Health Management, 2015. HERO & PHA
![Page 65: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/65.jpg)
65
Example Central Evaluation Question:
Do efforts to adopt and implement care
processes related to the Physical Activity Vital Sign improve patient
physical activity?
![Page 66: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/66.jpg)
66
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 67: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/67.jpg)
67
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 68: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/68.jpg)
68
QI: Role in Driving Evidence Base
Outcomes Research
Program Evaluation
Clinical Effectiveness
Implementation Science
Quasi-Experimental
Intervention Studies
Quality Improvement
Courtesy of L. SavitzInstitute of Medicine (IOM). “Health System Leaders Working Toward High-Value Care through Integration of Care and Research,” The National Academies, Workshop in Brief, June, 2014.
Driving the science of change/innovation…
![Page 69: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/69.jpg)
69
QI: Role in Driving Evidence Base
Outcomes Research
Program Evaluation
Clinical Effectiveness
Implementation Science
Quasi-Experimental
Intervention Studies
Quality Improvement
Courtesy of L. SavitzInstitute of Medicine (IOM). “Health System Leaders Working Toward High-Value Care through Integration of Care and Research,” The National Academies, Workshop in Brief, June, 2014.
Driving the science of change/innovation…
![Page 70: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/70.jpg)
70
QI: Role in Driving Evidence Base
Outcomes Research
Program Evaluation
Clinical Effectiveness
Implementation Science
Quasi-Experimental
Intervention Studies
Quality Improvement
Courtesy of L. SavitzInstitute of Medicine (IOM). “Health System Leaders Working Toward High-Value Care through Integration of Care and Research,” The National Academies, Workshop in Brief, June, 2014.
Driving the science of change/innovation…
![Page 71: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/71.jpg)
71
Designs & Methods
• Knowing what works requires that we design a study and use those methods that allow us to answer key questions.
• Design Approaches:– Intervention– Quasi-experimental– Observational– Time Series
• Methods:– Quantitative– Qualitative– Mixed
Courtesy of L. Savitz
![Page 72: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/72.jpg)
72
Design: observational
Are there differences in level of treatment for physical inactivity by patient demographics?
• Logistic regression
𝑦 (𝑃𝐴𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡 𝑙𝑒𝑣𝑒𝑙 )=𝛽0+𝛾 𝐹 ( h𝑑𝑒𝑚𝑜𝑔𝑟𝑎𝑝 𝑖𝑐𝑠 )+… 𝛽𝑘 ( covariates )+ μ
![Page 73: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/73.jpg)
73
Design: observational
How much impact on patients do levels of treatment for physical inactivity have?
• Mixed effects regression
𝑦 (𝑃𝐴 ; h h𝑒𝑎𝑙𝑡 𝑜𝑢𝑡𝑐𝑜𝑚𝑒𝑠 )=𝛽0𝑖+𝛾 𝐹 (𝑃𝐴𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡 )+𝛽𝑖𝑗 (𝑟𝑎𝑛𝑑𝑜𝑚)… 𝛽𝑖𝑗 ( 𝑓𝑖𝑥𝑒𝑑)+𝜇𝑖𝑗
![Page 74: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/74.jpg)
74
Method: mixed
What are behavioral and other differences in providers using and not using the PAVS?
• Descriptive statistics• Survey constructs of Theory of Planned Behavior
Adapted from: https://commons.wikimedia.org/w/index.php?curid=42261999
Attitude
Subjective Norm
Perceived Behavioral Control
Intention Behavior
![Page 75: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/75.jpg)
75
Design: quasi-experimental
Nonrandomized observational comparisons
Example:Does a program designed to increase ascertaining and recording patients’ self-reported physical activity as part of the initial visit intake improve glycemic control among patients with diabetes?
Grant RW. (2014). J Gen Intern Med, 2014;29(2):341-348
![Page 76: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/76.jpg)
76
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4EVS Clinic HbA1c Change Non-EVS Clinic HbA1c Change
Per
cent
Cha
nge
Changes in HbA1c Over Time Among Patients with Diabetes Attending EVS Versus Non-EVS
Medical Centers
Adapted from: Grant RW. (2014). J Gen Intern Med, 2014;29(2):341-348 EVS: Exercise Vital Sign
Al patients w/diabetes (n=70,083)
Patients w/HbA1c>7 (n=30,487)
Patients w/HbA1c>8 (n=13,440)
![Page 77: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/77.jpg)
77
Series1
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4EVS Clinic HbA1c Change Non-EVS Clinic HbA1c Change
Per
cent
Cha
nge
Changes in HbA1c Over Time Among Patients with Diabetes Attending EVS Versus Non-EVS
Medical Centers
Adapted from: Grant RW. (2014). J Gen Intern Med, 2014;29(2):341-348 EVS: Exercise Vital Sign
Al patients w/diabetes (n=70,083)
Patients w/HbA1c>7 (n=30,487)
Patients w/HbA1c>8 (n=13,440)
![Page 78: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/78.jpg)
78
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation
framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 79: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/79.jpg)
79
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation
framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
![Page 80: TBall ACSM Lecture 2016 - Healthcare PA Evaluation Methods_linked video](https://reader036.fdocuments.us/reader036/viewer/2022081521/58ef5a341a28ab106c8b4607/html5/thumbnails/80.jpg)
80
Steps for PA Evaluation & Quality Improvement
1. Organize Team2. Identify evaluation
framework/s3. Mission Statement4. Conceptual models5. Aim Statement6. QI modeling7. Query & track outcomes8. Design research
Thank youQuestions?