Implementing a Clinical Decision Support Tool to Improve Physical Activity.
Margaret M McCarthy, Adam Szerencsy, Leslie Taza-Rocano and 5 others
PMID 38207172WHAT IT FOUND
Patient physical activity questions were completed 35%-48% of the time, and provider alerts were opened and signed 2%-65% monthly.
This implementation report did not test whether physical activity improved.
Key findings
01In the clinic pilot, patients completed the physical activity questions 35%-48% of the time, and the EHR alert fired 79 to 125 times a month.
02Providers opened and signed the alert between 2% and 65% monthly and acknowledged it between 2% and 22% monthly.
03Of 59 patients enrolled in 12 weeks of remote monitoring, four were lost to follow-up, and 58% could connect their Fitbit to the record with written instructions or minor assistance.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in one academic preventive cardiology clinic, so it may not apply to nonacademic primary care clinics or clinics with different provider types. The patients enrolled in remote monitoring were likely more interested in improving physical activity, and the sample was limited in number and diversity and followed for only 12 weeks. The implementation evaluation did not measure how often providers viewed step-count data or commented on patient progress. Monthly implementation data were not available in real time, so low completion rates could not be addressed quickly. This paper reports implementation only; it does not report the patient physical activity or cardiovascular risk outcomes. Provider response to the alert varied widely, and patient portal completion was only 35%-48% of the time, so the workflow may need more support to be reliable.
Declared interests
The authors declare no conflicts of interest. The article is listed as NIH extramural research support.
The easy way to misread this
Do not read the alert uptake and positive interviews as evidence that the tool improved physical activity or cardiovascular risk. This paper reports implementation only; the patient outcome efficacy was published elsewhere.