Testing The Feasibility Of Referred At-risk Patients Participating At A Hospital-based Healthy-lifestyle Management Program

Abstract

PURPOSE: Facilitating health promotion programs within healthcare is supported by the Institute of Medicine, which is establishing a systematic implementation approach that incorporates eight social and behavioral vital signs including exercise in the electronic health record (EHR). Though limited time during clinic visits is a challenge for implementation. Using an established healthy-lifestyle management program (HLMP) to support this approach could reduce burden on clinical practitioner. The purpose was to test the feasibility of implementing fitness measures in an HLMP. METHODS: Healthy Me is a free HLMP offered to patients in a public, Midwest health system. Patients are enrolled through physician referral via EHR. Eligible patient have a BMI > 25, cardiovascular disease, pre /type II diabetes, and/or depression. Low-risk patients who meet eligibility criteria can enter Healthy Me through an EHR automated bulk referral process. Healthy Me is delivered by health coaches trained in motivational interviewing, group fitness, health promotion, and chronic disease management. Patients performed chair stand, arm curl and two-minute step tests. RESULTS: The sample included 1254 patients (80.1% women), who were 48.9 + 15.46 years of age, with a BMI of 37.4 + 10.46 and reported fair/good (74.9%), poor (16%) or very good/excellent (9.1%) health. Eighty-three patients (6.7%) completed multiple fitness tests and 654 (52.2%) completed one test. Only females completed multiple fitness tests. Chi-square test found those who completed one test had higher perceived health ratings (χ2 = 15.6, p = .048). Bivariate correlations found BMI was associated positively with waist measures (r = .88, p <.001), and negatively with chair the stand score (r = -.21, p = .015), march score (r = -.32, p = .029), general health rating (r = -.53, p <.001), general physical (r = .11, p = .054) and mental (r = .33, p = .043) health. CONCLUSIONS: Results revealed differential characteristics between patients who only visited Healthy Me and those who completed the health/fitness tests. Future directions include using tailored approaches to encourage fitness test completion. Multiple correlations with BMI and health/fitness parameters align with previous work and emphasize the importance of promoting healthy behaviors in HLMPs, such as exercise.