Presenter Status
Fellow
Abstract Type
QI
Primary Mentor
Megan Jensen
Start Date
12-5-2025 11:30 AM
End Date
12-5-2025 1:30 PM
Presentation Type
Abstract
Description
Background: Physical activity is a known preventative effort that has a clear role in improving cardiorespiratory fitness and health outcomes. Low levels of habitual physical activity (PA) in children and adolescents with congenital heart disease (CHD) leads to various negative health outcomes, yet review of the literature indicates that physicians, caregivers, and patients restrict physical activity owing to safety concerns [1]. Root cause analysis (Fig 1.1) identified a lack of readily available data to provide assessment of baseline PA in patients presenting to the cardiology clinic. Therefore, this project aims to implement physical activity as vital sign (PAVS) via a standardized questionnaire through the Electronic Health Record (EHR), with the goal of having 50% of qualifying patient encounters having documented PAVS logged by June 2025, and 90% by 1 year.
Methods: Various quality improvement tools were utilized to investigate the process surrounding documenting physical activity in cardiology clinic. Key themes were lack of knowledge, standardization, and readily available data on PAVS. Development and implementation of countermeasures were performed using a Driver diagram that lead to the development and formation of a patient performed questionnaire to provide providers with an assessment of the patients physical activity. In the initial PDSA cycle, there was distribution of physical copies of the questionnaire in the outpatient clinic setting to patients over 4 years of age, regardless of their cardiac diagnosis. The initial aim was to assess the feasibility of the questionnaire before incorporating it via the EHR. The questionnaire was then edited and revised based upon the results from the first PDSA cycle. Then, for the second PDSA cycle, this revised questionnaire was distributed via the EHR using the same inclusion criteria.
Results: In the first PDSA cycle, a total of 36 patient/parent filled questionnaires were completed and received. Of the returned questionnaires, 97 % (n=35/36) expressed the questions were easy to interpret, 100% felt that the questionnaire assessed patient’s PA baseline (n=35/35) and 44% (n=16/36) reported that the questionnaire initiated further discussions with their provider. The goal of this first cycle was to evaluate the PAVS questionnaire in its ability to accurately provide a description of a patient's physical activity with easy interpretation to the subject filling out the form. Based upon these results and feedback, the questionnaire was revised and formatted for implementation into the EHR. The second PDSA cycle saw the questionnaire implemented into the EHR with distribution to 1,311 patient encounters, to date.
Conclusion: Implementation of a standardized process to assess PA at cardiology clinic visits will help establish definite PA baseline in patients and encourage appropriate counseling by providers. We have transitioned the questionnaire to the EHR, which has allowed us to distribute to 1,311 patient encounters to date. Utilization of this tool will allow for a comparable baseline, in order to assess for any change in a patient's physical tolerance, as well as encourage physical activity and promote positive outcomes in this vulnerable population. Our hope is that implementation of this questionnaire will also spur more research into assessment of physical activity and methods to implement an exercise prescription, as well.
Utilization of Physical Activity as a Vital Sign (PAVS) to Improve Personalized Exercise Assessment and Counseling in Pediatric Cardiology Patients
Background: Physical activity is a known preventative effort that has a clear role in improving cardiorespiratory fitness and health outcomes. Low levels of habitual physical activity (PA) in children and adolescents with congenital heart disease (CHD) leads to various negative health outcomes, yet review of the literature indicates that physicians, caregivers, and patients restrict physical activity owing to safety concerns [1]. Root cause analysis (Fig 1.1) identified a lack of readily available data to provide assessment of baseline PA in patients presenting to the cardiology clinic. Therefore, this project aims to implement physical activity as vital sign (PAVS) via a standardized questionnaire through the Electronic Health Record (EHR), with the goal of having 50% of qualifying patient encounters having documented PAVS logged by June 2025, and 90% by 1 year.
Methods: Various quality improvement tools were utilized to investigate the process surrounding documenting physical activity in cardiology clinic. Key themes were lack of knowledge, standardization, and readily available data on PAVS. Development and implementation of countermeasures were performed using a Driver diagram that lead to the development and formation of a patient performed questionnaire to provide providers with an assessment of the patients physical activity. In the initial PDSA cycle, there was distribution of physical copies of the questionnaire in the outpatient clinic setting to patients over 4 years of age, regardless of their cardiac diagnosis. The initial aim was to assess the feasibility of the questionnaire before incorporating it via the EHR. The questionnaire was then edited and revised based upon the results from the first PDSA cycle. Then, for the second PDSA cycle, this revised questionnaire was distributed via the EHR using the same inclusion criteria.
Results: In the first PDSA cycle, a total of 36 patient/parent filled questionnaires were completed and received. Of the returned questionnaires, 97 % (n=35/36) expressed the questions were easy to interpret, 100% felt that the questionnaire assessed patient’s PA baseline (n=35/35) and 44% (n=16/36) reported that the questionnaire initiated further discussions with their provider. The goal of this first cycle was to evaluate the PAVS questionnaire in its ability to accurately provide a description of a patient's physical activity with easy interpretation to the subject filling out the form. Based upon these results and feedback, the questionnaire was revised and formatted for implementation into the EHR. The second PDSA cycle saw the questionnaire implemented into the EHR with distribution to 1,311 patient encounters, to date.
Conclusion: Implementation of a standardized process to assess PA at cardiology clinic visits will help establish definite PA baseline in patients and encourage appropriate counseling by providers. We have transitioned the questionnaire to the EHR, which has allowed us to distribute to 1,311 patient encounters to date. Utilization of this tool will allow for a comparable baseline, in order to assess for any change in a patient's physical tolerance, as well as encourage physical activity and promote positive outcomes in this vulnerable population. Our hope is that implementation of this questionnaire will also spur more research into assessment of physical activity and methods to implement an exercise prescription, as well.
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