Exercise as a Vital Sign in Specialties - EVS Part 2

When we started our Exercise as a Vital Sign program in KP Southern California back in 2009, our efforts were focused on patient's presenting to Primary Care departments.  We had a soft roll out of the initiative initially, encouraging departments to begin asking the question as they felt ready and comfortable.  By 2010, we had added it to our standard workflow for Primary Care to be done in every visit.  We haven't had any alerts telling our staff when to ask about exercise because it was an expectation that it would be done every time.  


In October of 2010, we added a prompt in to remind our staff to ask about exercise if it wasn't asked in the past 6 months, not in primary care as some would expect, but in Oncology, as part of our new Oncology Proactive Encounter Checklist.  We had a lot of people question why would want to encourage someone who was undergoing cancer treatment to exercise.  Heck... I even had to ask when Dr. Joanne Schottinger, KP Oncologist and Internist, said it needed to be added.  She explained that exercise, even if a gentle walk, can help fight off fatigue, depression, and many other symptoms that so many of these patient's experience.  Though I believed her, the proof was in the pudding when one of my dear friends who is 72 and undergoing breast cancer treatment (which WE (KP Baldwin Park) caught in the early stages) told me that when she is having a really tough day, she puts on her sneakers and a smile and goes for a walk.  

Need more proof...  

Walking Could Lower Fatigue In Cancer Patients, Study Shows

New research shows that an activity as simple as walking could help to lessen this fatigue. The study, published in the Journal of the American College of Surgeons included 102 people who had just had surgery done for their pancreatic or periampullary cancers. Eighty-five percent of them reported having fatigue at a moderate to severe level. 

Upon discharge from the hospital, half of the study participants were not instructed to do any sort of exercise upon going home. The other half of the study participants were told to do 20-minute walking exercises for their first month after discharge, leaving a five-minute warm-up and cool-down period. Throughout the three-month study, the study participants in the walking group were instructed to try to walk 90 to 150 extra minutes per week. 

At the end of the three-month study, the people in the walking group showed a decrease in fatigue levels of 27 percent, as well as a decrease in pain. Meanwhile, the people in the other group had improvements of 19 percent.

If it works for Oncology patient's, how about encouraging OB patient's to walk a little every day?  Why not!  In March of 2011, KP SCAL rolled out a new OB Proactive Care checklist where we prompt staff to ask about depression screening, stage important labs that are due, and yes, we even added a prompt to ask about exercise. 


On March 21st, 2012, we took this initiative one step farther and changed the frequency for how often we ask about exercise and added a new care gap to our other specialty checklists as well.  So now, every patient, no matter where they present within our system will be asked about exercise as part of their vital signs at least every four months.  


So let's recap what this looks like for our Kaiser Permanente members across our Southern California Region...


In Pediatrics, we ask about Nutrition, Exercise, and Screen Time on an annual basis


In Primary Care, OB, Oncology, and ALL other specialty departments, we ask about exercise as part of our EVS initiative every four months, unless that patient is in one of our chronic condition registries like asthma, hypertension, ckd, diabetes, cvd, etc, those patient's will have a prompt on their Proactive Care Checklist to update their exercise vitals if it hasn't been updated within the last 30 days.


As our CEO, George Halvorson, said so encouragingly "If you can, where you can, walk..."