Assessing the Feasibility of Physical Activity Systems Change Within an Urban Minority-serving Primary Care Practice

Primary care providers are uniquely positioned to promote physical activity, especially among medically vulnerable populations. However, system and practice-related factors such as lack of experience with physical activity promotion and billing/reimbursement challenges may pose challenges to integrating physical activity into primary care practice. PURPOSE: To critically examine information systems and assess providers physical activity attitudes and care strategies, to determine the feasibility of implementing an evidence-based physical activity promotion clinical workflow in an urban minority-serving medical practice in Atlanta, GA. METHODS: The Informatics for Integrating Biology and the Bedside (i2b2) data platform was used to query patient electronic medical record data from patients in the Morehouse Healthcare (MHC) practice. A combination of ICD-10 diagnostic codes, billing codes, procedure codes, patient encounters, and vital signs were utilized to identify 4 patient groups with physical inactivity associated diseases and conditions (obesity, hypertension, diabetes, CVD). Additional codes were used to query instances of physical activity counseling among these patient groups. Prevalence rates of MHC patients receiving PA counseling were compared to national 2010 NHIS estimates of self-reported PA counseling for each patient group. To assess provider PA attitudes and care practices, a survey was created and administered to MHC primary care providers, residents, and support staff. RESULTS: Data from over 30,000 patients seen between 2005-2020 were included in the i2b2 analysis. The prevalence of PA counseling was substantially lower among MHC patients compared to national estimates for all patient groups selected (e.g. 5.6% vs 41.2% for CVD patients). These results may indicate significant underreporting of PA counseling within physicians notes and billing records. The provider survey is currently being administered; results are forthcoming and be presented in the final presentation. CONCLUSIONS: This feasibility study will provide critical information for identifying strengths, weaknesses, opportunities, and threats to inform the future implementation of pragmatic physical activity-focused system changes within ethnic minority-serving primary care practices.