In my last blog, we considered a lesson from my college calculus professor, that paths are more interesting than function graphs. Today, we’ll explore why it helps to see a patient’s health ecology as a life path rather than as a risk profile (a function graph), and how group visits can help that process.
From time-to-time, our blogs will discuss life’s paths, whether the discussion is about managing a health care practice or mentoring a patient. In today’s era of ‘big data’ it is common to graph associations and relationships that form health status, but under-appreciate the role of external forces and events that created the path to a particular health status.
Today, lets examine why it’s so important to incorporate the physical activity vital sign (PAVS), sometimes called exercise vital sign (EVS), in the patient’s medical record.
For those who are not familiar with the PAVS, it’s a product of the number of days per week that the patient does moderate-to-vigorous intensity physical activity (or exercise) times the average number of minutes spent doing it each day. Moderate-to-vigorous intensity physical activity is abbreviated as MVPA, so the formula is:
PAVS = (MVPA minutes/day) x (# of days/week)
Last week, the American College of Sports Medicine held it's annual meeting in Orlando, and it was a whiriwind of activity (as always). For at least 20 years, now, it's been far too large to take in by oneself. I first went to ACSM as a beginning post-doctoral fellow in cardiovascular physiology, when my mentor Dr. Jere Mitchell generously covered my expenses to go to the meeting in Las Vegas in 1987. My, how things have changed!
This slide show explains how to use the SHQ in your practice. It covers the basic operations, showing how to operationalize the SHQ in Annual Wellness Visits. The use in care management visits is similar process, the main difference being how the patient is recruited to complete the SHQ.
This short slide presentation explains how you can use the SHQ in your practice.
Workforce health programs have been part of the corporate landscape for decades. While initial efforts were largely focused on executive leadership with specific health risks, these programs have since evolved to include entire workforce populations. Increasingly these programs include initiatives to incentivize “healthy behaviors” with varying levels of health care benefits.
This graphic does a very good job outlining the relationship between behavior and the clinical risks and endpoints that are so prevalent in our disease care system. While I applaud the display of this connection in one of our leading clinical journals, partly out of my hope that frontline care providers are better informed about the significance of primary prevention efforts as an avenue to prevent or delay the onset of chronic conditions, the image shows only the "tip of the iceberg".
Two days ago, the Institute of Medicine (IOM) published the first of two reports on the role of social and behavioral factors as determinants of health, and advocated for the inclusion of social and behavioral items in the electronic medical record (EMR). The report is available for free, and you can get it here:
http://www.iom.edu/Reports/2014/Capturing-Social-and-Behavioral-Domains-...
Being a physician-physiologist and lifelong sports and recreation enthusiast, it's not surprising that I'm an advocate of exercise as the most important medicine. But if we're going to think of exercise as a medicine, then we must scrutinize the therapeutic uses of exercise - know what health conditions it's good for and know how it can bring harm. This subject is the topic of the 4th edition of a textbook I've recently finished editing for the American College of Sports Medicine (ACSM).
