Determining patient eligibility for a physical activity referral scheme through EHR data extraction.

Abstract

Background: Physical Activity Referral Schemes (PARS) are an effective treatment option for promoting physical activity and positively impacting patient care. Retrospective evaluation of PARS implementation requires identifying the eligible patient population that was reached. However, during a clinic visit, health care providers (HCPs) may decide that a physical activity referral is not appropriate for various reasons, such as acute illness or recent surgical history. Including patient visits with these health conditions in assessing a PARS may lead to an overestimation of patients eligible for referral.

Objective: To develop a process that more accurately determines patient eligibility for a physical activity referral when retrospectively extracting patient visit data from the electronic health record (EHR).

Methods: Inclusion criteria were developed to identify patient visits potentially eligible for a physical activity referral based on five chronic conditions. These conditions were highlighted during the standardized training that staff received when implementing the PARS. Development of exclusion criteria incorporated exercise contraindications from published literature, input from practicing HCPs, and refinement by a multidisciplinary healthcare team. Inclusion/exclusion criteria were pooled and mapped to International Classification of Diseases, 10th edition, codes and applied to EHR data.

Results: A total of 334 referrals (numerator) were identified from the pool of eligible patient visits meeting the inclusion criteria. In calculating the denominator for our reach estimate, 479,536 patient visits were initially extracted from the EHR. Applying the inclusion criteria, 58% of these visits were PARS-eligible (n = 277,515). The eligible visits further decreased by 23% (n = 63,203) with the application of the exclusion criteria, leaving a total of 214,312 PARS-eligible visits (denominator), a 55% reduction from the initial number of total patient visits.

Conclusion: Through this multi-step process, we developed a novel approach for retrospectively identifying patient visits eligible for a physical activity referral that can be applied to extracted EHR data for subsequent evaluation. This process can be used by other healthcare systems and researchers in the assessment of PARS. Ongoing refinement of the exclusion criteria is needed to best reflect the eligible population and provide the most accurate estimate of the overall PARS reach.

Clinical trial registration: Not applicable.