Implementation Facilitation of Exercise is Medicine Greenville

Clinic-level differences in implementation of EIMG and reach of patients receiving EIMG referrals pre- and post-implementation facilitation

Reach (primary study outcome measure) will be assessed by estimating the number and proportion of eligible patient visits engaged in EIMG by providers. A patient's visit will be considered 'engaged' if they receive an EIMG referral. The proportion is estimated by dividing patient visits with an EIMG referral by all eligible patient visits. Reach will be calculated by provider and aggregated at the clinic level. Adoption will be assessed at the provider level by determining the number, proportion, and representativeness (i.e., sex, age, specialty) of providers that utilize any EIMG component in their practice compared to peers that do not use EIMG. Implementation will be assessed by determining the extent to which all three steps of EIMG (i.e., assessment, prescription, patient referral) are conducted with each eligible patient at the provider level, aggregated at the clinic level.

Effectiveness of participating in the community-based, 12-week evidence-informed PA program on patient PA levels and health outcomes

Effectiveness is the degree to which participating in the evidence-informed PA programs improves patient PA levels and health outcomes (i.e., changes in cardiometabolic biometric values). Patient PA levels will be evaluated using the PAVS and objective measurement (accelerometry) before starting the PA program, after completion of the PA program, and 12 weeks post-PA program. Patient health outcomes (i.e., body weight, blood pressure, hemoglobin A1c, lipid profiles) will be extracted from the Prisma Health electronic health record (EHR) at time of referral, after completion of the PA program, and at least 12 months after the PA program.

Cost of implementation facilitation and to estimate the effectiveness of increased EIMG referrals to the community-based PA on patient costs

Each ambulatory visit with an EIMG eligible diagnosis will serve as the standard unit of observation. Episodes of care will be defined after each visit through the end of follow-up and cost information will be summarized across each episode of care. For each episode of care we will extract from the EHR all healthcare utilization that occurred during the episode by type and quantity. Utilization types during the episode will be designated by Healthcare Common Procedure Coding System (HCPCS), Diagnosis Related Group (DRG), and National Drug (NDC) codes. In addition, we will use the REDCap-based data file to measure implementation costs and capture activity during the 12-week PA program. To obtain standardized costs across episodes, we will apply Prisma standard resource unit prices to all healthcare utilization. For each visit episode we will calculate Episode Healthcare Costs as the price-weighted sum of all healthcare resources used by patient "i" during the episode of care.