Prescribing Smart Aging: Integrating Health Systems with Community-Based Lifestyle Interventions

摘要/项目摘要 美国的医疗保健系统没有充分利用体育锻炼的好处 人口老龄化。严重的障碍限制了老年人启动和维持锻炼计划。 此外，几乎没有有效的工具来帮助临床医生将体力活动纳入他们的临床护理。 在这里，我们寻求测试提供锻炼和健康生活方式计划的有效性-Smart 老龄化--对医生和他们的老年患者。Smart Aging代表了多层次的合作伙伴关系 堪萨斯大学医院和大堪萨斯城基督教青年会网络，可广泛扩展 在现实世界中是可实施和可持续的。该计划从患者-医生层面开始，从 临床医生-通过电子处方将感兴趣的老年人转介到智能老龄化计划 嵌入在电子健康记录中。智能老龄化计划随后在社区中实施- 以基督教青年会为基础，扩展到参与者的家中(家庭锻炼、移动健康监测)，最终 将体力活动数据反馈给临床医生(将体力活动作为生命体征)。 该提案使用严格的随机对照试验设计来测试智能老龄化计划 带来有意义的和持续的健康益处。参与者将被随机(1：1比例)立即- START组与仅接受教育的对照组。我们假设智能老龄化计划将使我们的 心肺适能在12周和52周的初步研究结果(目标1)和积极影响 胰岛素抵抗、身体成分和脂质状况的次级代谢测量(目标2)。因为我们的目标是 为了创建一个有用的医生工具，我们还探索了与以下方面相关的重要发育结果(目标3) 该计划的可扩展性和实施情况，包括医生采用率和转诊模式、障碍 通过调查和访谈来使用和感知有用性。我们还将评估患者的体验 包括辍学率以及满意度、生活质量和自我效能感的测量。 我们的最终目标是为临床医生和他们的患者创建一个可扩展且经济高效的计划 通过多层次引导健康生活方式的行为改变，降低患慢性病的风险 干预。堪萨斯城的KU阿尔茨海默氏症中心和基督教青年会在 部署智能老龄化计划的各个方面，从转诊流程到移动健康监控，以及 现在寻求为临床医生和他们的患者测试其全面的包装。如果证明是有效的， 该计划将在全国范围内部署，将卫生系统与社区健身结合起来 资源。

Abstract/Project Summary The health care system is insufficiently capitalizing on the benefits of physical exercise in America's aging population. Significant barriers limit older adults from initiating and maintaining exercise programs. Additionally, few effective tools exist to help clinicians incorporate physical activity into their clinical care. Here, we seek to test the effectiveness of delivering an exercise and healthy lifestyle program – Smart Aging – to physicians and their older adult patients. Smart Aging represents a multi-level partnership between the University of Kansas Hospital and the Greater Kansas City YMCA network that is scalable, broadly implementable, and sustainable in the real world. The program begins at the patient-physician level with clinician-referral of interested older adults into the Smart Aging program via an electronic prescription embedded in the electronic health record. The Smart Aging program is then conducted in the community- based YMCA, extends into the participant's home (home exercise, mobile-health monitoring) and ultimately feeds physical activity data back to the clinician (“physical activity as a vital sign”). This proposal uses a rigorous randomized controlled trial design to test if the Smart Aging program induces meaningful and sustained health benefits. Participants will be randomized (1:1 ratio) to an immediate- start vs an education-only control group. We hypothesize that the Smart Aging program will benefit our primary study outcome of cardiorespiratory fitness at both 12 and 52 weeks (aim 1) and positively affect secondary metabolic measures of insulin resistance, body composition, and lipid status (aim 2). As our goal is to create a useful physician tool, we also explore important developmental outcomes (aim 3) relevant to the scalability and implementation of the program including physician adoption rates and referral patterns, barriers to use, and perceived usefulness through surveys and interviews. We will also assess the patient experience including drop-out rates and measures of satisfaction, quality-of-life, and self-efficacy. Our ultimate goal is to create a scalable and cost-effective program for clinicians and their patients to reduce the risk of chronic disease by inducing healthy lifestyle behavior changes through this multi-level intervention. The KU Alzheimer's Disease Center and YMCA of Greater Kansas City have experience in deploying various aspects of the Smart Aging program, from the referral process to m-Health monitoring, and now seek to test its comprehensive packaging for clinicians and their patients. If shown to be effective, the program will be deployable nationally to bring together health systems with community-based fitness resources.