exercise as medicine project

Resources for participating practices

 

Welcome

Thank you for being part of this program designed to implement evidence-based exercise interventions as part of comprehensive chronic disease management.

This page will be kept updated throughout the program to provide helpful information for participating practices.

If you have any questions or suggestions, please contact your NCPHN Quality Improvement Support Officer who will be able to assist.

Resources

Tips and details that needed clarification after the orientation workshop sessions:

How-to videos

Add a new owner

Play Video

Demographics

Play Video

Send a survey

Play Video

Create a first appointment

Play Video

SPPB Tips

Tips and details that needed clarification after the orientation workshop sessions:

  • The SPPB should always be done in this sequence: Balance, Walk, Sit-to-Stand.
  • Stick to the instruction script.
  • If you muck up the timing of the walk test or balance test, just do it again.
  • If you muck up the timing of sit-to-stand test you can’t repeat it in the same session. This is because the sit-to-stand test can cause some fatigue.
  • Start timing the gait speed test when the patient starts to move, not when you say go.
  • Start the sit-to-stand timing when you give the instruction to start.
  • Finish the 5 X sit-to-stand test when they get to standing position the fifth time.
  • You can use a 3m or 4m walk test, as long as you use the right set of scoring times for the distance.
  • Don’t walk in front of the person doing the walk test as this may set their pace. Walk behind them, to the side.

SPPB Tools

Demo of an app that includes the instructions, timer and score calculator: (you will still need to enter it into CarePro) 

Demonstration video of SPPB (8 minutes):

Detailed demonstration and clarification on tips and reasons for implementation instructions from the people that developed the SPPB (27 min):

Exercise as Medicine FAQs

Contract Related

You are required to maintain a minimum of 25 patients over the six month reporting period. If you are concerned with your progress, please contact your Quality Improvement Support Officer to set up a review meeting to ensure your funding stays on track.

NCPHN will provide tablets, mobile enablement when needed and training to practices free of charge to support data entry. Ensuring your data is up to date is important as on the first trading day of the month NCPHN receives a de-identified report to monitor the overall progress of the project.

Please talk to your Quality Improvement Support Officer if you are behind in your data entry.

All NCPHN contractors require Professional Indemnity and Public Liability Insurance. Additionally, all NSW employers, by law, require Workers Compensation Insurance.

If selected, you will need to demonstrate that your practice has $10 million Indemnity Insurance and $20 million public liability insurance. This is easy to do by contacting your insurance company and requesting a certificate of currency.

For more information about our insurance requirements visit https://hnc.org.au/professional-indemnity-and-public-liability-insurance

Payments

Only patients who have demonstrated a minimum improvement in the SPPB score of 2 at two time points, six or more months apart, will be eligible for the outcome payment.

Patient improvement is the key to this program. It is the volume of patients that will really drive the incentives. Each payment period requires measurements that demonstrate a minimum improvement in the SPPB score of 2 at two time points, six or more months apart.

A patient that improves by at least two points in a six month period would trigger a payment. A new baseline will be set with each payment. If the same patient improves by a further 2 points in the following 6 months, the practice will be eligible for another payment.

There is no penalty, but you won’t meet the criteria for outcomes payments. Some patient scores may fall for a range of reasons. Practices will be encouraged to measure regularly, so patients can see changes, though payment will be based only on the net change over 6 months. If it takes 9 months to achieve at least two points of improvement, then a payment will be triggered then.

The service delivery funding can be used at the practice’s discretion. If all funds are not utilised the practice can keep the remaining funds. Practices would be encouraged to utilise any leftover funds to increase the number of patients in the program, which will increase their access to additional outcomes payments.

You must maintain a minimum of 25 patients. There is no maximum, but outcomes payments will be capped at 100 in any 6 month payment period.

Privacy and Consent

No. Each practice needs to collect consent using their usual approaches and note that you have received consent in the enrolment process. NCPHN does not require a copy of the consent as this is between you and your patient.

The following text is provided to assist practices:

CarePro is a patient engagement and care management platform that will be used for all patients who consent to take part in the Exercise as Medicine Program.

The participating practice will be using this engagement tool each time a patient visits to record the physical score assessment and track measures over time while they are actively in the Exercise as Medicine Program.

The Exercise as Medicine Program is an initiative run by the North Coast PHN (Healthy North Coast). The PHN will receive data about you but nothing that can identify you (age, sex, condition type and score) to track participation in the program and provide reporting back to the practices.

The platform provider The Diary Corporation, support team ENTAG, and analytics provider GHD do not have any access to the patient records or sensitive data. Collectively we receive totals on how many patients are active in the program, however no demographic or identifiable data.

Measurements

A meaningful functional improvement at 6 months is a worthy health outcome.

Participants are encouraged to measure as often as they want – the tools chosen are aimed at guiding care and motivating to patients. Regular measure of, and feedback to patients about their progress, is an important aspect of motivation and engagement.

The minimum re-measure will be 3 monthly (refer statement of works 3.2.2). If there have been no measures in a 6 month period the patient will be regarded as inactive and will not count towards the minimum of 25 patients that the practice needs to have participating.

Patient selection is the practice’s responsibility.

You can re-measure them when they are well. After 6 months, payment will be triggered whenever the patient achieves a minimum of 2 points of improvement.

QoL measures would be good, but not as directly responsive to exercise intervention as a function measure. An implementation team may wish to use QoL measures, or other measures as well as the program specified function measure. Outcome payments will be based on the net change in the specified function score over 6 months.

To ensure consistency across the program, the SPPB will be the only acceptable tool to measure scores. During the orientation period, the care team will be trained to complete the SPPB to support usability.

Clinical

Outcomes payments will only be made for eligible patients, however practices have the discretion to include anyone who would benefit in their local program.

When initially diagnosed CCF and COPD patients often go through a phase of medication titration before settling on a stable medication regimen. Functional improvement is often seen in this period. This program is to pay for the additional functional improvement that can be attained through the exercise therapy rather than the initial medication stabilisation.

Sick day actions plans are encouraged as part of standard care, and these should continue where applicable.

The tests represent activities of daily living that are of real-life value. If you are better at doing sit to stand, or timed up and go, it has benefits no matter how it was achieved.

QoL of life measures would be good, but not as directly responsive to exercise intervention as a function measure. An implementation team may wish to use QoL measures, or other measures as well as the program specified function measure. Outcome payments will be based on the net change in the specified function score over 6 months.

Yes, patients can be enrolled or discharged from the program at any time.

This depends on the types of patients you enrol and the types of interventions you arrange.

We would not expect every patient to show an improvement in the function score, but enough of them should show an improvement to make the whole program worthwhile.

Some patients are likely to get clinical benefit from exercise therapy without showing improvement in SPPB score, e.g those that would otherwise have deteriorated, while others will show improvement in their function score with very little input.

Types of interventions can be adapted to the practice systems and individual patients, eg one on one, group, free community services, allied health services. It is likely that having a range (“menu”) of options will make it easier for your patients to find something that suites them well.

CarePro

CarePro is a user-friendly, enterprise-level care management and community-based care delivery platform which seamlessly integrates with the consumer-centered Diary.

The Diary is a personal health data collection and repository, and self-management app, which enables consumers to communicate and share their health information directly with their care team.

The two iOS applications work seamlessly together to create the end-to-end platform that connects service providers and patients into a single patient engagement platform to improve patient outcomes. In tandem with the patient facing application The Diary, CarePro enables care providers to increase patient engagement, ensure care plan adherence, leverage multi-directional communication, modify care plans as needed, and access key care team information.

The CarePro Diary platform refer to patients as ‘Owners’ of their health data. You will see the terms ‘patient’ and ‘Owner’ used throughout support manuals and FAQs, these words are interchangeable.

Groups are used primary for the service provider or care manager to filter the patient cohort within the Owner List.

Yes, a Patient (owner) can be added to more than one group to be filtered on.

This error is shown when a patient has already had the survey assigned to them.

Any outstanding surveys must be completed before a new survey is assigned to that patient (owner) Go back into the Owners tab, find the patient and either complete or delete the outstanding survey.

This is referred to as ‘Close User’ in the platform. To close a user, tap on the Owners Tab and select the patient you would like to close. Tap on the ellipsis in the upper right corner and select ‘Edit User Profile’. Scroll to the bottom of the tab and tap on ‘CLOSE USER’. The patient will now be taken from the active owner list and can be reviewed by filtering by ‘closed’ status.

Follow the steps to ‘Close User’. To close a user tap on the Owners Tab, select the patient you would like to close. Tap on the ellipsis in the upper right corner and select ‘Edit User Profile’. Scroll to the bottom of the tab and tap on ‘CLOSE USER’. The patient will now be taken from the active owner list and can be reviewed by filtering by ‘closed’ status.

No, The Diary Corporation do not use, share, or sell any of your information without your express permission. The Diary Corporation only track how CarePro/The Diary is used, not the information contained in it.

Health data in CarePro and The Diary can be entered in numerous ways. As the Diary and CarePro applications are built using iOS framework, data is directly linked to Apple Health. This means that if a patient has a personal iPhone or Apple watch all health-related data (ie. Steps, Exercise Activity, Sleep, Stand Hours) will automatically be fed into the patient’s profile. Third party applications or devices that link into Apple Health can also be pulled directly into CarePro and displayed in a patient’s dashboard. Service providers can manually enter data into any health module or use the dictation feature of iOS.

The Diary CarePro have built integrations with 4 x TGA approved iHealth Monitoring devices that will automatically write the readings into the patient’s dashboard.

Visit https://secure.thediary.com/ and log in with the same username and password you use for your iOS app.

Primarily administrating staff.