Initial validation of an exercise "vital sign" in electronic medical records.
OBJECTIVE
The objective of this study is to describe the face and discriminant validity of an exercise vital sign (EVS) for use in an outpatient electronic medical record.


METHODS
Eligible patients were 1,793,385 adults 18 yr and older who were members of a large health care system in Southern California. To determine face validity, median total self-reported minutes per week of exercise as measured by the EVS were compared with findings from national population-based surveys. To determine discriminant validity, multivariate Poisson regression models with robust variance estimation were used to examine the ability of the EVS to discriminate between groups of patients with differing physical activity (PA) levels on the basis of demographics and health status.


RESULTS
After 1.5 yr of implementation, 86% (1,537,798) of all eligible patients had an EVS in their electronic medical record. Overall, 36.3% of patients were completely inactive (0 min of exercise per week), 33.3% were insufficiently active (more than 0 but less than 150 min·wk), and 30.4% were sufficiently active (150 min or more per week). As compared with national population-based surveys, patient reports of PA were lower but followed similar patterns. As hypothesized, patients who were older, obese, of a racial/ethnic minority, and had higher disease burdens were more likely to be inactive, suggesting that the EVS has discriminant validity.


CONCLUSIONS
We found that the EVS has good face and discriminant validity and may provide more conservative estimates of PA behavior when compared with national surveys. The EVS has the potential to provide information about the relationship between exercise and health care use, cost, and chronic disease that has not been previously available at the population level.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. Karen.J.Coleman@kp.org
Karen Jacqueline
KJ
Coleman
Eunis
E
Ngor
Kristi
K
Reynolds
Virginia P
VP
Quinn
Corinna
C
Koebnick
Deborah Rohm
DR
Young
Barbara
B
Sternfeld
Robert E
RE
Sallis
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D002140:California; D003376:Counseling; D016002:Discriminant Analysis; D057286:Electronic Health Records; D015444:Exercise / Q000502:physiology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology; D016012:Poisson Distribution; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult