Effects of screening for geriatric conditions and advance care planning at the Medicare Annual Wellness Visit.
Effects of screening for geriatric conditions and advance care planning at the Medicare Annual Wellness Visit.
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DOI：
10.1111/jgs.17546
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发表时间：
2022-03
影响因子：
6.3
通讯作者：
Colburn JL
中科院分区：
文献类型：
--
作者：
Nothelle SK;McGuire M;Boyd CM;Colburn JL
The Medicare Annual Wellness Visit (AWV) requires screening for geriatrics conditions and can include advance care planning (ACP). We examined (1) the prevalence of positive screens for falls, cognitive impairment, and activities of daily living (ADL) impairment, (2) referrals/orders generated potentially in response, (3) the increase in ACP among those with 2 AWV. In this retrospective analysis, we used electronic medical record data from a Mid-Atlantic group ambulatory practice. We included adults age >65 who had ≥1 AWV (n=16,176) in years 2014–2017. Analyses on high-risk prescribing were limited to those (n=13,537) with ≥3 months of follow up and ACP to those (n=9097) with 2 AWV. We used responses from the AWV health risk questionnaire to identify screening status for falls, cognitive and ADL impairment and whether an older adult had an ACP. For each screen we identified orders/referrals placed potentially in response (e.g. physical therapy for falls). High-risk medications were based on the 2019 Beers Criteria. Positive screening rates were 38% for falls, 23% for cognition and 32% for ADL impairment. The adjusted odds of having an order placed potentially in response to the screening were 1.8 (95% CI 1.6–2.0) for falls, 1.4 (1.3–1.7) for cognition, 2.8 (2.4–3.3) for ADL impairment. The adjusted odds of a high-risk prescription in the three months after a positive screen was 2.1 (95% CI 1.8–2.5) for falls and 1.9 (95% CI 1.6–2.4) for cognition. Of those with 2 AWV, 48% had an ACP at the first AWV. Among the remaining 52% with no ACP at the first AWV, the predicted probability of having an ACP at the second AWV was 0.22 (95% CI 0.18–0.25). Our results may indicate positive effects of screening for geriatric conditions at the AWV, and highlight opportunities to improve geriatrics care related to prescribing and ACP.
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影响因子：
39.2
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Wenger, NS;Solomon, DH;Shekelle, PG
通讯作者：
Shekelle, PG
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Elixhauser, A;Steiner, C;Coffey, RN
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通讯作者：
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