Outcomes of A Virtual Practice-Tailored Medicare Annual Wellness Visit Intervention.
Outcomes of A Virtual Practice-Tailored Medicare Annual Wellness Visit Intervention.
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DOI：
10.3122/jabfm.2022.220342r1
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发表时间：
2023-05-08
影响因子：
2.9
通讯作者：
Wenger, Neil S.
中科院分区：
文献类型：
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作者：
Tarn, Derjung M.;Pace, Wilson D.;Tseng, Chi -Hong;Callen, Elisabeth;Loskutova, Natalia Y.;Stange, Kurt C.;Wenger, Neil S.
需要采取干预措施，以促进医疗保险年度健康访问（AWV）的利用，这是一个未充分利用的机会，可以进行筛查和计划个性化的预防性健康服务。我们于2021年（COVID-19疫情期间）在3个小型社区诊所实施了“实践定制AWV”干预措施，通过远程诊所重新设计和电子病历支持。该干预措施将基于电子健康记录（EHR）的工具与实践重新设计方法和资源相结合。结果包括完成AWV和履行建议的预防服务。基线时，这3家诊所有1513名医疗保险患者在过去12个月内至少接受过一次就诊。AWV使用率从基线时的7%上升到干预实施后8个月的54%;提前护理计划增加了10.7%（从7.9%上升到18.6%）;抑郁症筛查增加了16.3%（从51.7%上升到68.0%）;酒精滥用筛查增加了17.3%（从42.6%上升到59.9%）。每一个人的预防性卫生服务，更经常收到的患者与AWV比那些没有。在患者层面，所有合格预防服务（最多评估12项）的完成率从47.5%上升到53.8%（p<0.001）。亚组分析显示，与没有AWV的患者相比，AWV患者完成了更大比例的总推荐预防性卫生服务。虚拟实施的干预措施，结合EHR为基础的工具与实践重新设计的方法增加了AWV和预防服务的利用率在医疗保险患者。鉴于这一干预措施在2019冠状病毒病大流行期间取得了成功（当时的做法有许多相互竞争的需求），应更多地考虑以虚拟方式提供未来的干预措施。
Interventions are needed to promote utilization of the Medicare Annual Wellness Visit (AWV), an underused opportunity to perform screenings and plan individualized preventive health services. Using remote practice redesign and electronic medical record support, we implemented the Practice-Tailored AWV intervention in 2021 (during the COVID-19 pandemic) in 3 small community-based practices. The intervention combines electronic health record (EHR)-based tools with practice redesign approaches and resources. Outcomes included completion of AWV and fulfillment of recommended preventive services. At baseline the 3 practices had 1513 Medicare patients with at least one visit in the past 12 months. AWV utilization went from 7% at baseline to 54% eight months post-intervention implementation; advance care planning increased 10.7% (from 7.9% to 18.6%); depression screening increased 16.3% (from 51.7% to 68.0%); and alcohol misuse screening increased 17.3% (from 42.6% to 59.9%). Every individual preventive health service was received more often by patients with an AWV than those without. At the patient level, fulfillment of all eligible preventive services (of a maximum of 12 evaluated) went from 47.5% to 53.8% (p<0.001). Subgroup analyses showed that patients with AWVs completed a greater percentage of their total recommended preventive health services than those without an AWV. Virtual implementation of an intervention that combined EHR-based tools with practice redesign approaches increased AWV and preventive services utilization in Medicare patients. Given the success of this intervention during the COVID-19 pandemic (when practices had many competing demands), greater consideration should be given to delivering future interventions virtually.