Increasing the Feasibility, Impact, and Equity of the Medicare Annual Wellness Visit (AWV)

项目摘要 老年人对循证预防性卫生服务的利用严重不足，这些服务被证明可以减少严重的 疾病、发病率和死亡率。事实上，只有不到一半的65岁及以上的成年人是最新的证据- 基于专家委员会推荐的癌症筛查和疫苗接种（例如，USPSTF和 CDC/ACIP）。那些最有可能接受不良预防保健的人包括种族和少数民族群体 社会经济地位低下的人。然而，在老年人中采取干预措施来弥补这种利用不足， 大多数是针对个别的预防保健服务，而不是病人所需的全部服务。 2011年医疗保险年度健康访问（AWV）的建立是一个伟大的和未充分利用的机会， 响应国家癌症研究所的呼吁，多层次的干预措施，解决供应和 对严重未得到充分利用的预防保健服务的需求。这种对患者免费的AWV访问使提供者 集中时间开展预防性卫生服务。 我们开发了一种多层次干预措施来增加AWV的使用，成功地增加了3例患者的AWV使用率。 小型（2-5个供应商）试点做法。干预措施解决了患者AWV增加的复杂性 （服务需求）、提供者（服务供应）和实践水平。它结合了电子健康记录 （EHR）生成的信息和工具，以及为提供者提供信息的实践重新设计工具和方法， （a）向病人提供有关个别病人所需的预防性健康服务的资料。该提案的目标是 评估干预措施对提高AWV和预防性卫生服务的效果的实用性试验 利用率我们将在地理和种族/族裔多样化的社区实施干预措施， 基于实践，联邦合格的卫生中心，和学术卫生系统的做法。做法包括 小型到中型的初级保健实践（包括单独的实践），这通常是代表不足， research.本研究的具体目的是：1）评价干预对使用a）AWV和B） USPSTF和CDC/ACIP推荐的3种不同类型实践环境中的预防服务; 2） 评估干预措施对减少AWV使用中种族/民族差异的影响;以及3）评估 影响干预工具和方法的实施和可持续性的因素， 策略，以及在不同患者环境中的干预效果。通过视频会议和远程 通过部署电子健康记录工具，这种低成本的干预措施可以很容易地传播到小型和单独的实践中 全国各地预期使用预防性保健服务的病人人数将增加， 人口健康和较低的死亡率，特别是在高危种族/少数民族患者中。

Project Summary Older adults vastly underutilize evidence-based preventive health services that are proven to reduce serious illness, morbidity and mortality. In fact, fewer than half of adults aged 65 and older are up-to-date on evidence- based cancer screenings and vaccinations recommended by expert committees (e.g., the USPSTF and CDC/ACIP). Those at greatest risk for receiving poor preventive care include racial and ethnic minority groups and persons of low socioeconomic status. Yet interventions to remedy this underutilization in older adults have mostly targeted individual preventive health services, rather than the totality of services needed by patients. The 2011 Medicare establishment of the Annual Wellness Visit (AWV) is a great and underused opportunity to respond to the National Cancer Institute's calls for multilevel interventions that address both the supply and demand for vastly underutilized preventive health services. This free-to-the-patient AWV visit gives providers dedicated time to focus on preventive health services. We developed a multilevel intervention to increase AWV use that successfully increased AWV utilization in 3 small (2-5 provider) pilot practices. The intervention addresses the complexities of increasing AWVs at patient (demand for services), provider (supply of services), and practice levels. It combines electronic health record (EHR)-generated information and tools with practice redesign tools and approaches to inform providers and patients about the preventive health services needed by individual patients. This proposal's goal is to conduct a pragmatic trial to evaluate the effect of the intervention on increasing AWV and preventive health services utilization. We will implement the intervention in geographically and racially/ethnically diverse community- based practices, Federally Qualified Health Centers, and academic health system practices. Practices include small to mid-size primary care practices (including solo practices), which typically are under-represented in research. Specific aims of this study are to: 1) Evaluate the effect of the intervention on use of a) AWVs and b) USPSTF and CDC/ACIP-recommended preventive services in 3 different types of practice settings; 2) Evaluate the effect of the intervention on reducing racial/ethnic disparities in AWV utilization; and 3) Evaluate factors affecting implementation and sustainability of the intervention tools and approaches, implementation strategies, and intervention effect in diverse patient settings. Implemented via video conferencing and remote deployment of EHR tools, this low-cost intervention could easily be disseminated to small and solo practices across the country. The anticipated increase in patient use of preventive health services will improve population health and lower mortality, particularly in at-risk racial/ethnic minority patients.