Medicare Annual Wellness Visit Practice Redesign Toolkit: A Tailored Intervention to Improve Preventive Health Service Use

医疗保险年度健康就诊实践重新设计工具包：改善预防性健康服务使用的定制干预措施

• 批准号: 10238828
• 负责人: DERJUNG M TARN
• 金额: $ 24.28万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10238828
• 关键词: Academy; Address; Adult; Advisory Committees; Agreement; American; Breast Cancer Detection; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical Decision Support Systems; Colorectal Cancer; Communities; Country; Coupled; Data; Data Coordinating Center; Early Diagnosis; Early treatment; Effectiveness; Elderly; Electronic Health Record; Family Physicians; Geography; Goals; Health Services Needs; Herpes zoster disease; Immunization; Individual; Infection prevention; Influenza; Institutes; Intervention; Low income; Malignant neoplasm of prostate; Medicare; Minority; Morbidity - disease rate; National Cancer Institute; Nursing Staff; Office Nursing; Online Systems; Outcome; Patients; Phase; Physicians; Pneumonia; Population-Based Registry; Preventive Health Services; Preventive care; Preventive service; Primary Health Care; Provider; Public Health; Randomized Controlled Trials; Research; Risk; Screening for cancer; Services; Solo Practices; Syndrome; System; Testing; Time; Training; United States; Vaccination; Videoconferencing; Visit; Work; Writing; base; cloud based; colorectal cancer treatment; data sharing; ethnic diversity; ethnic minority population; evidence base; health data; health service use; human old age (65+); improved; individual patient; intervention cost; intervention effect; intervention refinement; malignant breast neoplasm; meetings; mortality; novel; older patient; patient registry; population health; practice-based research network; pragmatic trial; racial and ethnic; racial and ethnic disparities; service providers; stem; tool; uptake

Project Summary 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. Fewer than half of adults aged 65 and older are up- to-date on cancer screenings and vaccinations recommended by the United States Preventive Services Task Force (USPSTF), CDC, and Advisory Committee on Immunization Practices (ACIP), and at the same time many non-evidence-based services are delivered. Those at greatest risk for receiving poor preventive care include racial / ethnic minorities and low income Americans. The free-to-the-patient AWV visit gives providers dedicated time to focus on preventive health services. We have developed a promising multilevel intervention to increase AWV use. This proposal’s goal is to refine and implement a novel AWV Practice Redesign Toolkit to stimulate AWV visit use in small and mid-size primary care practices, and to evaluate its effects on increasing delivery rates of evidence-based preventive services and reducing rates of services not supported by scientific evidence. This multilevel practice redesign intervention addresses the complexities of increasing AWVs at patient (demand for services), provider (supply of services), and practice levels. It also uses electronic health record (EHR)-generated information and tools to inform providers and patients about the preventive health services needed by individual patients. The R61 study aims are to: 1) demonstrate the feasibility of obtaining access to a mid-size practice’s EHR system to create a population-based registry of patients in need of AWVs and preventive health services, and to notify providers and patients of the need for these services; and 2) refine, pilot-test and demonstrate the feasibility of implementing the AWV Practice Redesign Toolkit intervention in a mid-size practice. R61 results will inform additional intervention refinements which will be implemented in the R33 phase. The R33 study aims are to implement the AWV Practice Redesign Toolkit intervention in geographically and racially/ethnically diverse practices, and to conduct a pragmatic trial to evaluate the effect of: intervention uptake on use of AWVs, physician ordering of preventive health services, and use and overuse of preventive health services. Practices will belong to unique nationwide practice networks - the DARTNet Institute (an electronic research network and health data coordinating center) and the American Academy of Family Physicians National Research Network (the largest practice-based research network in the United States, consisting of mostly small and mid-size primary care practices which typically are under-represented in research). Implemented via video conferencing and remote deployment of EHR tools, this low-cost intervention could be easily 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.

项目摘要 2011年建立的联邦医疗保险年度健康访问(AWV)是一个很好的机会，但没有得到充分利用 响应国家癌症研究所的呼吁，采取多层次的干预措施，既解决供应问题，又解决 对未得到充分利用的预防性卫生服务的需求。在65岁及以上的成年人中，只有不到一半的人是老年人- 美国预防服务工作组建议的癌症筛查和疫苗接种的最新情况 部队(USPSTF)、疾病预防控制中心和免疫做法咨询委员会(ACIP)，同时 许多非循证服务都是提供的。那些接受不良预防护理的风险最大的人 包括少数族裔和低收入美国人。免费向患者提供AWV访问为提供商提供 有专门的时间专注于预防性卫生服务。 我们已经开发出一种前景看好的多水平干预措施，以增加AWV的使用。这项提案的目标是提炼 并实施新的AWV实践重新设计工具包，以刺激中小型AWV访问使用 初级保健做法，并评估其对提高循证预防接生率的影响 服务和降低没有科学证据支持的服务比率。这一多层次的实践重新设计 干预措施解决了患者(服务需求)、提供者(供应)增加AWV的复杂性 服务)和实践水平。它还使用电子健康记录(EHR)生成的信息和工具来 告知提供者和患者个别患者所需的预防性卫生服务。R61 研究的目的是：1)论证使用中型诊所的EHR系统的可行性 建立以人群为基础的需要AWV和预防性保健服务的患者登记，并通知 提供者和患者对这些服务的需求；以及2)完善、试行并证明 在中等规模的实践中实施AWV实践重新设计工具包干预。R61结果将通知 将在R33阶段实施的额外干预改进。R33研究的目的是 在不同地域和种族/民族中实施AWV实践重新设计工具包干预 并进行一项务实的试验，以评估以下措施的效果：干预吸纳对使用AWV的影响； 医生订购预防性卫生服务，以及预防性卫生服务的使用和过度使用。实践 将属于独特的全国性实践网络-DARTNet研究所(一个电子研究网络和 健康数据协调中心)和美国家庭医生学会国家研究网络 (美国最大的实践性研究网络，主要由中小型企业组成 初级保健做法通常在研究中代表性不足)。通过视频会议实施 和远程部署电子病历工具，这种低成本的干预可以很容易地传播到小型和单独的 在全国各地都有这种做法。预期患者使用预防性保健服务的增加将会有所改善 人口健康和更低的死亡率，特别是在有风险的种族/少数民族患者中。

项目成果

Outcomes of A Virtual Practice-Tailored Medicare Annual Wellness Visit Intervention.

• DOI: 10.3122/jabfm.2022.220342r1
• 发表时间: 2023-05-08
• 期刊: JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
• 影响因子: 2.9
• 作者: Tarn, Derjung M.;Pace, Wilson D.;Tseng, Chi -Hong;Callen, Elisabeth;Loskutova, Natalia Y.;Stange, Kurt C.;Wenger, Neil S.
• 通讯作者: Wenger, Neil S.