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

项目摘要 老年人极大地未充分利用以证据为基础的预防性卫生服务，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，在65岁及以上的成年人中，只有不到一半的人拥有最新的证据- 由专家委员会推荐的癌症筛查和疫苗接种(例如，USPSTF和 CDC/ACIP)。接受不良预防护理的风险最大的群体包括种族和少数民族群体。 以及社会经济地位较低的人。然而，纠正老年人这种未充分利用的干预措施 主要针对个别预防性保健服务，而不是患者所需的全部服务。 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。这一免费的AWV访问为提供商提供了 有专门的时间专注于预防性卫生服务。 我们开发了多级别干预来增加AWV使用率，在3个月中成功提高了AWV使用率 小规模(2-5个提供商)试点实践。干预措施解决了增加患者AWV的复杂性 (服务需求)、提供者(服务提供)和实践水平。它结合了电子健康记录 (EHR)生成的信息和工具，以及实践重新设计工具和方法，以告知提供商和 患者对个别患者所需的预防保健服务的了解。这项提案的目标是进行 评估干预措施对提高AWV和预防保健服务效果的务实试验 利用率。我们将在地理和种族/民族多元化的社区实施干预- 基于实践、联邦合格的卫生中心和学术卫生系统实践。实践包括 中小型初级保健实践(包括单独实践)，这些实践通常在 研究。这项研究的具体目的是：1)评估干预对a)AWV和b)使用的影响 USPSTF和CDC/ACIP--在3种不同类型的实践环境中推荐的预防性服务；2) 评估干预措施在减少AWV使用方面的种族/民族差异方面的效果；以及3)评估 影响干预工具和方法的执行和可持续性的因素 策略，以及在不同患者环境下的干预效果。通过视频会议和远程 部署电子病历工具，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 在全国各地。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。

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.