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

项目摘要 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。不到一半的65岁及以上的成年人- 美国预防服务工作组推荐的癌症筛查和疫苗接种 部队（USPSTF），CDC和免疫实践咨询委员会（ACIP），同时 提供了许多非循证服务。那些最有可能接受不良预防保健的人 包括少数民族和低收入美国人。免费给病人的AWV访问给提供者 集中时间开展预防性卫生服务。 我们已经开发了一种有前途的多层次干预措施，以增加AWV的使用。该提案的目标是完善 并实施一个新的AWV实践重新设计工具包，以刺激AWV访问使用在中小型企业 初级保健实践，并评估其对提高循证预防性 服务，并降低没有科学证据支持的服务的比率。这种多层次的实践重新设计 干预解决了增加患者（服务需求）、提供者（供应） 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， 向提供者和病人通报个别病人所需的预防保健服务。R61 研究的目的是：1）证明获得访问中型实践的EHR系统的可行性， 建立一个基于人口的登记册，登记需要AWV和预防性卫生服务的患者，并通知 提供者和患者对这些服务的需求;以及2）完善，试点测试和演示的可行性 在中等规模的实践中实施AWV实践重新设计工具包干预。R61结果将告知 将在R33阶段实施的额外干预改进。R33研究的目的是 在地理和种族/民族多样的地区实施AWV做法重新设计工具包干预措施 实践，并进行一项务实的试验，以评估以下方面的影响：对AWV使用的干预吸收， 预防性保健服务的医嘱以及预防性保健服务的使用和过度使用。做法 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， 健康数据协调中心）和美国家庭医生学会国家研究网络 (the美国最大的基于实践的研究网络，主要由中小型企业组成。 在研究中通常代表性不足的初级保健实践）。通过视频会议实施 和远程部署EHR工具，这种低成本的干预措施可以很容易地传播到小和单独的 全国各地的做法。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 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.