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

提高 Medicare 年度健康就诊 (AWV) 的可行性、影响力和公平性

基本信息

批准号：
10650107
负责人：
DERJUNG M TARN
金额：
$ 65万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-01 至 2028-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10650107
关键词：
Academy Address Adult Affect American Caring Communities Country Couples Data Data Coordinating Center Dedications Elderly Electronic Health Record Electronics Eligibility Determination Equity Evaluation Evidence based intervention Family Physicians Federally Qualified Health Center Fee-for-Service Plans Feedback Future Geography Goals Health Health Services Needs Health system Individual Intervention Longevity Low income Medicare Methods Morbidity - disease rate National Cancer Institute Nursing Staff Outcome Assessment Patients Persons Population Preventive Preventive Health Services Preventive care Preventive service Provider Public Health Randomized, Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reporting Research Resources Risk Risk Assessment Screening for cancer Services Solo Practices Time United States United States Preventative Services Task Force Vaccination Videoconferencing Visit Work community based practice design ethnic disparity ethnic diversity ethnic minority ethnic minority population evidence base health data health service use human old age (65+)implementation intervention implementation strategy improved individual patient intervention cost intervention effect intervention refinement low socioeconomic status minority patient mortality novel population health post implementation practice setting practice-based research network pragmatic trial primary care practice racial disparity racial diversity racial minority racial minority population recruit screening screening services stem tool uptake

项目摘要

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.

项目摘要老年人将基于证据的预防卫生服务大大不足，这被证明减少了严重疾病，发病率和死亡率。实际上，在65岁及以上年龄较大的成年人中，只有不到一半的证据 - 专家委员会推荐的基于癌症筛查和疫苗接种（例如USPSTF和 CDC/ACIP）。接受预防性不佳的风险最大的人包括种族和少数民族群体和社会经济状况低下的人。然而，在老年人中纠正这种利用不足的干预措施有主要是针对个人预防性卫生服务，而不是患者所需的全部服务。 2011年Medicare建立年度健康访问（AWV）是一个很棒的机会回应国家癌症研究所的多层次干预措施，以解决供应和供应对预防性卫生服务的大量需求。这次免费的AWV访问为提供者提供了专注于预防保健服务的时间。我们开发了一种多层次干预措施，以增加AWV的使用，从而成功增加了AWV利用率3 小（2-5个提供商）试验实践。干预措施解决了患者增加AWV的复杂性（服务需求），提供商（服务供应）和实践水平。它结合了电子健康记录（EHR）通过实践重新设计工具和方法为提供者和方法提供的信息和工具患者关于个别患者所需的预防保健服务。该提议的目标是进行一项务实的试验，以评估干预措施对增加AWV和预防保健服务的影响利用率。我们将在地理和种族/种族多样化的社区中实施干预措施 - 基于实践，联邦资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（包括个人实践），通常代表不足研究。这项研究的具体目的是：1）评估干预对使用A）AWV和B的影响 USPSTF和CDC/ACIP-RECERDENDERIVE TREFICTIVE SERVICY在3种不同类型的练习环境中； 2）评估干预措施对降低AWV利用中种族/种族差异的影响； 3）评估影响干预工具和方法的实施和可持续性的因素，实施策略和干预效果在不同的患者环境中。通过视频会议和远程实施部署EHR工具，这种低成本干预很容易被传播到小型的独奏实践中在全国范围内。预期使用预防保健服务的预期增加将有所改善人口健康和较低的死亡率，特别是在高危种族/族裔少数民族患者中。