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.

项目概要老年人大大没有充分利用基于证据的预防性卫生服务，这些服务已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 岁及以上成年人掌握最新证据—— 基于专家委员会（例如 USPSTF 和疾病预防控制中心/ACIP）。接受不良预防性护理的风险最大的人包括少数种族和族裔群体以及社会经济地位低下的人。然而，纠正老年人这种利用不足的干预措施已经主要针对个人预防性保健服务，而不是患者所需的服务总体。 2011 年 Medicare 设立的年度健康访问 (AWV) 是一个很好的但未被充分利用的机会响应国家癌症研究所的呼吁，采取多层次干预措施解决供应和对严重未充分利用的预防性卫生服务的需求。这种免费的 AWV 就诊为医疗服务提供者提供了专门时间专注于预防性卫生服务。我们开发了多级干预措施来增加 AWV 的使用，并在 3 年内成功提高了 AWV 的使用率小型（2-5 个提供商）试点实践。该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，以通知提供者和患者了解个别患者所需的预防性保健服务。该提案的目标是进行评估干预措施对增加 AWV 和预防性卫生服务的效果的务实试验利用率。我们将在地理和种族/民族多样化的社区实施干预—— 基于实践、联邦合格的健康中心和学术健康系统实践。实践包括中小型初级保健机构（包括单独的机构），通常在这些机构中代表性不足研究。本研究的具体目的是： 1) 评估干预措施对 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服务； 2）评估干预措施对减少 AWV 使用方面的种族/民族差异的效果； 3) 评估影响干预工具和方法的实施和可持续性的因素、实施情况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实施部署电子病历工具，这种低成本干预措施可以很容易地传播到小型和单独的诊所全国各地。预计患者对预防性卫生服务的使用将会增加人口健康和较低的死亡率，特别是高危种族/族裔患者。