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: 10687253
• 负责人: DERJUNG M TARN
• 金额: $ 49.43万
• 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 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10687253
• 关键词: Academy; Address; Adult; Advisory Committees; Agreement; American; Breast Cancer Detection; Caring; Cessation of life; Clinical Decision Support Systems; Communities; Country; Coupled; Data; Data Coordinating Center; Dedications; Early Diagnosis; Early treatment; Effectiveness; Elderly; Electronic Health Record; Electronics; Eligibility Determination; Family Physicians; Geography; Goals; Health Services Needs; Herpes zoster disease; Immunization; Individual; Infection prevention; Influenza; Intervention; Low income; Medicare; Morbidity - disease rate; National Cancer Institute; Notification; Nursing Staff; Online Systems; Outcome Assessment; Patients; Phase; Physicians; Pneumonia; Population-Based Registry; Preventive Health Services; Preventive care; Preventive service; Prostate; Provider; Public Health; Randomized, Controlled Trials; Recommendation; Research; Risk; Screening for cancer; Services; Solo Practices; Syndrome; Time; Training; United States; United States Preventative Services Task Force; Vaccination; Videoconferencing; Visit; Work; Writing; cloud based; colorectal cancer screening; colorectal cancer treatment; data sharing; design; electronic health record system; ethnic disparity; ethnic diversity; ethnic minority; evidence base; health data; health service use; human old age (65+); improved; individual patient; intervention cost; intervention effect; intervention refinement; malignant breast neoplasm; meetings; minority patient; mortality; novel; older patient; patient registry; pilot test; population health; practice-based research network; pragmatic trial; primary care practice; racial disparity; racial diversity; racial minority; stem; therapy design; 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.

项目概要 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 65 岁及以上的成年人中，只有不到一半的人对预防性卫生服务的需求大大未得到充分利用。 美国预防服务任务组推荐的最新癌症筛查和疫苗接种 部队 (USPSTF)、疾病预防控制中心 (CDC) 和免疫实践咨询委员会 (ACIP)，同时 为那些最有可能接受不良预防性护理的人提供了许多非证据服务。 包括少数族裔和低收入美国人。免费的 AWV 就诊为医疗服务提供者提供服务。 专门时间专注于预防性卫生服务。 我们开发了一种有前途的多层次干预措施来增加 AWV 的使用。该提案的目标是完善。 实施新颖的 AWV 实践重新设计工具包，以刺激 AWV 访问在中小型企业中的使用 初级保健实践，并评估其对提高循证预防措施实施率的影响 服务并降低没有科学证据支持的服务率。这种多层次的实践重新设计。 干预解决了患者（服务需求）、提供者（供应）AWV 增加的复杂性 它还使用电子健康记录 (EHR) 生成的信息和工具来实现。 告知提供者和患者有关个别患者所需的预防性健康服务。 研究旨在： 1) 证明获得中型诊所 EHR 系统访问权限的可行性 创建一个基于人群的需要 AWV 和预防性卫生服务的患者登记册，并通知 提供者和患者对这些服务的需求；以及 2) 完善、试点测试并证明其可行性 在中型实践中实施 AWV 实践重新设计工具包干预 R61 结果将提供信息。 将在 R33 阶段实施的额外干预细化 R33 研究的目的是： 在地理和种族/民族多样化中实施 AWV 实践重新设计工具包干预 实践，并进行务实试验来评估以下效果：对 AWV 使用的干预措施的采用， 医生对预防性保健服务的预约，以及预防性保健服务的使用和过度使用。 将属于独特的全国性实践网络 - DARTNet Institute（一个电子研究网络和 健康数据协调中心）和美国家庭医师学会国家研究网络 （美国最大的基于实践的研究网络，主要由中小型研究机构组成） 初级保健实践在研究中通常代表性不足）。 以及 EHR 工具的远程部署，这种低成本干预措施可以轻松传播给小型和个人 全国范围内的实践预计将改善患者对预防性卫生服务的使用。 人口健康和较低的死亡率，特别是高危种族/族裔患者。