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: 10238828
• 负责人: DERJUNG M TARN
• 金额: $ 24.28万
• 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 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10238828
• 关键词: Academy; Address; Adult; Advisory Committees; Agreement; American; Breast Cancer Detection; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical Decision Support Systems; Colorectal Cancer; Communities; Country; Coupled; Data; Data Coordinating Center; Early Diagnosis; Early treatment; Effectiveness; Elderly; Electronic Health Record; Family Physicians; Geography; Goals; Health Services Needs; Herpes zoster disease; Immunization; Individual; Infection prevention; Influenza; Institutes; Intervention; Low income; Malignant neoplasm of prostate; Medicare; Minority; Morbidity - disease rate; National Cancer Institute; Nursing Staff; Office Nursing; Online Systems; Outcome; Patients; Phase; Physicians; Pneumonia; Population-Based Registry; Preventive Health Services; Preventive care; Preventive service; Primary Health Care; Provider; Public Health; Randomized Controlled Trials; Research; Risk; Screening for cancer; Services; Solo Practices; Syndrome; System; Testing; Time; Training; United States; Vaccination; Videoconferencing; Visit; Work; Writing; base; cloud based; colorectal cancer treatment; data sharing; ethnic diversity; ethnic minority population; evidence base; health data; health service use; human old age (65+); improved; individual patient; intervention cost; intervention effect; intervention refinement; malignant breast neoplasm; meetings; mortality; novel; older patient; patient registry; population health; practice-based research network; pragmatic trial; racial and ethnic; racial and ethnic disparities; service providers; stem; 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.

项目摘要 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。不到65岁及以上的成年人中不到一半 美国预防服务任务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 提供了许多基于非证据的服务。那些接受预防性不佳的风险最大的人 包括种族 /族裔少数民族和低收入美国人。免费到患者的AWV访问提供了提供者 专注于预防保健服务的时间。 我们已经开发了一种承诺的多层次干预来增加AWV的使用。该提议的目标是完善 并实施一种新颖的AWV练习重新设计工具包，以刺激中小型的AWV访问使用 初级保健实践，并评估其对提高基于证据的预防率提高的影响 服务和降低科学证据支持的服务率。这种多级实践重新设计 干预措施解决了患者增加AWV的复杂性（服务需求），提供商（供应商 服务）和练习水平。它还使用电子健康记录（EHR）生成的信息和工具 将各个患者所需的预防保健服务告知提供者和患者。 R61 研究目的是：1）证明可以获取中型实践的EHR系统的可行性 创建基于人群的注册表，需要AWV和预防保健服务的患者，并通知 提供者和患者需要这些服务； 2）提炼，试点测试并证明 在中型实践中实施AWV实践重新设计工具包干预。 R61结果将告知 将在R33阶段实施的其他干预精炼。 R33研究的目的是 在地理和种族/种族上实施AWV实践重新设计工具包干预 实践，并进行务实的试验，以评估以下效果：干预吸收对AWV的使用， 医师订购预防卫生服务，并使用和过度使用预防保健服务。实践 将属于独特的国家实践网络 - Dartnet Institute（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，主要由中小型组成 通常在研究中代表不足的初级保健实践）。通过视频会议实施 和EHR工具的远程部署，这种低成本干预措施可以很容易地分发到小而固体 全国各地的实践。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。

项目成果

Small Solutions for Primary Care Are Part of a Larger Problem.

• DOI: 10.7326/m21-4509
• 发表时间: 2022-08
• 期刊: ANNALS OF INTERNAL MEDICINE
• 影响因子: 39.2
• 作者: Tarn, Derjung Mimi;Wenger, Neil S.;Stange, Kurt C.
• 通讯作者: Stange, Kurt C.

Outcomes of A Virtual Practice-Tailored Medicare Annual Wellness Visit Intervention.

• DOI: 10.3122/jabfm.2022.220342r1
• 发表时间: 2023-05-08
• 期刊: JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
• 影响因子: 2.9
• 作者: Tarn, Derjung M.;Pace, Wilson D.;Tseng, Chi -Hong;Callen, Elisabeth;Loskutova, Natalia Y.;Stange, Kurt C.;Wenger, Neil S.
• 通讯作者: Wenger, Neil S.