Health Economics and Outcomes Research, IQVIA, 8280 Willow Oaks Corporate Drive, Suite 775, Fairfax, VA 22034, United States of America; Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030, United States of America.
Harvey L. Neiman Health Policy Institute, 1891 Preston White Drive, Reston, VA 20191, United States of America; School of Economics, Georgia Institute of Technology, Atlanta, GA 30332, United States of America.
Prev Med. 2018 Nov;116:126-133. doi: 10.1016/j.ypmed.2018.08.035. Epub 2018 Aug 31.
The study aim was to assess the effect of receiving an Annual Wellness Visit (AWV) between 2011 and 2013 on the annual rate of eight preventive services recommended for the Medicare population following the AWV. We used retrospective Medicare claims from 2009 to 2014 for a 5% national sample of fee-for-service beneficiaries in the United States. Propensity score-adjusted logistic regressions were performed to estimate the log odds of the probability of receiving the preventive services between beneficiaries who received AWVs during 2011-13 and those who did not during the same period. The average marginal effect was also reported. Among 845,318 patients who met the inclusion and exclusion criteria, 23% had an AWV in 2011-2013. In a propensity-matched sample of 381,934 patients, AWV participants are more likely to undergo subsequent preventive services within a year (adjusted odds ratio ranges from 1.46 (95% CI, 1.44, 1.49) to 2.43 (95% CI, 2.38, 2.49). The findings are consistent using secondary outcomes or with subgroups defined by baseline primary care provider visits or baseline preventive services. These analyses showed that AWV is associated with a significant increase in all the preventive services examined. As Healthy People 2020 has established a target goal to increase the proportion of older adults who receive a core set of clinical preventive services by 10%, AWV represents a promising opportunity to facilitate the delivery of preventive care for the elderly and to advance our knowledge about effective strategies for healthy aging.
这项研究旨在评估 2011 年至 2013 年期间接受年度健康访视（AWV）对 AWV 后 Medicare 人群推荐的八项预防服务的年度利用率的影响。我们使用了来自 2009 年至 2014 年的美国全国 5%的按服务收费受益人的回顾性医疗保险索赔数据。采用倾向评分调整的逻辑回归来估计接受预防服务的可能性对数比值，比较接受和未接受 2011-13 年 AWV 的受益人的预防服务利用率。还报告了平均边际效应。在符合纳入和排除标准的 845318 名患者中，有 23%在 2011-2013 年期间接受了 AWV。在 381934 名倾向评分匹配的患者中，AWV 参与者在一年内更有可能接受后续的预防服务（调整后的优势比范围从 1.46（95%置信区间，1.44，1.49）到 2.43（95%置信区间，2.38，2.49）。使用次要结果或根据基线初级保健提供者就诊或基线预防服务定义的亚组进行的分析也得出了一致的结果。这些分析表明，AWV 与所有检查的预防服务的利用率显著增加有关。由于《健康人民 2020》已经确立了一个目标，即增加接受核心临床预防服务的老年人比例 10%，AWV 代表了一个有前途的机会，可以促进老年人的预防保健服务的提供，并增进我们对健康老龄化有效策略的了解。
