From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA (DMT); DARTNet Institute, Aurora, CO (WDP); Division of General Internal Medicine/Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA (C-HT, NSW); American Academy of Family Physicians, Leawood, KS (EC, NYL); and Center for Community Health Integration and Department of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA (DMT); DARTNet Institute, Aurora, CO (WDP); Division of General Internal Medicine/Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA (C-HT, NSW); American Academy of Family Physicians, Leawood, KS (EC, NYL); and Center for Community Health Integration and Department of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH.
J Am Board Fam Med. 2023 May 8;36(3):501-509. doi: 10.3122/jabfm.2022.220342R1. Epub 2023 Apr 7.
Interventions are needed to promote utilization of the Medicare Annual Wellness Visit (AWV), an underused opportunity to perform screenings and plan individualized preventive health services.
Using remote practice redesign and electronic health record (EHR) support, we implemented the Practice-Tailored AWV intervention in 2021 (during the COVID-19 pandemic) in 3 small community-based practices. The intervention combines EHR-based tools with practice redesign approaches and resources. Outcomes included completion of AWV and fulfillment of recommended preventive services.
At baseline the 3 practices had 1,513 Medicare patients with at least 1 visit in the past 12 months. AWV utilization went from 7% at baseline to 54% 8 months postintervention implementation; advance care planning increased 10.7% (from 7.9% to 18.6%); depression screening increased 16.3% (from 51.7% to 68.0%); and alcohol misuse screening increased 17.3% (from 42.6% to 59.9%). Every individual preventive health service was received more often by patients with an AWV than those without. At the patient level, fulfillment of all eligible preventive services (of a maximum of 12 evaluated) went from 47.5% to 53.8% ( .001). Subgroup analyses showed that patients with AWVs completed a greater percentage of their total recommended preventive health services than those without an AWV.
Virtual implementation of an intervention that combined EHR-based tools with practice redesign approaches increased AWV and preventive services utilization in Medicare patients. Given the success of this intervention during the COVID-19 pandemic (when practices had many competing demands), greater consideration should be given to delivering future interventions virtually.
需要采取干预措施来促进利用医疗保险年度健康访视（AWV），这是一个未充分利用的机会，可以进行筛查并计划个性化的预防保健服务。
我们使用远程实践重新设计和电子健康记录（EHR）支持，于 2021 年（在 COVID-19 大流行期间）在 3 家小型社区实践中实施了基于实践的 AWV 干预措施。该干预措施将基于 EHR 的工具与实践重新设计方法和资源相结合。结果包括完成 AWV 和完成推荐的预防服务。
在基线时，这 3 家实践共有 1513 名 Medicare 患者，在过去 12 个月中有至少 1 次就诊。AWV 的利用率从基线时的 7%增加到干预实施后 8 个月时的 54%；预先护理计划增加了 10.7%（从 7.9%增加到 18.6%）；抑郁症筛查增加了 16.3%（从 51.7%增加到 68.0%）；酒精滥用筛查增加了 17.3%（从 42.6%增加到 59.9%）。接受 AWV 的患者比未接受 AWV 的患者更频繁地接受每一项个体预防保健服务。在患者层面上，符合所有合格预防服务（最多评估 12 项）的比例从 47.5%增加到 53.8%（<.001）。亚组分析表明，接受 AWV 的患者完成的总推荐预防保健服务百分比高于未接受 AWV 的患者。
在 Medicare 患者中，虚拟实施将基于 EHR 的工具与实践重新设计方法相结合的干预措施增加了 AWV 和预防服务的利用率。鉴于该干预措施在 COVID-19 大流行期间（实践有许多竞争需求时）取得了成功，应该更多地考虑以虚拟方式提供未来的干预措施。
