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.
Evidence-based preventive health services are vastly underutilized by older Americans. This proposal?s promising multilevel intervention will stimulate greater use of the Medicare Annual Wellness Visit, an established but underused mechanism that gives providers dedicated time to focus on preventive health services. The anticipated increase in preventive health services stemming from greater Annual Wellness Visit use will improve population health and lower mortality, particularly in at-risk racial/ethnic minority patients.
