A study in older adults finds that combining Medicare annual wellness and problem-focused visits is associated with increased annual wellness visit completion rates and fewer no shows. A complementary Innovations in Primary Care article describes automated previsit test ordering and scheduling that brings result discussions to the visit.
Two articles in Annals of Family Medicinehighlight practical ways to make primary care easier for older adults to navigate. One study reports increased annual wellness visit completion rates, decreased no-show rates, and improved completion of multiple quality measures by offering 40-minute combined annual wellness and problem-focused visits with patients' usual clinicians. A second article describes how automating previsit test ordering and scheduling allows results to be reviewed during the visit with less back-and-forth afterward.
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Medicare annual wellness visits are meant to provide preventive care guidance for Medicare beneficiaries, including older adults and people with disabilities. A recurrent barrier is that patients often bring medical concerns to these annual wellness appointments, crowding out prevention. In this original research study, researchers at the Joan C. Edwards School of Medicine at Marshall University report a nine-month quality improvement effort in a family medicine department with five clinics, focusing on Medicare patients aged 65 and older. The department team booked longer, 40-minute “combined” appointments so patients could complete the Medicare annual wellness visit and, if needed, have specific problem concerns handled in the same visit with their regularly seen physician.
The annual wellness visit completion rate rose from 8.4% to 50.8% over nine months. No-show rates were lower for combined than for wellness-only visits (11.9% vs. 19.6%) and for visits with the patient's usual clinician than with a noncontinuity clinician (12.5% vs. 25.4%). Orders and screenings increased across multiple measures such as depression, falls, function, pain; breast/cervical/colorectal/lung cancer screening; DEXA; hemoglobin A1c; urine microalbumin; hepatitis C; and HIV.
In an Innovations in Primary Care article, a team at Mayo Clinic in Rochester, Minnesota, reports a workflow project to automate previsit ordering and scheduling of preventive and chronic disease tests at a community internal medicine practice in a suburban medical center. Using the Epic electronic health record (EHR), the team used registry and health-maintenance tools to identify established older adult patients eligible for annual wellness visits and routine screening/surveillance. They built an Epic Campaign to auto-order tests due in the next six months, send a patient-portal message three weeks before the visit listing those tests, enable self-scheduling, and invite patients to list up to three concerns for their agenda. Clinicians reviewed replies and adjusted plans ahead of the appointment. To date, about 3,500 patients have received the automated communication; 81% read the message and about 27% replied. Patients appreciated completing tests before the visit so results could be discussed during the visit. Clinicians reported reducedpost-visit results communication; few patients canceled after pretesting.
Articles Cited:
Optimizing Medicare Annual Wellness Visits Through Quality Improvement: Leveraging Process, Continuity, and Combined Visits
Courtney D. Wellman, MD; Richard Conway, DO; Ashley Beaty, MSN, RN-BC; Kueitsung Shih, MS, MPH; Christopher Schafer, MSHI; and Adam M. Franks, MD
Automated Pre-Visit Test Ordering for the Complex Older Adult: From Chaos to Coordination
Majken T. Wingo, MD; John C. Matulis III, DO, MPH; Kyle A. Tobin, MS; and Rajeev Chaudhry, MBBS, MPH
Annals of Family Medicine is an open access, peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals of Family Medicine is sponsored by six family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, and the North American Primary Care Research Group. Annals of Family Medicine is published online six times each year, charges no fee for publication, and contains original research from the clinical, biomedical, social, and health services areas, as well as contributions on methodology and theory, selected reviews, essays, and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed for free on the journal's website,www.AnnFamMed.org.
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SOURCE Annals of Family Medicine
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