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

Derjung M. Tarn; Wilson D. Pace; Chi-Hong Tseng; Elisabeth Callen; Natalia Y. Loskutova; Kurt C. Stange; Neil S. Wenger

doi:10.3122/jabfm.2022.220342R1

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Figure 1.
Effect of practice-tailored medicare annual wellness visit (AWV) Intervention on rates of AWVs, overall and by practice site.

Tables

Figures

Download figure
Open in new tab
Download figure
Open in new tab

View popup

Table 2.

Characteristics of Patients Eligible for AWVs at Baseline and 8 Months Post-Intervention Implementation, Overall and by AWV Completion in the past 12 Months

	Baseline				8 Months Post-Implementation
Characteristic	All PatientsN = 1513	AWV Not Completed, n = 1406	AWV Completed, n = 107	p-Value for comparison of those with and without AWVs	All Patients (n = 1167)	AWV Not Completed, n = 537	AWV Completed, n = 630	p-Value for comparison of those with and without AWVs
Age, mean (S.D.)^*	71.5 (11.3)	71.3 (11.5)	73.6 (8.1)	0.05	72.5 (11.1)	71.0 (12.3)	73.7 (9.8)	0.001
Gender, n (%)				0.005				0.81
Women	864 (57.1)	789 (56.1)	75 (70.1)		648 (55.5)	296 (55.1)	353 (55.9)	0.81
Men	649 (42.9)	617 (43.9)	32 (29.9)		519 (44.5)	241 (44.9)	278 (44.1)
Race, n (%)^†				1.00				0.47
White	1101 (93.1)	1014 (93.0)	87 (93.5)		867 (94.4)	393 (95.2)	474 (93.9)	0.47
Non-White (Asian, Black, Hispanic, other)	82 (6.9)	76 (7.0)	6 (6.5)		51 (5.6)	20 (4.8)	31 (6.1)
Type of Medicare insurance, n (%)^*				0.04				0.75
Fee-for-service Medicare	1344 (88.8)	1256 (98.5)	88 (37.0)		1073 (91.9)	492 (91.6)	581 (92.2)	0.75
Medicare Advantage	169 (11.2)	19 (1.5)	150 (63.0)		94 (8.1)	45 (8.4)	49 (7.8)
Medicaid insurance, n (%)	199 (13.2)	189 (13.4)	10 (9.3)	0.30	159 (13.6)	84 (15.6)	75 (11.9)	0.07

Abbreviation: AWV, medicare annual wellness visit, S.D., standard deviation.
↵* P < .01 for the comparison of patient characteristics at Baseline and 8-month post-implementation.
↵† Race was unknown or declined by 330 (21.8%) patients at baseline and by 249 (21.3%) 8 months post-implementation.

View popup

Table 3.

Preventive Health Services Completion Among Eligible Patients at Baseline and 8 Months Post-Intervention Implementation

Preventive Health Service	Baseline		8 Months Post-Implementation		p-Value for difference in % fulfillment
Preventive Health Service	Eligible Cohort, n	Fulfilled, n (%)	Eligible Cohort, n	Fulfilled, n (%)	p-Value for difference in % fulfillment
Vaccinations
Influenza	1512	840 (56.3)	1166	693 (59.6)	0.032
Herpes zoster (shingles)	1431	622 (43.5)	1119	530 (47.4)	<0.001
Pneumococcal (PPSV23)	1149	831 (72.3)	1000	744 (74.4)	<0.001
Tetanus (Td or Tdap)	1512	862 (57.0)	1166	662 (56.8)	<0.001
Cancer screening
Colorectal cancer	945	324 (34.3)	675	222 (32.9)	0.026
Breast cancer screening (mammogram)	517	215 (41.6)	340	153 (45.0)	0.777
Cervical cancer screening^*	116	64 (55.2)	75	46 (61.3)	0.357
PSA (prostate)^**	320	204 (63.8)	308	174 (56.5)	0.028
Other screening
Osteoporosis	317	120 (37.9)	231	103 (44.6)	<0.001
Hepatitis C	1179	275 (23.3)	861	249 (28.9)	<0.001
Alcohol misuse screening	1492	635 (42.6)	1161	696 (59.9)	<0.001
Depression screening	1279	661 (51.7)	954	649 (68.0)	<0.001
Tobacco use screening	1498	1266 (84.5)	1161	926 (79.8)	<0.001
Advance care planning	1234	97 (7.9)	1026	191 (18.6)	<0.001
Fulfillment of recommended preventive health services^‡	1513	47.5 (S.D. = 25.2)	1167	53.8 (S.D. = 25.8)	<0.001

↵*% females aged 65 and younger who are up to date on cervical cancer screening (pap smear and/or HPV testing).
↵**% males over age 70 (without prostate cancer, a previous elevated PSA in the past year, or a prescription for a 5-alpha reductase inhibitor) who received prostate specific antigen testing in the past year.
↵^‡% fulfillment of all recommended preventive health services listed in this table computed at the patient level [except for tetanus vaccination (since Medicare Part B does not routinely cover it) and PSA screening (a measure of overuse)] (maximum of n = 12 services).

View popup

Table 4.

Preventive Health Services Completion Among Eligible Patients by Completion of Annual Wellness Visits (at Baseline and 8 Months Post-Intervention Implementation)

Preventive Health Service	Baseline			8 Months Post-Implementation
Preventive Health Service	Completed AWV, % (n = 107)	Did Not Complete AWV, % (n = 1406)	p-Value	Completed AWV, % (n = 630)	Did Not Complete AWV, % (n = 537)	p-Value
Vaccinations
Influenza	55.1	55.9	0.249	62.7	56.3	0.036
Herpes zoster (shingles)	60.0	42.2	<0.001	53.5	39.9	<0.001
Pneumococcal (PPSV23)	85.1	71.2	0.004	83.2	63.4	<0.001
Tetanus (Td or Tdap)	74.8	55.7	<0.001	63.0	49.4	<0.001
Cancer screening
Colorectal cancer	22.2	35.1	0.037	37.5	27.7	0.006
Mammogram	48.8	41.0	0.331	49.5	39.5	0.065
Pap smear	100.0	54.0	0.113	77.4	50.0	0.014
PSA (prostate)	71.4	63.4	0.542	74.7	35.2	<0.001
Other screening
Osteoporosis	36.0	38.0	0.843	54.5	33.6	0.001
Hepatitis C	24.1	23.3	0.852	37.1	20.2	<0.001
Alcohol misuse screening	90.7	38.8	<0.001	91.4	23.0	<0.001
Depression screening	93.9	48.2	<0.001	97.5	33.8	<0.001
Tobacco use screening	89.7	84.1	0.122	86.4	71.9	<0.001
Advance care planning	10.1	7.7	0.388	27.4	7.5	<0.001
Fulfillment of recommended preventive health services^*	61.5	46.4	<0.001	65.7	39.7	<0.001

Abbreviation: AWV.
↵*% fulfillment of all recommended preventive health services listed in this table computed at the patient level [except for tetanus vaccination (since Medicare Part B does not routinely cover it) and PSA screening (a measure of overuse)] (maximum of n = 12 services).