Longitudinal analysis of Annual Wellness Visit use among Medicare enrollees: Provider, enrollee, and clinic factors.

Jennifer L Gabbard, Ellis Beurle, Zhang Zhang, Erica L Frechman, Kristin Lenoir, Emilie Duchesneau, Michelle M Mielke, Amresh D Hanchate
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Abstract

Background: The utilization of Annual Wellness Visits (AWVs), preventive healthcare visits covered by Medicare Part B, has grown steadily since their inception in 2011. However, longitudinal patterns and variations in use across enrollees, providers, and clinics remain poorly understood.

Objective: This study aimed to analyze AWV usage trends from 2018 to 2022 among a sizable cohort of Medicare beneficiaries, employing electronic health record (EHR) data. The goal was to assess AWV frequency and explore variations across enrollees, providers, and clinics.

Design: This retrospective observational study utilized EHR data from Medicare beneficiaries aged 66 and above, receiving continuous primary care from 2018 to 2022 (N = 24,549). Enrollees were classified into three categories based on their AWV utilization over a 5-year period: low users (0-1 AWVs), moderate users (2-3 AWVs), and regular users (4-5 AWVs). AWV usage patterns were examined across individual demographics and provider/clinic characteristics using multilevel regression models.

Key results: Over the 2018-2022 period, 58.6% were regular AWV users, 27.7% were moderate users, and 13.7% were low users. Differences in primary care providers and clinics accounted for 56.4% (95% CI, 45.3%-66.9%) of the variation between low and regular users. Among enrollees who visited the same providers and clinics, individuals were less likely to be regular users of AWVs if they were 85 and older, Hispanic, from socioeconomically disadvantaged areas, or had multiple comorbidities.

Conclusions: The majority of Medicare beneficiaries in the study engaged with AWVs, with 86% having two or more over the 5-year period. These findings underscore the broad acceptance of AWVs among beneficiaries but also show that clinic and provider factors influence usage, especially among older, minoritized, and socioeconomically disadvantaged populations. Interventions at the provider and clinic levels are necessary to further improve AWV uptake, particularly for vulnerable groups.

对医疗保险参保者使用年度健康门诊的纵向分析:医疗服务提供者、参保者和诊所因素。
背景:年度健康门诊(AWVs)是医疗保险 B 部分承保的预防性保健门诊,自 2011 年推出以来,其使用率稳步增长。然而,人们对参保者、医疗服务提供者和诊所之间的纵向使用模式和差异仍知之甚少:本研究旨在利用电子健康记录 (EHR) 数据,分析 2018 年至 2022 年期间相当规模的医疗保险受益人群体中 AWV 的使用趋势。目标是评估 AWV 使用频率,并探索参保者、医疗服务提供者和诊所之间的差异:这项回顾性观察研究利用了 2018 年至 2022 年期间接受持续初级保健的 66 岁及以上医疗保险受益人的电子病历数据(N = 24,549)。根据参保者在 5 年内的 AWV 使用情况将其分为三类:低度使用者(0-1 次 AWV)、中度使用者(2-3 次 AWV)和经常使用者(4-5 次 AWV)。使用多层次回归模型对个人人口统计学特征和医疗服务提供者/诊所特征的 AWV 使用模式进行了研究:在 2018-2022 年期间,58.6% 的人经常使用 AWV,27.7% 的人中度使用,13.7% 的人低度使用。初级保健提供者和诊所的差异占低度使用者和定期使用者之间差异的 56.4%(95% CI,45.3%-66.9%)。在就诊于同一医疗机构和诊所的参保者中,如果年龄在 85 岁及以上、西班牙裔、来自社会经济条件较差的地区或患有多种并发症,则不太可能经常使用 AWV:本研究中的大多数医疗保险受益人都使用过自动售票机,其中 86% 的受益人在 5 年内使用过两次或两次以上自动售票机。这些研究结果表明,受益人广泛接受了AWV,但同时也表明,诊所和医疗服务提供者的因素会影响AWV的使用,尤其是在老年人、少数民族和社会经济条件较差的人群中。有必要在医疗服务提供者和诊所层面采取干预措施,以进一步提高预警系统的使用率,尤其是弱势群体的使用率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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