A Qualitative Study of a Pilot of Clinician Perspectives on the Delivery of Medicare Annual Wellness Visits for Patients with Dementia in an Academic Health Science Center in Texas.

Abstract

Background: Little is known about clinicians' perspectives on the process and outcomes of Medicare Annual Wellness Visits (AWVs) in Medicare beneficiaries with mild cognitive impairment (MCI) or Alzheimer's Disease and Related Dementias (ADRD).

Objectives: We sought clinicians' opinions on the impact of AWVs on health outcomes and disparity reduction for beneficiaries with MCI/ADRD.

Design: Institute for Healthcare Improvement's 4Ms framework of an age-friendly health system informed the design of this qualitative study of a pilot.

Methods: We used convenience sampling and recruited clinicians from a single academic-health-science center's catchment area in Texas, who billed for at least 1 AWV to participate in a one-time, one-on-one, semi-structured interview conducted via phone/Zoom. Participants verbally agreed to participate. This study met the federal regulations for a Quality Assessment project.

Results: We interviewed 26 clinicians (17 female; 26 non-Hispanic, 12 White, 10 Asian, 4 Black; 16 in family medicine and 5 in internal medicine). Most agreed AWVs improve health outcomes (n = 23, 88.5%) and reduce health disparities for Medicare beneficiaries with MCI/ADRD (n = 20, 76.9%). The top three "what works" themes were: (1) non-primary care providers (eg, wellness nurses) streamline AWV delivery by screening patients, providing resources/support, and sharing abnormal findings with primary care providers (PCPs); (2) PCPs do AWVs themselves to be in alignment with issues identified; and (3) sufficient time allotted to learn what matters most to patients and caregivers. The top three "what does not work" themes were: (1) clinicians desire having a family caregiver present; (2) clinicians need the full hour for in-depth screenings and holistic care; and (3) clinics need on-site social workers to address nonmedical issues.

Conclusions: Clinicians agreed that AWVs helped improve health outcomes and reduce health disparities. Tailoring AWV components by MCI/ADRD stage will optimize the visit, maximize health outcomes, and decrease disparities in access to care.