ABSTRACT

We established a Geriatrics Workforce Enhancement Program (GWEP) clinic to enhance resident training on comprehensive preventive care and chronic disease management, and to increase the number of older patients who received Medicare Annual Wellness Visit (AWV) preventive services. A total of 1,104 patients were tracked at baseline and during the intervention period. Patients were grouped into two categories: Adult (aged 55–64) and Senior (aged 65+). Clinical quality measures were monitored by electronic health record and tracked through monthly reports at baseline (May 2018) and during the intervention period (July 2018-June 2019). In the Senior group, the proportion of patients receiving the Medicare AWV increased after GWEP began (p <.001). Additionally, the Senior group showed significant improvements in the frequency of body mass index assessments (p = .04), colorectal cancer screenings (p < .001), advance directive documentation (p < .001), cognitive screenings (p < .001), and pneumococcal vaccinations (p < .001). In the Adult group, a trending increase was seen in influenza vaccinations (p = .06). Curricular innovations including the establishment of a GWEP clinic in our residency outpatient center, development of new educational materials, and use of a nurse coordinator resulted in significant improvements in the percentage of older adults who received the Medicare AWV benefit and preventive health performance metrics.

摘要

我们建立了老年医学劳动力增强计划 (GWEP) 诊所，以加强住院医师对综合预防保健和慢性病管理的培训，并增加接受 Medicare 年度健康访问 (AWV) 预防服务的老年患者人数。在基线和干预期间共跟踪了 1,104 名患者。患者分为两类：成人（55-64 岁）和老年人（65 岁以上）。临床质量测量通过电子健康记录进行监测，并通过基线（2018 年 5 月）和干预期间（2018 年 7 月至 2019 年 6 月）的月度报告进行跟踪。在老年人组中，GWEP 开始后接受 Medicare AWV 的患者比例增加（p<.001)。此外，老年人组在体重指数评估 ( p = .04)、结直肠癌筛查 ( p < .001)、预先指示文件 ( p < .001)、认知筛查 ( p < .001) 的频率方面表现出显着改善) 和肺炎球菌疫苗接种 ( p < .001)。在成人组中，流感疫苗接种呈上升趋势（p= .06)。课程创新，包括在我们的住院门诊中心建立 GWEP 诊所、开发新的教育材料和使用护士协调员，显着提高了接受 Medicare AWV 福利和预防性健康绩效指标的老年人的百分比。