Dissertation/Thesis Abstract

Quality of Care in Nurse-led Medicare Wellness Visits
by Byers, Marcia A., Ph.D., University of Arkansas for Medical Sciences, 2017, 118; 10274067
Abstract (Summary)

Introduction/Purpose: The effectiveness of newly reimbursable nurse-led Medicare Annual Wellness Visits (AWVs) on point-of-care evidenced-based screening is unknown. The purpose of this study was to compare alcohol misuse screening, tobacco use screening, and smoking cessation between nurse-led preventive/wellness visits and visits led by physicians.

Background: Medicare wellness visits are intended to address prevention and early detection of diseases. In 2011, a Medicare expansion of services allowed reimbursement of nurse-led wellness visits at the same rates as physician-led visits. A network of primary care clinics utilized Registered Nurses (RNs), without advanced degrees, to conduct wellness visits.

Methods: This study retrospectively examined trends in preventive/wellness visits and compared rates of alcohol misuse screening, tobacco use screening, and smoking cessation, in patients who attended preventive/wellness visits conducted by RNs and visits conducted by physicians between 2011 and 2015. Electronic medical record (EMR) data were extracted from a network of primary care clinics in Arkansas.

Results: The number of preventive/wellness visits increased annually from 2011 through 2014, with a slight decrease in 2015. Screening completion was significantly related to the type of provider leading the visit, with patients in the RN-led group more likely to be screened for alcohol misuse (p<.001) and tobacco use (p <.001). Among patients who attended RN-led visits, 29.1% of prior smokers reported not smoking at their last visit compared to 18.2% in MD-led visits, but the finding was not statistically significant at the 5% level of confidence ( p=0.077). Patients’ attending RN-led visits had an increased probability of smoking cessation by almost 10 percentage points, but again, the finding was not statistically significant at conventional levels.

Discussion/Conclusion: Utilizing RNs to conduct Medicare Wellness Visits is an effective approach to increase clinical uptake of wellness visits and improve rates of recommended evidence-based screening. The findings also suggest that smoking cessation may be higher in patients that attend RN-led visits compared to MD-led visits; while not statistically significant, the findings are clinically relevant. As changes in health care policy continue to reshape practice models, additional research is needed to determine the full impact of enhanced RN roles in primary care settings.

Indexing (document details)
Advisor: Wright, Patricia
Commitee: Matthews, Ellyn, Mitchell, Anita, Nemeth, Lynne S., Tilford, J. Mick
School: University of Arkansas for Medical Sciences
Department: Nursing Science
School Location: United States -- Arkansas
Source: DAI-B 78/12(E), Dissertation Abstracts International
Source Type: DISSERTATION
Subjects: Nursing
Keywords: Annual wellness visits, Enhanced rn roles, Medicare wellness visits, Nurse-led visits, Quality improvement
Publication Number: 10274067
ISBN: 978-0-355-06726-2
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