From the 2024 HVPA National Conference
Christine Rawlinson MSN (Johns Hopkins Community Physicians), Kellie Renich MSN, Nichole Jantzi MSHS, Maura Mcguire MD
Background:
Annual wellness visits (AWVs) are essential components of preventive care, aimed at assessing patients’ overall health and mitigating health risks before they escalate. Nationally, AWV completion rates among eligible adults remain low. In response to the increasing demand for comprehensive preventive services and the need to alleviate the burden on primary care practitioners (PCPs), the integration of registered nurses (RNs) to lead AWVs, incident to PCPs, has emerged as a promising intervention in team-based care. In addition to completing comprehensive assessments, RNs follow standard protocols to ensure follow-up of specified abnormalities, promoting continuity in the delivery of high-quality care.
Objective:
A standardized curriculum was developed at an academic, multi-site ambulatory care organization (ACO), to equip RNs with the skills and knowledge to complete AWVs and coordinate appropriate follow up for geriatric conditions (GC) identified during the visit. This abstract aims to explore the impact of standardized education on the RNs’ ability to complete comprehensive AWVs and its impact on care.
Methods:
A four-hour class was developed for ambulatory RNs. Content included (1) identification of eligible patients; (2) completion and interpretation of a Health Risk Assessment (HRA) questionnaire; (3) identification of and protocols for abnormal findings; (4) patient counseling and education; (5) “incident to” billing and documentation (6) provider communication. The class covered protocols for management of GCs and patient needs revealed in HRA responses, including advanced care planning, Timed-Up-and-Go Test or Mini-cog exam, referral to physical therapy or social work, or follow-up with the PCP. After class, at-the-elbow support was made available to RNs during initial patient visits. The program was approved by leadership and organizational compliance prior to implementation.
Results:
Between February 2023 and January 2024, thirty-three nurses attended the standardized training. Eleven nurses independently completed AWVs after completing the course. A total of 112 RN-led AWVs have been verified and billed by PCPs working with RNs who completed the course. A spot audit of 30 visits showed that 83% had one or more GCs or needs requiring follow-up, while 17% had no identified needs. Of patients with GCs, all but 3% were addressed according to protocols taught during the class. AWV completion was high at baseline and remained high after implementing RN-led AWVs (80% vs. 81%).
Conclusions:
Education targeting the unique skills of RNs was successfully developed and implemented. Level 1 evaluations showed that 88% of learners evaluated the class positively and there were no negative evaluations. While less than 1% of AWVs in the ACO have been RN-led, preliminary results indicate high levels of quality care and consistent approach to geriatric conditions suggested by the HRA. Adoption of RN-led AWVs represents a promising approach to enhancing comprehensive, interdisciplinary care and improved outcomes. Ambulatory care groups looking for approaches to improve the delivery of AWVs could consider adopting this model.
Clinical Implications:
The development of a comprehensive education program to integrate RN-led AWVs into primary care practices has positive clinical implications. It enables the RN to promote proactive and preventive care, leading to improved patient outcomes by the identification and coordination of additional care needs while alleviating the primary burden of responsibility from PCPs. Healthcare stakeholders should prioritize supporting and expanding the implementation of RN-led AWVs as a standard of care, recognizing their potential to transform healthcare delivery.