Increasing the feasibility, impact, and equity of the Medicare Annual Wellness Visit (AWV) with a practice tailored AWV intervention: A stepped wedge clinical trial protocol

Older adults vastly underutilize evidence-based preventive health services and screenings that reduce illness, morbidity and mortality. The free-to-patient Medicare Annual Wellness Visit (AWV) is an opportunity to enhance preventive healthcare use, but also is underused. To evaluate the effect of a practice-tailored intervention on the sustained use of Medicare AWVs and on guideline-recommended preventive services and racial/ethnic disparities in 3 types of practice settings. This is a stepped wedge cluster randomized controlled trial. The intervention will be implemented at the practice level in 24 primary care practices across the country (8 community-based, 8 academic, and 8 serving medically underserved populations). Electronic health record data will be used to assess changes in AWV and preventive service delivery rates and racial, ethnic, and gender disparities. Semi-structured interviews will be conducted with clinicians/staff and patients, and clinicians will be surveyed to assess the process and acceptability of the intervention. The protocol is registered on clinicaltrials.gov (NCT05910736). Analyses will determine the effect of the intervention on AWV visit and preventive health services use at 12- and 24-months post-intervention implementation. Additional analyses will evaluate the effect of the intervention on reducing racial/ethnic disparities. A practice-tailored intervention has the potential to increase use of AWVs and preventive health services, and reduce racial/ethnic disparities, in diverse practice settings.