--- title: "Annual Wellness Visits: preventive visits in seniors. | Sutter Health" description: "Evaluated changes in preventive visit utilization with Medicare's Annual Wellness Visits, begun in 2011, how coverage expansion differentially affected seniors." url: "https://www.sutterhealth.org/research/publications/annual-wellness-visits-preventive-visits-in-seniors-1055312376" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Annual Wellness Visits: preventive visits in seniors. # Preventive visit among older adults with Medicare's introduction of Annual Wellness Visit: closing gaps in underutilization. Chung S, Romanelli RJ, Stults C, & Luft H. _Prev Med. https://doi.org/10.1016/j.ypmed.2018.08.018_ 2018-08-23 ## Abstract Preventive visit rates are low among older adults in the United States. We evaluated changes in preventive visit utilization with Medicare's introduction of Annual Wellness Visits (AWVs) in 2011. We further assessed how coverage expansion differentially affected older adults who were previously underutilizing the service. The study included Medicare beneficiaries aged 65 to 85 from a mixed-payer multispecialty outpatient healthcare organization in northern California between 2007 and 2016. Data from the electronic health records were used, and the unit of analysis was patient-year (N?=?456,281). Multivariable logistic regression models were used to assess determinants of “any preventive visit” use. Prior to the AWV coverage (2007–2010), Medicare beneficiaries who were older, with serious chronic conditions, and with a fee-for-services (FFS) plan underutilized preventive visits such that odds ratio (OR) for age groups (vs. age 65–69) ranges from 0.826 (age 70–74) to 0.522 (age 80–85); for Charlson comorbidity index (CCI) (vs. 0 CCI) ranges from 0.77 (1 CCI) to 0.65 (≥2 CCI); and for FFS (vs. HMO) is 0.236. With the Medicare coverage (2011–2016), the age-based gap reduced substantially, but the difference persisted, e.g., OR for age 80–85 (vs. 65–69) is 0.628, and FFS (vs. HMO) beneficiaries still have far lower odds of using a preventive visit (OR?=?0.278). The gap based on comorbidity was not reduced. Medicare's coverage expansion facilitated the use of preventive visit particularly for older adults with more advanced age or with FFS, thereby reducing disparities in preventive visit use. [PubMed abstract](https://www.sciencedirect.com/science/article/pii/S0091743518302494?showall%3Dtrue%26via%3Dihub) ![Cheryl Stults, Ph.D.](https://dyn.mktgcdn.com/p/3IhveEwq-t5WoqAzSNGeAr-4g4yrj4v7x1QcPGdCX_s/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Cheryl Stults, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/cheryl-stults-phd-1049681000) ## Research topics - [Aging and Longevity](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Aging+and+Longevity%5C%22%22) - [Health Disparities](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Disparities%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) - [Prevention and Health Maintenance](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Prevention+and+Health+Maintenance%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Atherosclerotic cardiovascular disease risk prediction in disaggregated Asian and Hispanic subgroups using electronic health records.](https://www.sutterhealth.org/research/publications/cvd-risk-prediction-in-asian-and-hispanic-subgroups-in-ehrs-1055312765) Rodriguez F, Chung S, Blum MR, Coulet A, Basu S, Palaniappan LP. J Am Heart Assoc. 8(14):e011874. doi: 10.1161/JAHA.118.011874. Epub 2019 Jul 11. 2019 Jul 16 - Publication ### [Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate.](https://www.sutterhealth.org/research/publications/medicare-preventive-care-in-fee-for-svce-pts-1055312874) Chung S, Lesser LI, Lauderdale DS, Johns NE, Palaniappan LP, Luft HS. Health Aff (Millwood). 34(1):11-20. doi: 10.1377/hlthaff.2014.0483. 2015 Jan 01 - Publication ### [Using citizen scientists to gather, analyze, and disseminate information about neighborhood features that affect active living.](https://www.sutterhealth.org/research/publications/use-citizen-scientists-gather-info-active-living-1055312885) Winter SJ, Goldman Rosas L, Padilla Romero P, Sheats JL, Buman MP, Baker C, King AC. J Immigr Minor Health. \[Epub ahead of print\] 2015 Jul 17 - Publication ### [Using electronic health record data to measure care quality for individuals with multiple chronic medical conditions.](https://www.sutterhealth.org/research/publications/ehr-care-quality-pts-mccs-1055312497) Bayliss EA, McQuillan DB, Ellis JL, Maciejewski ML, Zeng C, Barton MB, Boyd CM, Fortin M, Ling SM, Tai-Seale M, Ralston JD, Ritchie CS, Zulman DM. J Am Geriatr Soc. doi: 10.1111/jgs.14248. \[Epub ahead of print\] 2016 Jul 07 - Publication ### [Multiple locations of advance care planning documentation in an electronic health record: are they easy to find?](https://www.sutterhealth.org/research/publications/advance-care-planning-documents-in-ehr-locatable-1055312697) Wilson CJ, Newman J, Tapper S, Lai S, Cheng PH, Wu FM, Tai-Seale M. J Palliat Med. 16(9):1089-94. doi: 10.1089/jpm.2012.0472. Epub 2013 Jun 6. 2013 Sep 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/annual-wellness-visits-preventive-visits-in-seniors-1055312376#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Annual Wellness Visits: preventive visits in seniors."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/annual-wellness-visits-preventive-visits-in-seniors-1055312376#medicalscholarlyarticle","name":"Preventive visit among older adults with Medicare's introduction of Annual Wellness Visit: closing gaps in underutilization.","headline":"Annual Wellness Visits: preventive visits in seniors.","abstract":"Preventive visit rates are low among older adults in the United States. We evaluated changes in preventive visit utilization with Medicare's introduction of Annual Wellness Visits (AWVs) in 2011. We further assessed how coverage expansion differentially affected older adults who were previously underutilizing the service. The study included Medicare beneficiaries aged 65 to 85 from a mixed-payer multispecialty outpatient healthcare organization in northern California between 2007 and 2016. Data from the electronic health records were used, and the unit of analysis was patient-year (N?=?456,281). Multivariable logistic regression models were used to assess determinants of “any preventive visit” use. Prior to the AWV coverage (2007–2010), Medicare beneficiaries who were older, with serious chronic conditions, and with a fee-for-services (FFS) plan underutilized preventive visits such that odds ratio (OR) for age groups (vs. age 65–69) ranges from 0.826 (age 70–74) to 0.522 (age 80–85); for Charlson comorbidity index (CCI) (vs. 0 CCI) ranges from 0.77 (1 CCI) to 0.65 (≥2 CCI); and for FFS (vs. HMO) is 0.236. With the Medicare coverage (2011–2016), the age-based gap reduced substantially, but the difference persisted, e.g., OR for age 80–85 (vs. 65–69) is 0.628, and FFS (vs. HMO) beneficiaries still have far lower odds of using a preventive visit (OR?=?0.278). The gap based on comorbidity was not reduced. 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