ORCID

https://orcid.org/0000-0002-7478-8406

Date of Graduation

12-17-2022

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice (DNP)

Department

School of Nursing

Advisor(s)

Jeannie Scruggs Corey

Jeffrey Feit

Abstract

The passage of the Patient Portability and Affordable Care Act had a goal of increasing access for preventive care. The Medicare Annual Wellness Visit (AWV) has been a free yearly, comprehensive preventive care opportunity for most Medicare beneficiaries since 2011. Because of the time intensive nature of these visits, the overall national completion rate for them has been low as providers often perceive time and resource constraints. Registered Nurses (RNs) have the skill set to complete these visits with minimal provider involvement. Rural residents often face health care access barriers and outcome disparities, and Rural Health Clinics (RHCs) are a resource intended to increase access to health care in these disparate areas, but Registered Nurses are an underused resource in this setting. This program evaluation examined the impact of RN-led AWVs on preventive care completion in 5 RHCs in northwestern Virginia. These visits increased access to primary care while closing gaps in screening and preventive care including breast and colon cancer screenings with 66.7% and 45.8% completion rates after the visit. The visits also demonstrated emergency department encounters and hospital admission rates (19.9% and 8.8%) that were lower than the 2018 Medicare national average (27% and 15%). Potential role sustainability was demonstrated with the new generated income (approximately $45,000 in 6 months) and productivity for the clinic.

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