The Medicare annual wellness visit: An opportunity to improve health system identification of hearing loss?

Background Hearing loss is prevalent and consequential but under‐diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient‐reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown. Methods We use 5 ye...

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Bibliographic Details
Published in:Journal of the American Geriatrics Society (JAGS) 2024-10, Vol.72 (10), p.3089-3097
Main Authors: Powell, Danielle S., Wu, Mingche M. J., Nothelle, Stephanie, Smith, Jamie M., Gleason, Kelly, Oh, Esther S., Lum, Hillary D., Reed, Nicholas S., Wolff, Jennifer L.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
annual wellness visit
Diagnosis
Documentation
Electronic Health Records
Electronic medical records
Female
hearing
Hearing loss
Hearing Loss - diagnosis
Hearing protection
Humans
Male
Medicare
Medicare - statistics & numerical data
Older people
Patients
Primary care
Primary Health Care - statistics & numerical data
Referral and Consultation - statistics & numerical data
Risk assessment
Risk Assessment - methods
United States
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Summary:Background Hearing loss is prevalent and consequential but under‐diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient‐reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown. Methods We use 5 years of electronic medical record (EMR) data (2017–2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (n = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care. Results Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, p = 0.01; 68.9% vs. 37.5%, p 
ISSN:0002-8614
1532-5415
1532-5415
DOI:10.1111/jgs.19111