Registered Nurse-Led Annual Wellness Visits in Rural Health Clinics: A Program Evaluation of a New Role

Purpose: The purpose this program evaluation was to explore the outcomes of a registered nurse-led annual wellness visit (AWV) intervention on AWV completion numbers as well as preventive care gap closures after the introduction of two primary care RNs to five northwestern Virginia rural health clinics (RHCs) and initiation of an RN-led AWV pilot.

Background/significance: The passage of the Patient Portability and Affordable Care Act had a goal of increasing access for preventive care. The Medicare annual wellness visit 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 healthcare access barriers and outcome disparities, and rural health clinics are a resource intended to increase access to health care in these disparate areas, but registered nurses are an underused resource in this setting. A literature review demonstrated an overall lack of studies on RN primary care roles. and no studies were found with a specific focus on these roles in federally designated rural health clinics.

Methods: This PRECEDE-PROCEED program evaluation examined the impact of RN-led AWVs on preventive care completion in 5 RHCs in northwestern Virginia.

Results: These visits increased access to primary care services 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 that had a statistically significantly lower rate than the 2019 Medicare local and national averages. Potential role sustainability was demonstrated with the new generated income (approximately $45,000 in 6 months) and productivity for the clinic.

Conclusions/implications: This program evaluation demonstrated an increase in patient access to preventive care services as well as helping to inform potential financial sustainability of the RN role in the rural health clinic care setting. Both the Institute for Healthcare Improvement and the Institute of Medicine’s Future of Nursing Report have compelled primary care redesign that focuses on continuity and care transitions across settings, preventive care, and the use of RNs at the top of scope practice to have an important role in this redesign. This evaluation was a means to explore patient and clinic outcomes from an RN-led, evidence-based intervention and serves as a foundational assessment to guide continued scholarly exploration of registered nursing interventions and care opportunities in various primary care settings.