KEY ACTIVITY #6B:
Incorporate Preventive Activities into Acute Visits
This key activity involves the following elements of person-centered population-based care: operationalize clinical guidelines; behavioral health integration; address social needs.
Overview
Ensuring that prevention activities are incorporated into acute visit appointments expands access to care. This creates opportunities to build interventions that are responsive to patients’ and families’ needs and preferences for engaging in the health system.
For people with behavioral health conditions, behavioral health screening activities can be incorporated into acute visits, if such screenings are aligned with patient preferences.
Melding well-care activities into acute visits meets the patient and/or their family where they are and maximizes the value of their time in the clinic with a focus on prevention. A sizable percentage of a clinic’s patient population will only seek care when they require an acute visit, so it makes sense to provide as much opportunity for quality care during these visits as possible.
Patients and families who live in poverty and whose opportunities have been limited by disinvestment are likely to benefit from the ability to access preventive care when they are able to visit the clinic. For example, patients who balance competing demands may struggle to keep scheduled appointments and benefit from having the opportunity to engage in wellness care during a sick visit. Due to financial constraints, patients and their families may prioritize urgent care over routine or preventive care.
Screening at acute visits is one way for care teams to take a whole-person care approach. For people with behavioral health conditions, incorporating routine screening into acute visits ensures that all patients are screened for mental health and unhealthy substance use. Universal screening can support destigmatizing behavioral health needs. Furthermore, even when the patient identifies the presenting problem as physical, the visit often comprises a psychosocial dimension.
Clinical decision support to prompt the care team to attend to preventive care during all visits is an effective strategy. Ideally, these could be positioned to be available to the extended care team and not restricted to the medical clinician. Prompting strategies can be reinforced through the availability of care guideline-driven order sets and standing orders (see above) available in the EHR. Care quality and care gap reports, analyzed against visit history, can be utilized to track progress by clinician and care team in leveraging sick visit opportunities to meet guidelines. Pre-visit planning supports the identification of existing care gaps.
Action steps and roles
1. Use pre-visit planning.
Suggested team member(s) responsible: QI lead, care team lead, frontline staff.
Deploy a pre-visit planning process that includes a pre-visit checklist, incorporation of data from registries and care gap reports, and a staff huddle to identify which patients with scheduled acute visits are due for behavioral health screenings. See Key Activity 8: Develop or Refine and Implement a Pre-Visit Planning Process for more.
2. Empower rooming staff to engage patients in the decision to do the preventive care activity.
Suggested team member(s) responsible: Director or care team lead.
Aim to screen for depression, anxiety and unhealthy substance use during all acute visits, and make space to limit the number of screenings based on how sick an individual is feeling and their capacity to engage.
Screenings, especially behavioral health screenings, require rooming staff to read the room to decide whether to go ahead with the screening. Consider that screenings can lengthen a visit and/or raise topics that patients may not be prepared to tackle when feeling unwell. Care team leaders can empower rooming staff to offer screenings and to express the importance of patients’ own priorities, especially if patients feel limited by their time or are feeling too unwell to complete screenings.