Pre-Visit Planning:

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Pre-visit planning can identify and address gaps in care for patients who are physically present at the clinic. This tool is focused on identifying and addressing preventive and health maintenance gaps in care, leveraging a team-based approach.

Leverage team-based care and the electronic health record (EHR) to improve efficiency and minimize or eliminate paperwork as much as possible. Think about all the tasks involved and whether one needs a medical license to do it. If not, consider delegating that task to someone else on the care team besides the clinician. For example, one does not need a medical license to identify when patients are due for immunizations and to administer them, provided these are within the scope of practice for the individual and are an agreed upon clinic protocol.

These are not recommendations for care due; it is a starter list from which to choose what is right and doable at a given organization. High-functioning medical homes commit to identifying and addressing all gaps in care – chronic and preventive – regardless of the visit reason. This may be an aspirational goal to work towards. Actions to take to address all gaps in care should be very clear. The table below includes examples that can be customized to any practice. Add checklist items for special populations, such as newborns or pregnant patients.

Recognizing that there are reasons this may not work for all practices, a few suggestions are:

• Have someone on the care team complete a chart review of patients coming in for the day. This is sometimes called “scrubbing the chart” or “chart prep.” Make notes of the gaps in care – chronic care and preventive – for each patient. This takes time upfront but can ultimately be a big timesaver for both the practice and patient alike. It also can reduce the time and effort to conduct outreach to remind patients of services that are due after they leave the clinic.
• During the huddle, have the care team look at each patient's electronic chart together. Instead of noting what care is due on the paper huddle sheet, clarify what needs to be done to close the gaps in care for each patient – if the checklist is not already quite clear about these steps.
• Get standing orders and workflows in place to empower medical assistants (MAs) and nurses to enter orders (that may need to be signed by a licensed clinician) for care that is due prior to the patient's arrival and to facilitate or coordinate other aspects of closing gaps in care before, during and after the visit.

When engaging in pre-visit planning, many organizations include advising adult patients to bring their medications in a bag; having patients complete imaging, lab and other tests prior to their visit; ensuring that hospital and referral notes and results are in the chart; preparing rooms with equipment that may be needed for procedures; accommodating those with special needs (e.g., patient who needs an interpreter, disabled person, others who need special accommodations, etc.); gathering information or records for new patients; and more.

These are not care recommendations; any pre-visit planning checklists or activities must be reviewed and endorsed or approved by medical staff. Pre-visit planning checklists must be updated on an ongoing basis and at least annually as guidelines change and new evidence emerges.

COMMON PREVENTIVE AND HEALTH MAINTENANCE SERVICES

Updated January 1, 2024