Evaluation of behavioral economic strategies to raise influenza vaccination rates across a health system: Results from a randomized clinical trial.
Evaluation of behavioral economic strategies to raise influenza vaccination rates across a health system: Results from a randomized clinical trial.
复制标题
对提高整个卫生系统流感疫苗接种率的行为经济策略的评估：随机临床试验的结果。
DOI：
10.1016/j.ypmed.2023.107474
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发表时间：
2023
影响因子：
5.1
通讯作者：
Lerner,
中科院分区：
文献类型：
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作者：
Szilagyi,PeterG;Casillas,Alejandra;Duru,OKenrik;Ong,MichaelK;Vangala,Sitaram;Tseng,Chi-Hong;Albertin,Christina;Humiston,SharonG;Ross,MindyK;Friedman,SarahR;Evans,Sharon;Sloyan,Michael;Bogard,JonathanE;Fox,CraigR;Lerner,
流感疫苗接种率很低。与美国大型卫生系统合作，我们使用电子健康记录的患者门户评估了三种卫生系统范围的干预措施，以提高流感疫苗接种率。我们在治疗组内采用嵌套析因设计进行了双臂随机对照试验，将患者随机分为常规护理对照(无门脉干预)或一个或多个门脉干预。我们在2020-2021年流感疫苗接种季节纳入了该卫生系统内的所有患者，该季节与新冠肺炎大流行重叠。通过患者门户，我们同时测试了：预先承诺消息(2020年9月发送，要求患者承诺接种)；每月门户提醒(2020年10月至12月)、直接预约安排(患者可以在多个地点自行安排流感疫苗接种)；预约前提醒消息(在预定的初级保健预约之前发送，提醒患者接种流感疫苗)。主要结果衡量标准是流感疫苗接种量(2020年10月1日至2021年3月31日)。我们随机选择了213,773名患者(196,070名18岁的成人≥，17,703名儿童)。流感疫苗接种率总体较低(39.0%)。研究组的疫苗接种率没有差异：对照组(38.9%)，预先承诺与不预先承诺(39.2%/38.9%)，直接预约是/否(39.1%/39.1%)，预约前提醒是/否(39.1%/39.1%)；所有比较p>；>0.017(经多次比较调整p值截止值)。在调整了年龄、性别、保险、种族、民族和以前接种流感疫苗后，所有干预措施都没有增加疫苗接种率。我们得出结论，在新冠肺炎大流行期间，患者门户网站提醒患者接种流感疫苗的干预措施并未提高流感免疫率。除了门户创新之外，还需要更密集或量身定制的干预措施来增加流感疫苗接种。
Influenza vaccination rates are low. Working with a large US health system, we evaluated three health system-wide interventions using the electronic health record's patient portal to improve influenza vaccination rates. We performed a two-arm RCT with a nested factorial design within the treatment arm, randomizing patients to usual-care control (no portal interventions) or to one or more portal interventions. We included all patients within this health system during the 2020–2021 influenza vaccination season, which overlapped with the COVID-19 pandemic. Through the patient portal, we simultaneously tested:pre-commitment messages(sent September 2020, asking patients to commit to a vaccination);monthly portal reminders(October – December 2020),direct appointment scheduling (patients could self-schedule influenza vaccination at multiple sites); andpre-appointment reminder messages(sent before scheduled primary care appointments, reminding patients about influenza vaccination). The main outcome measure was receipt of influenza vaccine (10/01/2020–03/31/2021). We randomized 213,773 patients (196,070 adults ≥18 years, 17,703 children). Influenza vaccination rates overall were low (39.0%). Vaccination rates for study arms did not differ: Control (38.9%), pre-commitment vs no pre-commitment (39.2%/38.9%), direct appointment scheduling yes/no (39.1%/39.1%), pre-appointment reminders yes/no (39.1%/39.1%);p> 0.017 for all comparisons (pvalue cut-off adjusted for multiple comparisons). After adjusting for age, gender, insurance, race, ethnicity, and prior influenza vaccination, none of the interventions increased vaccination rates. We conclude that patient portal interventions to remind patients to receive influenza vaccine during the COVID-19 pandemic did not raise influenza immunization rates. More intensive or tailored interventions are needed beyond portal innovations to increase influenza vaccination.