Use of Electronic Health Records to Improve Maternal Vaccination
Use of Electronic Health Records to Improve Maternal Vaccination
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DOI：
10.1016/j.whi.2019.04.017
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发表时间：
2019-07-01
影响因子：
3.2
通讯作者：
Dempsey, Amanda F.
中科院分区：
文献类型：
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作者：
Brewer, Sarah E.;Barnard, Juliana;Dempsey, Amanda F.
简介：准确的产妇疫苗接种电子健康记录（EHR）文件是增加疫苗接种率的循证战略的重要组成部分。在一项更大的干预试验中，本研究评估了定制方案和免疫冠军对妇产科实践的产妇疫苗EHR文档的影响-包括管理，历史和参考-并试图了解临床工作人员对EHR文档中的障碍和解决方案的经验。方法：2012年和2014年，在干预前和干预后期间审查了产科患者图表（N = 275）的随机样本，以评估疫苗接种文件的变化。在干预期间和干预后对诊所工作人员进行了深入访谈，以评估临床提供者和工作人员使用EHR记录孕产妇疫苗活动的经验（N = 34次访谈）。结果：EHR中流感疫苗的任何疫苗接种活动的记录从27%提高到60%（p < .001），破伤风-白喉-无细胞百日咳疫苗的记录从13%提高到87%（p < .001）。文献的改进主要是在不可搜索的注释中，而不是在可搜索的领域（流感为52%，破伤风-白喉-无细胞百日咳为59%）。诊所工作人员报告的电子健康档案文件的障碍包括观念，输入疫苗信息到可搜索的领域是耗时的，可搜索的领域难以use.Conclusions：现有的电子健康档案结构化领域不满足产科提供者的需求，孕产妇免疫接种带来的挑战。我们建议妇产科实践与工作人员合作，制定有效的孕产妇疫苗接种文件协议，在选择EHR时测试可用性，并自定义警报，以有效地提醒临床工作人员避免警报疲劳。此外，我们建议，未来的工作解决需要改进孕产妇疫苗接种文件，以促进质量的提高，在妇产科设置。(C)2019年Jacobs Institute of Women’s Health。爱思唯尔公司出版
Introduction: Accurate electronic health record (EHR) documentation of maternal vaccination is an essential component of evidence-based strategies to increase vaccination uptake. Within a larger intervention trial, this study assessed the impact of tailored protocols and immunization champions on obstetrics-gynecology practices' EHR documentation of maternal vaccines-including administration, history, and refusals-and sought to understand clinical staffs experience of the barriers and solutions to documentation in the EHR.Methods: In 2012 and 2014, random samples of obstetric patient charts (N = 275) were reviewed during the pre-intervention and postintervention periods to assess changes in vaccination documentation. In-depth interviews with clinic staff were conducted during and after the intervention to evaluate the experience of clinical providers and staff in using the EHR to document maternal vaccine activities (N = 34 interviews). Analyses were conducted in 2015 and 2016.Results: Documentation of any vaccination activities in the EHR for influenza vaccine improved from 27% to 60% (p < .001) and from 13% to 87% (p < .001) for tetanus-diphtheria-acellular-pertussis vaccine. Documentation improvements were largely located in unsearchable notes rather than in searchable fields (52% for influenza, 59% for tetanus-diphtheria-acellular-pertussis). Barriers to EHR documentation reported by clinic staff included perceptions that inputting vaccine information into searchable fields was time consuming and that searchable fields were difficult to use.Conclusions: Existing EHR structured fields do not meet the needs of obstetric providers, posing challenges for maternal immunization. We recommend obstetrics-gynecology practices collaborate with staff to develop effective maternal vaccination documentation protocols, test usability when selecting an EHR, and customize alerts to balance effectively reminding clinical staff against alert fatigue. Further, we recommend that future work address the need for improved maternal vaccination documentation to facilitate quality improvement in obstetrics-gynecology settings. (C) 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.