Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: A Randomized Controlled Trial
Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: A Randomized Controlled Trial
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DOI：
10.1007/s11606-017-4266-9
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发表时间：
2018-05-01
影响因子：
5.7
通讯作者：
Mazor, Kathleen M.
中科院分区：
文献类型：
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作者：
Cutrona, Sarah L.;Golden, Jessica G.;Mazor, Kathleen M.
通过电子健康记录（EHR）患者门户信息和交互式语音应答（IVR）呼叫向患者提供流感疫苗接种提醒，为改善患者护理提供了一种创新方法。测试门户网站和IVR外展在提高流感疫苗接种率方面的有效性。促进流感疫苗接种的EHR门户信息和IVR呼叫的随机对照试验。流感季节开始后2个月未记录流感疫苗接种的成年人（2014-2015年）。使用析因设计，我们将20,000名活跃的门户用户分配到四个研究组之一：(a)收到宣传流感疫苗的门户信息，(b)收到具有类似内容的IVR呼叫，(c) a和b都收到，或(d)两者都没有（常规护理）。我们将10,000名非门户用户随机分配到接收IVR呼叫或常规护理。在所有干预组中，如果目标患者未接种肺炎球菌疫苗，则包括肺炎球菌疫苗接种信息。在2015年4月测量的2014-2015年流感季节期间，ehr记录的流感疫苗接种情况。在门户网站用户中，14.0%（702人）接受门户网站信息和电话，13.4%（669人）接受信息，12.8%（642人）接受电话，11.6%（582人）接受常规护理的人接种了疫苗。在对门户用户的多变量分析中，单独接收门户信息（OR 1.20, 95% CI 1.06-1.35）或单独IVR呼叫（OR 1.15, 95% CI 1.02-1.30）的人比通常的护理接受者更有可能接种疫苗。那些同时收到短信和电话的人也比常规护理组更有可能接种疫苗（特别分析，使用Bonferroni校正：OR 1.29, 97.5% CI 1.13, 1.48）。在非门户用户中，8.5%的电话接受者和8.6%的常规护理接受者接种了流感疫苗（p = NS）。肺炎球菌疫苗接种率没有明显改善。我们的外联工作在流感疫苗接种率方面取得了微小但显著的改善。注册：ClinicalTrials.gov标识符NCT02266277 （https://clinicaltrials.gov/ct2/show/NCT02266277）。
Patient reminders for influenza vaccination, delivered via electronic health record (EHR) patient portal messages and interactive voice response (IVR) calls, offer an innovative approach to improving patient care.To test the effectiveness of portal and IVR outreach in improving rates of influenza vaccination.Randomized controlled trial of EHR portal messages and IVR calls promoting influenza vaccination.Adults with no documented influenza vaccination 2 months after the start of influenza season (2014-2015).Using a factorial design, we assigned 20,000 patients who were active portal users to one of four study arms: (a) receipt of a portal message promoting influenza vaccines, (b) receipt of IVR call with similar content, (c) both a and b, or (d) neither (usual care). We randomized 10,000 non-portal users to receipt of IVR call or usual care. In all intervention arms, information on pneumococcal vaccination was included if the targeted patient was overdue for pneumococcal vaccine.EHR-documented influenza vaccination during the 2014-2015 influenza season, measured April 2015.Among portal users, 14.0% (702) of those receiving both portal messages and calls, 13.4% (669) of message recipients, 12.8% (642) of call recipients, and 11.6% (582) of those with usual care received vaccines. On multivariable analysis of portal users, those receiving portal messages alone (OR 1.20, 95% CI 1.06-1.35) or IVR calls alone (OR 1.15 95% CI 1.02-1.30) were more likely than usual care recipients to be vaccinated. Those receiving both messages and calls were also more likely than the usual care group to be vaccinated (ad hoc analysis, using a Bonferroni correction: OR 1.29, 97.5% CI 1.13, 1.48). Among non-portal users, 8.5% of call recipients and 8.6% of usual care recipients received influenza vaccines (p = NS). Pneumococcal vaccination rates showed no significant improvement.Our outreach achieved a small but significant improvement in influenza vaccination rates.Registration: ClinicalTrials.gov Identifier NCT02266277 (https://clinicaltrials.gov/ct2/show/NCT02266277).