Impact of Electronic Health Record-Based Alerts on Influenza Vaccination for Children With Asthma
Impact of Electronic Health Record-Based Alerts on Influenza Vaccination for Children With Asthma
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DOI：
10.1542/peds.2008-2823
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发表时间：
2009-07-01
期刊：
影响因子：
8
通讯作者：
Alessandrini, Evaline A.
中科院分区：
文献类型：
--
作者：
Fiks, Alexander G.;Hunter, Kenya F.;Alessandrini, Evaline A.
目的：我们的目标是评估流感疫苗的临床警报错过的机会接种疫苗和整体流感疫苗接种率的儿童和青少年与asthene.METHODS的影响：前瞻性，群集随机试验的20个初级保健网站之间进行了2006年10月1日，2007年3月31日。在干预中心，对于5至19岁哮喘儿童，在所有门诊访视时都出现了基于电子健康记录的流感疫苗临床警报，这些儿童应接种疫苗。在对相关协变量进行标准化后，将干预和对照地点患者在访视时获得的免疫接种机会比例和完成疫苗接种的总体比率与前一年进行比较。该研究有>80%的权力，以检测8%的研究和基线年之间的变化率在干预与控制practices.RESULTS：共23 418访问和11 919名儿童被列入研究年和21 422访问和10 667名儿童在前一年。大多数儿童是5至9岁的男性，有私人保险。通过对选定协变量进行标准化，干预地点的疫苗接种机会从14.4%增加到18.6%，对照地点从12.7%增加到16.3%，提高了0.3%。干预点标准化流感疫苗接种率比对照点提高了3.4%。比率增加最多的4种做法（>= 11%）都在干预组。疫苗接收是更常见的儿童谁曾接种疫苗，随着访问数量的增加，在赛季初的护理，并在预防与急性护理visits.CONCLUSIONS：临床警报与流感疫苗接种率只有适度的改善。儿科2009;124：159-169
OBJECTIVE: The goal was to assess the impact of influenza vaccine clinical alerts on missed opportunities for vaccination and on overall influenza immunization rates for children and adolescents with asthma.METHODS: A prospective, cluster-randomized trial of 20 primary care sites was conducted between October 1, 2006, and March 31, 2007. At intervention sites, electronic health record-based clinical alerts for influenza vaccine appeared at all office visits for children between 5 and 19 years of age with asthma who were due for vaccine. The proportion of captured immunization opportunities at visits and overall rates of complete vaccination for patients at intervention and control sites were compared with those for the previous year, after standardization for relevant covariates. The study had >80% power to detect an 8% difference in the change in rates between the study and baseline years at intervention versus control practices.RESULTS: A total of 23 418 visits and 11 919 children were included in the study year and 21 422 visits and 10 667 children in the previous year. The majority of children were male, 5 to 9 years of age, and privately insured. With standardization for selected covariates, captured vaccination opportunities increased from 14.4% to 18.6% at intervention sites and from 12.7% to 16.3% at control sites, a 0.3% greater improvement. Standardized influenza vaccination rates improved 3.4% more at intervention sites than at control sites. The 4 practices with the greatest increases in rates (>= 11%) were all in the intervention group. Vaccine receipt was more common among children who had been vaccinated previously, with increasing numbers of visits, with care early in the season, and at preventive versus acute care visits.CONCLUSIONS: Clinical alerts were associated with only modest improvements in influenza vaccination rates. Pediatrics 2009;124:159-169