Improving Rates of Influenza Vaccination Through Electronic Health Record Portal Messages, Interactive Voice Recognition Calls and Patient-Enabled Electronic Health Record Updates: Protocol for a Randomized Controlled Trial
Improving Rates of Influenza Vaccination Through Electronic Health Record Portal Messages, Interactive Voice Recognition Calls and Patient-Enabled Electronic Health Record Updates: Protocol for a Randomized Controlled Trial
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DOI：
10.2196/resprot.5478
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发表时间：
2016-04-01
影响因子：
1.7
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.;Sreedhara, Meera;Mazor, Kathleen M.
背景：临床决策支持(CDS)，包括对提供者和患者的计算机提醒，可以改善健康结果。促进流感疫苗接种的CDS通过电子健康记录(EHR)患者门户和交互式语音识别(IVR)呼叫直接传递给患者，提供了一种改善患者护理的创新方法。目的：在马萨诸塞州中部的一个大型多专科小组实践中测试EHR患者门户和IVR扩展对提高流感疫苗接种率的有效性。方法：我们描述了一项旨在促进流感疫苗接种的非盲目随机对照试验。在我们的准备阶段，我们对患者、提供者和工作人员进行了定性访谈，以告知使用嵌入式问卷和IVR呼叫脚本开发EHR门户消息。我们还向所有医生和工作人员提供了关于流感疫苗的全业务教育，包括关于现有疫苗特定EHR CDS的信息。外展将针对在流感季节开始后仍未接种疫苗两个月以上的成年患者。利用计算机生成的随机化和析因设计，我们将20,000名活跃使用电子患者门户的患者分配到4个研究分支中的一个：(1)收到宣传流感疫苗和提供在线预约安排的门户消息；(2)收到内容相似但没有预约便利的IVR电话；(3)(1)和(2)两者；或(4)既不(1)也不(2)(常规护理)。我们将把没有电子门户的患者(10,000名患者)随机分为(1)接受IVR呼叫或(2)常规护理。门户消息和IVR呼叫都促进了流感疫苗的完成。我们的主要结果是2014-15年流感季节按我们的团体实践接种流感疫苗的合格患者的百分比。这两种外展方法还要求患者自我报告在诊所外完成的流感疫苗接种或流感疫苗接种的障碍。来自两种外展模式的自我报告数据将被上传到EHR，以提高现有提供者指导的EHR CDS(疫苗警报)的准确性。结果：在我们建议的样本量下，使用析因设计，使用基线疫苗接种率估计进行的功率计算表明，每臂4286名参与者将提供80%的力量来检测组间流感疫苗接种率3%的改善(阿尔法=0.05；双侧)。将进行意向治疗未经调整的卡方分析，以评估门户信息单独或与IVR呼叫结合使用对流感疫苗接种率的影响。该项目于2014年1月获得资金。本文所述项目的患者登记工作已于2014年12月完成。数据分析目前正在进行中，第一批结果有望于2016年提交发表。结论：如果成功，这项研究的干预措施可能会被其他大型卫生保健组织采用，以提高其合格患者的疫苗接种率。
Background: Clinical decision support (CDS), including computerized reminders for providers and patients, can improve health outcomes. CDS promoting influenza vaccination, delivered directly to patients via an electronic health record (EHR) patient portal and interactive voice recognition (IVR) calls, offers an innovative approach to improving patient care.Objective: To test the effectiveness of an EHR patient portal and IVR outreach to improve rates of influenza vaccination in a large multispecialty group practice in central Massachusetts.Methods: We describe a nonblinded, randomized controlled trial of EHR patient portal messages and IVR calls designed to promote influenza vaccination. In our preparatory phase, we conducted qualitative interviews with patients, providers, and staff to inform development of EHR portal messages with embedded questionnaires and IVR call scripts. We also provided practice-wide education on influenza vaccines to all physicians and staff members, including information on existing vaccine-specific EHR CDS. Outreach will target adult patients who remain unvaccinated for more than 2 months after the start of the influenza season. Using computer-generated randomization and a factorial design, we will assign 20,000 patients who are active users of electronic patient portals to one of the 4 study arms: (1) receipt of a portal message promoting influenza vaccines and offering online appointment scheduling; (2) receipt of an IVR call with similar content but without appointment facilitation; (3) both (1) and (2); or (4) neither (1) nor (2) (usual care). We will randomize patients without electronic portals (10,000 patients) to (1) receipt of IVR call or (2) usual care. Both portal messages and IVR calls promote influenza vaccine completion. Our primary outcome is percentage of eligible patients with influenza vaccines administered at our group practice during the 2014-15 influenza season. Both outreach methods also solicit patient self-report on influenza vaccinations completed outside the clinic or on barriers to influenza vaccination. Self-reported data from both outreach modes will be uploaded into the EHR to increase accuracy of existing provider-directed EHR CDS (vaccine alerts).Results: With our proposed sample size and using a factorial design, power calculations using baseline vaccination rate estimates indicated that 4286 participants per arm would give 80% power to detect a 3% improvement in influenza vaccination rates between groups (alpha=.05; 2-sided). Intention-to-treat unadjusted chi-square analyses will be performed to assess the impact of portal messages, either alone or in combination with the IVR call, on influenza vaccination rates. The project was funded in January 2014. Patient enrollment for the project described here completed in December 2014. Data analysis is currently under way and first results are expected to be submitted for publication in 2016.Conclusions: If successful, this study's intervention may be adapted by other large health care organizations to increase vaccination rates among their eligible patients.