TY - JOUR
T1 - Effect of provider prompts on adolescent immunization rates
T2 - A randomized trial
AU - Szilagyi, Peter G.
AU - Serwint, Janet R.
AU - Humiston, Sharon G.
AU - Rand, Cynthia M.
AU - Schaffer, Stanley
AU - Vincelli, Phyllis
AU - Dhepyasuwan, Nui
AU - Blumkin, Aaron
AU - Albertin, Christina
AU - Curtis, C. Robinette
N1 - Funding Information:
A portion of this paper was presented at the 2014 Pediatric Academic Societies annual meeting, Vancouver, BC, May 3–6, 2014. This study was funded by the US Centers for Disease Control and Prevention (grant 5U011P000312 ). A nonoverlapping portion of the overall study was published in Clinical Pediatrics 2013;52:706–716. We appreciate the collaboration of the physicians and staff at the participating primary care practices. We also appreciate the thoughtful reviewer critiques, which improved the article substantially.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Objective Adolescent immunization rates are suboptimal. Experts recommend provider prompts at health care visits to improve rates. We assessed the impact of either electronic health record (EHR) or nurse- or staff-initiated provider prompts on adolescent immunization rates. Methods We conducted a randomized controlled trial, allocating practices in 1 of 2 practice-based research networks (PBRN) to provider prompts or standard-of-care control. Ten primary care practices participated, 5 intervention and 5 controls, each matched in pairs on urban, suburban, or rural location and practice type (pediatric or family medicine), from a PBRN in Greater Rochester, New York (GR-PBRN); and 12 practices, 6 intervention, 6 controls, similarly matched, from a national pediatric continuity clinic PBRN (CORNET). The study period was 1 year per practice, ranging from June 2011 to January 2013. Study participants were adolescents 11 to 17 years attending these 22 practices; random sample of chart reviews per practice for baseline and postintervention year to assess immunization rates (n = 7,040 total chart reviews for adolescents with >1 visit in a period). The intervention was an EHR prompt (4 GR-PBRN and 5 CORNET practice pairs) (alert) that appeared on providers' computer screens at all office visits, indicating the specific immunizations that adolescents were recommended to receive. Staff prompts (1 GR-PBRN pair and 1 CORNET pair) in the form of a reminder sheet was placed on the provider's desk in the exam room indicating the vaccines due. We compared immunization rates, stratified by PBRN, for routine vaccines (meningococcus, pertussis, human papillomavirus, influenza) at study beginning and end. Results Intervention and control practices within each PBRN were similar at baseline for demographics and immunization rates. Immunization rates at the study end for adolescents who were behind on immunizations at study initiation were not significantly different for intervention versus control practices for any vaccine or combination of vaccines. Results were similar for each PBRN and also when only EHR-based prompts was assessed. For example, at study end, 3-dose human papillomavirus vaccination rates for GR-PBRN intervention versus control practices were 51% versus 53% (adjusted odds ratio 0.96; 95% confidence interval 0.64-1.34); CORNET intervention versus control rates were 50% versus 42% (adjusted odds ratio 1.06; 95% confidence interval 0.68-1.88). Conclusions and Relevance: In both a local and national setting, provider prompts failed to improve adolescent immunization rates. More rigorous practice-based changes are needed.
AB - Objective Adolescent immunization rates are suboptimal. Experts recommend provider prompts at health care visits to improve rates. We assessed the impact of either electronic health record (EHR) or nurse- or staff-initiated provider prompts on adolescent immunization rates. Methods We conducted a randomized controlled trial, allocating practices in 1 of 2 practice-based research networks (PBRN) to provider prompts or standard-of-care control. Ten primary care practices participated, 5 intervention and 5 controls, each matched in pairs on urban, suburban, or rural location and practice type (pediatric or family medicine), from a PBRN in Greater Rochester, New York (GR-PBRN); and 12 practices, 6 intervention, 6 controls, similarly matched, from a national pediatric continuity clinic PBRN (CORNET). The study period was 1 year per practice, ranging from June 2011 to January 2013. Study participants were adolescents 11 to 17 years attending these 22 practices; random sample of chart reviews per practice for baseline and postintervention year to assess immunization rates (n = 7,040 total chart reviews for adolescents with >1 visit in a period). The intervention was an EHR prompt (4 GR-PBRN and 5 CORNET practice pairs) (alert) that appeared on providers' computer screens at all office visits, indicating the specific immunizations that adolescents were recommended to receive. Staff prompts (1 GR-PBRN pair and 1 CORNET pair) in the form of a reminder sheet was placed on the provider's desk in the exam room indicating the vaccines due. We compared immunization rates, stratified by PBRN, for routine vaccines (meningococcus, pertussis, human papillomavirus, influenza) at study beginning and end. Results Intervention and control practices within each PBRN were similar at baseline for demographics and immunization rates. Immunization rates at the study end for adolescents who were behind on immunizations at study initiation were not significantly different for intervention versus control practices for any vaccine or combination of vaccines. Results were similar for each PBRN and also when only EHR-based prompts was assessed. For example, at study end, 3-dose human papillomavirus vaccination rates for GR-PBRN intervention versus control practices were 51% versus 53% (adjusted odds ratio 0.96; 95% confidence interval 0.64-1.34); CORNET intervention versus control rates were 50% versus 42% (adjusted odds ratio 1.06; 95% confidence interval 0.68-1.88). Conclusions and Relevance: In both a local and national setting, provider prompts failed to improve adolescent immunization rates. More rigorous practice-based changes are needed.
KW - EHR
KW - HPV
KW - Tdap
KW - adolescent immunization
KW - influenza
KW - meningococcal
KW - outreach
KW - provider prompt
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U2 - 10.1016/j.acap.2014.10.006
DO - 10.1016/j.acap.2014.10.006
M3 - Article
C2 - 25748976
AN - SCOPUS:84924361595
SN - 1876-2859
VL - 15
SP - 149
EP - 157
JO - Academic Pediatrics
JF - Academic Pediatrics
IS - 2
ER -