Fiks Alexander G, Hunter Kenya F, Localio A Russell, Grundmeier Robert W, Bryant-Stephens Tyra, Luberti Anthony A, Bell Louis M, Alessandrini Evaline A
Pediatric Generalist Research Group, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
Pediatrics. 2009 Jul;124(1):159-69. doi: 10.1542/peds.2008-2823.
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.
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.
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 (>or=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.
Clinical alerts were associated with only modest improvements in influenza vaccination rates.
评估流感疫苗临床警报对哮喘儿童及青少年疫苗接种错失机会以及总体流感免疫率的影响。
于2006年10月1日至2007年3月31日期间，对20个初级保健机构进行了一项前瞻性、整群随机试验。在干预机构，针对5至19岁患有哮喘且应接种疫苗的儿童，每次门诊就诊时都会出现基于电子健康记录的流感疫苗临床警报。在对相关协变量进行标准化处理后，将干预机构和对照机构就诊时捕获的免疫接种机会比例以及患者的完全接种总体率与上一年进行比较。该研究有超过80%的把握度检测出干预机构与对照机构在研究年份与基线年份之间接种率变化的8%差异。
研究年度共纳入23418次就诊和11919名儿童，上一年为21422次就诊和10667名儿童。大多数儿童为男性，年龄在5至9岁之间，且有私人保险。经过选定协变量的标准化处理后，干预机构捕获的疫苗接种机会从14.4%增至18.6%，对照机构从12.7%增至16.3%，干预机构的改善幅度高出0.3%。干预机构的标准化流感疫苗接种率比对照机构提高了3.4%以上。接种率增幅最大（≥11%）的4个机构均在干预组。在之前接种过疫苗的儿童、就诊次数增加的儿童、季节早期就诊的儿童以及预防性就诊而非急性病就诊的儿童中，疫苗接种情况更为常见。
临床警报仅使流感疫苗接种率有适度提高。
