Divisions of General Pediatrics and Epidemiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Acad Pediatr. 2013 Sep-Oct;13(5):458-65. doi: 10.1016/j.acap.2013.03.004. Epub 2013 Mar 14.
Though an essential pediatric preventive service, immunizations are challenging to deliver reliably. Our objective was to measure the impact on pediatric immunization rates of providing clinicians with electronic health record-derived immunization prompting.
Operating in a large, urban, hospital-based pediatric primary care clinic, we evaluated 2 interventions to improve immunization delivery to children ages 2, 6, and 13 years: point-of-care, patient-specific electronic clinical decision support (CDS) when children overdue for immunizations presented for care, and provider-specific bulletins listing children overdue for immunizations.
Overall, the proportion of children up to date for a composite of recommended immunizations at ages 2, 6, and 13 years was not different in the intervention (CDS active) and historical control (CDS not active) periods; historical immunization rates were high. The proportion of children receiving 2 doses of hepatitis A immunization before their second birthday was significantly improved during the intervention period. Human papillomavirus (HPV) immunization delivery was low during both control and intervention periods and was unchanged for 13-year-olds. For 14-year-olds, however, 4 of the 5 highest quarterly rates of complete HPV immunization occurred in the final year of the intervention. Provider-specific bulletins listing children overdue for immunizations increased the likelihood of identified children receiving catch-up hepatitis A immunizations (hazard ratio 1.32; 95% confidence interval 1.12-1.56); results for HPV and the composite of recommended immunizations were of a similar magnitude but not statistically significant.
In our patient population, with high baseline uptake of recommended immunizations, electronic health record-derived immunization prompting had a limited effect on immunization delivery. Benefit was more clearly demonstrated for newer immunizations with lower baseline uptake.
免疫接种虽是基本的儿科预防措施，但难以可靠实施。我们的目标是评估为临床医生提供电子健康记录（EHR）衍生的免疫接种提示对儿童免疫接种率的影响。
在一家大型城市医院儿科初级保健诊所中，我们评估了 2 种干预措施，以改善儿童（2、6 和 13 岁）的免疫接种服务：当免疫接种逾期的儿童就诊时，提供基于即时、患者特异性的电子临床决策支持（CDS），以及提供 Provider-Specific Bulletin，列出免疫接种逾期的儿童。
总体而言，在干预（CDS 激活）和历史对照（CDS 不激活）期，2 岁、6 岁和 13 岁儿童复合推荐免疫接种的最新比例无差异；历史免疫接种率较高。在干预期间，儿童在 2 岁生日前接受 2 剂甲型肝炎免疫接种的比例显著提高。HPV 免疫接种服务在对照和干预期间均较低，13 岁儿童未改变。然而，对于 14 岁儿童，干预最后一年有 4 个季度的 HPV 完全免疫接种率最高。列出免疫接种逾期儿童的 Provider-Specific Bulletin 增加了识别儿童接受甲型肝炎补种免疫接种的可能性（危险比 1.32；95%置信区间 1.12-1.56）；HPV 和推荐免疫接种的复合结果相似，但无统计学意义。
在我们的患者群体中，由于推荐免疫接种的基础接种率较高，EHR 衍生的免疫接种提示对免疫接种服务的影响有限。对于基础接种率较低的新疫苗，其效果更为明显。
