Patel Mitesh S, Volpp Kevin G, Small Dylan S, Wynne Craig, Zhu Jingsan, Yang Lin, Honeywell Steven, Day Susan C
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
J Gen Intern Med. 2017 Jul;32(7):790-795. doi: 10.1007/s11606-017-4046-6. Epub 2017 Mar 23.
Despite the benefits of influenza vaccination, each year more than half of adults in the United States do not receive it.
To evaluate the association between an active choice intervention in the electronic health record (EHR) and changes in influenza vaccination rates.
Observational study.
Adults eligible for influenza vaccination with a clinic visit at one of three internal medicine practices at the University of Pennsylvania Health System between September 2010 and March 2013.
The EHR confirmed patient eligibility during the clinic visit and, upon accessing the patient chart, prompted the physician and their medical assistant to actively choose to "accept" or "cancel" an order for the influenza vaccine.
Change in influenza vaccination order rates at the intervention practice compared to two control practices for the 2012-2013 flu season, comparing trends during the prior two flu seasons adjusting for time trends and patient and clinic visit characteristics.
The sample (n = 45,926 patients) was 62.9% female, 35.9% white, and 54.4% black, with a mean age of 50.2 years. Trends were similar between practices during the 2 years in the pre-intervention period. Vaccination rates increased in both groups in the post-intervention year, but the intervention practice using active choice had a significantly greater increase than the control (adjusted difference-in-difference: 6.6 percentage points; 95% CI, 5.1-8.1; P < 0.001), representing a 37.3% relative increase compared to the pre-intervention period. More than 99.9% (9938/9941) of orders placed during the study period resulted in vaccination.
Active choice through the EHR was associated with a significant increase in influenza vaccination rates.
尽管流感疫苗接种有益，但美国每年仍有超过一半的成年人未接种。
评估电子健康记录（EHR）中的主动选择干预与流感疫苗接种率变化之间的关联。
观察性研究。
2010年9月至2013年3月期间，在宾夕法尼亚大学医疗系统的三家内科诊所之一就诊且符合流感疫苗接种条件的成年人。
EHR在诊所就诊期间确认患者是否符合条件，并在访问患者病历后，促使医生及其医疗助理主动选择“接受”或“取消”流感疫苗订单。
将干预诊所与两家对照诊所在2012 - 2013流感季节的流感疫苗接种订单率变化进行比较，并根据时间趋势、患者和诊所就诊特征，对前两个流感季节的趋势进行调整。
样本（n = 45926名患者）中女性占62.9%，白人占35.9%，黑人占54.4%，平均年龄为50.2岁。干预前两年各诊所的趋势相似。干预后一年两组的接种率均有所上升，但采用主动选择的干预诊所的增幅显著高于对照组（调整后的差异差值：6.6个百分点；95%可信区间，5.1 - 8.1；P < 0.001），与干预前相比相对增幅为37.3%。研究期间下达的订单中超过99.9%（9938/9941）导致了疫苗接种。
通过电子健康记录进行主动选择与流感疫苗接种率显著提高相关。
