Veterans Health Administration, Bedford, MA, USA.
University of Massachusetts Medical School, Worcester, MA, USA.
J Gen Intern Med. 2018 May;33(5):659-667. doi: 10.1007/s11606-017-4266-9. Epub 2018 Jan 30.
Patient reminders for influenza vaccination, delivered via electronic health record (EHR) patient portal messages and interactive voice response (IVR) calls, offer an innovative approach to improving patient care.
To test the effectiveness of portal and IVR outreach in improving rates of influenza vaccination.
Randomized controlled trial of EHR portal messages and IVR calls promoting influenza vaccination.
Adults with no documented influenza vaccination 2 months after the start of influenza season (2014-2015).
Using a factorial design, we assigned 20,000 patients who were active portal users to one of four study arms: (a) receipt of a portal message promoting influenza vaccines, (b) receipt of IVR call with similar content, (c) both a and b, or (d) neither (usual care). We randomized 10,000 non-portal users to receipt of IVR call or usual care. In all intervention arms, information on pneumococcal vaccination was included if the targeted patient was overdue for pneumococcal vaccine.
EHR-documented influenza vaccination during the 2014-2015 influenza season, measured April 2015.
Among portal users, 14.0% (702) of those receiving both portal messages and calls, 13.4% (669) of message recipients, 12.8% (642) of call recipients, and 11.6% (582) of those with usual care received vaccines. On multivariable analysis of portal users, those receiving portal messages alone (OR 1.20, 95% CI 1.06-1.35) or IVR calls alone (OR 1.15 95% CI 1.02-1.30) were more likely than usual care recipients to be vaccinated. Those receiving both messages and calls were also more likely than the usual care group to be vaccinated (ad hoc analysis, using a Bonferroni correction: OR 1.29, 97.5% CI 1.13, 1.48). Among non-portal users, 8.5% of call recipients and 8.6% of usual care recipients received influenza vaccines (p = NS). Pneumococcal vaccination rates showed no significant improvement.
Our outreach achieved a small but significant improvement in influenza vaccination rates. Registration: ClinicalTrials.gov Identifier NCT02266277 ( https://clinicaltrials.gov/ct2/show/NCT02266277 ).
通过电子健康记录 (EHR) 患者门户消息和交互式语音应答 (IVR) 呼叫提供的患者提醒，为改善患者护理提供了一种创新方法。
测试门户和 IVR 外展在提高流感疫苗接种率方面的有效性。
EHR 门户消息和 IVR 呼叫促进流感疫苗接种的随机对照试验。
流感季节开始后 2 个月内无流感疫苗接种记录的成年人（2014-2015 年）。
使用析因设计，我们将 20000 名活跃门户用户分配到以下四个研究组之一：(a) 接收促进流感疫苗接种的门户消息，(b) 接收具有类似内容的 IVR 呼叫，(c) 同时接收 a 和 b，或 (d) 不接收（常规护理）。我们随机将 10000 名非门户用户分配到 IVR 呼叫或常规护理。在所有干预组中，如果目标患者需要接种肺炎球菌疫苗，则包括肺炎球菌疫苗接种信息。
2014-2015 年流感季节期间 EHR 记录的流感疫苗接种情况，于 2015 年 4 月进行测量。
在门户用户中，接受门户消息和电话的患者中有 14.0%（702 人）、接受消息的患者中有 13.4%（669 人）、接受电话的患者中有 12.8%（642 人）和接受常规护理的患者中有 11.6%（582 人）接种了疫苗。对门户用户进行多变量分析，单独接受门户消息（OR 1.20，95%CI 1.06-1.35）或单独接受 IVR 呼叫（OR 1.15，95%CI 1.02-1.30）的患者比接受常规护理的患者更有可能接种疫苗。同时接受消息和电话的患者也比常规护理组更有可能接种疫苗（即席分析，使用 Bonferroni 校正：OR 1.29，97.5%CI 1.13，1.48）。在非门户用户中，8.5%的呼叫接收者和 8.6%的常规护理接收者接种了流感疫苗（p=NS）。肺炎球菌疫苗接种率没有显著提高。
我们的外展工作使流感疫苗接种率略有但显著提高。注册：ClinicalTrials.gov 标识符 NCT02266277（https://clinicaltrials.gov/ct2/show/NCT02266277）。
