Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia.
Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2018 Sep 7;1(5):e181770. doi: 10.1001/jamanetworkopen.2018.1770.
Influenza vaccination rates in the United States are suboptimal near 40%, but little is known about variations in care based on clinic appointment time.
To compare differences in influenza vaccination rates by clinic appointment time and to evaluate the association of an active choice intervention in the electronic health record with changes in vaccination rates.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective, quality improvement study of 11 primary care practices at the University of Pennsylvania Health System from September 1, 2014, to March 31, 2017. Participants included adults eligible for influenza vaccination. Data analysis was conducted from October 20, 2017, to March 9, 2018.
During the 2016 to 2017 influenza season, 3 primary care practices at the University of Pennsylvania Health System implemented an active choice intervention in the electronic health record that prompted medical assistants to ask patients about influenza vaccination during check-in and template vaccination orders for clinicians to review during the visit.
Influenza vaccination rates.
The sample comprised 96 291 patients with a mean (SD) age of 56.2 (17.0) years; 41 865 (43.5%) were men, 61 813 (64.2%) were white, and 23 802 (24.7%) were black. Among all practices across all 3 years, vaccination rates were approximately 44% from 8 am to 10 am, declined to 41.2% by 11 am and 38.3% at noon, increased to 40.2% at 1 pm, and then declined to 34.3% at 3 pm and 32.0% at 4 pm (P < .001 for adjusted linear trend). For the 3 years, vaccination rates were 46.9%, 47.2%, and 45.6% at control practices and 49.7%, 52.2%, and 59.3% at intervention practices, respectively. In adjusted analyses, compared with control practices over time, the active choice intervention was associated with a significant 9.5-percentage point increase in vaccination rates (95% CI, 4.1-14.3; P < .001). Vaccination rates increased similarly across times of the day.
Influenza vaccination rates significantly declined as the clinic day progressed. The active choice intervention was associated with a significant increase in influenza vaccination rates that were similar in magnitude throughout the day.
美国的流感疫苗接种率接近 40%，并不理想，但基于诊所预约时间的护理差异却鲜为人知。
通过比较诊所预约时间的差异，来比较流感疫苗接种率的差异，并评估电子病历中的主动选择干预措施与接种率变化的相关性。
设计、设置和参与者：这是一项回顾性、质量改进研究，共纳入了宾夕法尼亚大学卫生系统的 11 个初级保健诊所，时间为 2014 年 9 月 1 日至 2017 年 3 月 31 日。参与者包括符合流感疫苗接种条件的成年人。数据分析于 2017 年 10 月 20 日至 2018 年 3 月 9 日进行。
在 2016 至 2017 年流感季节，宾夕法尼亚大学卫生系统的 3 个初级保健诊所实施了电子病历中的主动选择干预措施，该措施促使医疗助理在登记时询问患者流感疫苗接种情况，并为临床医生在就诊期间审查接种订单生成模板。
流感疫苗接种率。
该样本包括 96291 名患者，平均（标准差）年龄为 56.2（17.0）岁；41865 名（43.5%）为男性，61813 名（64.2%）为白人，23802 名（24.7%）为黑人。在所有 3 年的所有实践中，从早上 8 点到 10 点的接种率约为 44%，上午 11 点下降到 41.2%，中午下降到 38.3%，下午 1 点上升到 40.2%，下午 3 点下降到 34.3%，下午 4 点下降到 32.0%（调整线性趋势，P<0.001）。在 3 年中，对照组的接种率分别为 46.9%、47.2%和 45.6%，干预组分别为 49.7%、52.2%和 59.3%。在调整分析中，与对照组相比，主动选择干预措施在时间上与接种率显著增加 9.5 个百分点（95%CI，4.1-14.3；P<0.001）相关。在一天中的不同时间，接种率的增加情况相似。
随着就诊日的推进，流感疫苗接种率显著下降。主动选择干预措施与流感疫苗接种率显著增加相关，全天的增幅相似。
