Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
J Gen Intern Med. 2022 Feb;37(3):615-623. doi: 10.1007/s11606-021-07023-w. Epub 2021 Sep 1.
Adult influenza vaccination rates are low. Tailored patient reminders might raise rates.
Evaluate impact of a health system's patient portal reminders: (1) tailored to patient characteristics and (2) incorporating behavioral science strategies, on influenza vaccination rates among adults.
Pragmatic 6-arm randomized trial across a health system during the 2019-2020 influenza vaccination season. The setting was one large health system-53 adult primary care practices.
All adult patients who used the patient portal within 12 months, stratified by the following: young adults (18-64 years, without diabetes), older adults (≥65 years, without diabetes), and those with diabetes (≥18 years).
Patients were randomized within strata to either (1) pre-commitment reminder alone (1 message, mid-October), (2) pre-commitment + loss frame messages, (3) pre-commitment + gain frame messages, (4) loss frame messages alone, (5) gain frame messages alone, or (6) standard of care control. Patients in the pre-commitment group were sent a message in mid-October, asking if they planned on getting an influenza vaccination. Patients in loss or gain frame groups were sent up to 3 portal reminders (late October, November, and December, if no documented influenza vaccination in the EHR) about importance and safety of influenza vaccine.
Receipt of 1 influenza vaccine from 10/01/2019 to 03/31/2020.
196,486 patients (145,166 young adults, 29,795 older adults, 21,525 adults with diabetes) were randomized. Influenza vaccination rates were as follows: for young adults 36.8%, for older adults 55.6%, and for diabetics 60.6%. On unadjusted and adjusted (for age, gender, insurance, race, ethnicity, and prior influenza vaccine history) analyses, influenza vaccination rates were not statistically different for any study group versus control.
Patient reminders sent by a health system's patient portal that were tailored to patient demographics (young adults, older adults, diabetes) and that incorporated two behavioral economic messaging strategies (pre-commitment and loss/gain framing) were not effective in raising influenza vaccination rates.
This trial was registered with ClinicalTrials.gov (NCT04110314).
成人流感疫苗接种率较低。有针对性的患者提醒可能会提高接种率。
评估医疗系统患者门户提醒的效果：（1）针对患者特征，（2）结合行为科学策略，对成年流感疫苗接种率的影响。
在 2019-2020 流感疫苗接种季节，在一个医疗系统中进行了一项实用的 6 臂随机试验。该环境是一个大型医疗系统-53 个成人初级保健诊所。
在 12 个月内使用患者门户的所有成年患者，分为以下几类：年轻成年人（18-64 岁，无糖尿病），老年人（≥65 岁，无糖尿病）和患有糖尿病（≥18 岁）的成年人。
患者在分层内随机分配到以下任何一组：（1）仅预先承诺提醒（1 条消息，10 月中旬），（2）预先承诺+损失框架消息，（3）预先承诺+收益框架消息，（4）仅损失框架消息，（5）仅收益框架消息，或（6）标准护理对照。预先承诺组的患者在 10 月中旬收到一条消息，询问他们是否计划接种流感疫苗。损失或收益框架组的患者最多会收到 3 次门户提醒（如果在 EHR 中未记录流感疫苗接种情况，则在 10 月下旬，11 月和 12 月），提醒他们流感疫苗的重要性和安全性。
从 10/01/2019 至 03/31/2020 期间接受 1 次流感疫苗。
共随机分配了 196,486 名患者（145,166 名年轻成年人，29,795 名老年人，21,525 名患有糖尿病的成年人）。流感疫苗接种率如下：年轻成年人为 36.8％，老年人为 55.6％，糖尿病患者为 60.6％。在未调整和调整（按年龄，性别，保险，种族，民族和既往流感疫苗接种史）分析中，与对照组相比，任何研究组的流感疫苗接种率均无统计学差异。
通过医疗系统的患者门户发送的针对患者人口统计学特征（年轻成年人，老年人，糖尿病）的患者提醒，并采用了两种行为经济学消息传递策略（预先承诺和损失/收益框架），并未有效提高流感疫苗接种率。
该试验已在 ClinicalTrials.gov（NCT04110314）注册。
