Improving Immunization Delivery using an Electronic Health Record: The ImmProve Project

Abstract

Objective 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. Methods 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. Results 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 prior to their second birthday was significantly improved during the intervention period. Human papilloma virus (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 (CI): 1.12–1.56]); results for HPV and the composite of recommended immunizations were of a similar magnitude but not statistically significant. Conclusions 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.

Effect of Provider Prompts on Adolescent Immunization Rates: A Randomized Trial

“…11,12,[21][22][23][24] We conducted a randomized controlled trial in 2 practice-based research networks (PBRNs), an upstate New York network and a national network of pediatric continuity clinics, to evaluate the impact of provider prompts on adolescent immunization rates. We used communitybased participatory research methods for practitioners to reach a consensus on the intervention to be studied, which converged on provider prompts, and then conducted the intervention in both PBRNs.…”

Interventions to Improve HPV Vaccine Uptake: A Systematic Review

“…Inaccurate vaccine tracking resulting in missed vaccination opportunities were cited as potential barriers to intervention success. 59 Behavioral Interventions: Patient-and Provider-Targeted Interventions (n = 2)…”

Practice- and Community-Based Interventions to Increase Human Papillomavirus Vaccine Coverage

“…19–32 Characteristics are summarized in eTable 1 in the Supplement. Physician- and community-based interventions used a variety of approaches, including reminder and recall systems (n = 7), physician-focused interventions (n = 7), school-based programs (n = 2), and social marketing (n = 2).…”

“…Another randomized physician-focused intervention used the audit and feedback approach and found a nonsignificant increase in timeliness of HPV vaccination (27% increase). 19 Finally, evaluation of the AFIX approach that provided in-person or webinar consultations to vaccine coordinators in primary care clinics revealed significant short-term gains in coverage for the HPV vaccine among 11- to 12-year-olds but not among 13- to 18-year-olds. 25 Of the 5 programs that used quasiexperimental designs (pre-post analysis), 3 found increases in HPV vaccination rates, 20,22,28 1 did not observe an increase, 19 and 1 intervention had mixed results.…”