Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: A Randomized Controlled Trial

Cutrona, Sarah L.; Golden, Jessica G.; Goff, Sarah L.; Ogarek, Jessica; Barton, Bruce; Fisher, Lloyd D.; Preusse, Peggy; Sundaresan, Devi; Garber, Lawrence; Mazor, Kathleen M.

doi:10.1007/s11606-017-4266-9

Cited by 32 publications

(31 citation statements)

References 21 publications

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“…Relatively low rates of self-reported vaccination completion may also be attributable to the timing of our outreach—intentionally positioned at the start of the flu season. In contrast, our past work [ 26 ] captured much higher proportions of self-reported vaccinations (2591/20,000 intervention patients) when participants were approached several months past the start of flu season, which highlights the importance of asking patients to self-report vaccinations administered outside the clinic.…”

Section: Discussionmentioning

confidence: 79%

“…We conducted a nonblinded randomized controlled intervention (NCT02266277) at a large multispecialty medical group in central Massachusetts. Previously, our team developed and tested interactive voice response and portal outreach which we targeted to patients who had no documented vaccination 2 months after the start of the season [ 25 , 26 ]; this study adapted our previous approach, targeting a broader population in early September in order to promote early vaccination and provide information on September and October flu clinic dates.…”

Section: Methodsmentioning

confidence: 99%

“…This study consisted of interactive voice response or portal-based outreach. Qualitative interviews conducted with patients, physicians, nurses, and staff informed the development of our outreach material [ 25 , 26 ].…”

Section: Methodsmentioning

confidence: 99%

“…Clinical decision support has been shown to improve health outcomes by supporting the delivery of timely, evidence-based and guideline-concordant medical care, including annual vaccinations [ 24 - 26 ]. Clinical decision support includes computerized reminders both to providers and patients.…”

Section: Introductionmentioning

confidence: 99%

“…Previous patient outreach interventions have been shown to improve rates of vaccination completion and have been tested using multiple options including mailed letters, postcards, live phone calls, automated phone messages, and combination postcard/phone-based [ 39 , 40 ]. Few studies have tested the use of patient-directed vaccination reminders sent via patient portals [ 25 , 26 , 41 ].…”

Section: Introductionmentioning

confidence: 99%

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Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial

Wijesundara¹,

Fukunaga²,

Ogarek³

et al. 2020

J Med Internet Res

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Background Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. Objective The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. Methods Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record–documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. Results Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (P=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) of usual care had documented vaccinations (P=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%), and over half of interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) responded to a similar question. Conclusions Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. Trial Registration ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277

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Section: Discussionmentioning

confidence: 79%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial

Wijesundara¹,

Fukunaga²,

Ogarek³

et al. 2020

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

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Effect of Patient Portal Reminders Sent by a Health Care System on Influenza Vaccination Rates

Szilâgyi

Albertin

Casillas³

et al. 2020

JAMA Intern Med

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Effect of Electronic Outreach Using Patient Portal Messages on Well Child Care Visit Completion

Berset

Burkhardt

et al. 2022

JAMA Netw Open

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ImportanceOutreach messages to patients overdue for well child care (WCC) can be delivered different ways (ie, telephone calls and text messages). Use of electronic health record patient portals is increasingly common but their effectiveness is uncertain.ObjectiveTo determine the effectiveness of patient portal outreach messages, with and without the date of the last WCC, on the scheduling and completion of WCC visits and completion of vaccinations.Design, Setting, and ParticipantsAn intention-to-treat, multigroup, randomized clinical trial was conducted at 3 academic primary care practices from July 30 to October 4, 2021. The population included predominantly non-Hispanic Black, low-income children (age, 6-17 years) whose parent had an active portal account.InterventionsParticipants were randomized to the standard message, tailored message, or no message (control) group. Two messages were delivered to those in the message groups.Main Outcomes and MeasuresOutcomes included WCC visit scheduled within 2 weeks of the first intervention message, WCC visit completed within 8 weeks (primary outcome), and receipt of COVID-19 vaccine within 8 weeks.ResultsNine hundred forty-five patients participated (mean [SD] age, 9.9 [3.3] years, 493 [52.2%] girls, 590 [62.4%] non-Hispanic Black, 807 [85.4%] publicly insured). Scheduling rates were 18.4% in the standard message group (adjusted risk ratio [aRR], 1.97; 95% CI, 1.32-2.84) and 14.9% in the tailored message group (aRR, 1.57; 95% CI, 1.02-2.34) compared with the control group (9.5%). Well child care visit completion rates were 24.1% in the standard message group (aRR, 1.92; 95% CI, 1.38-2.60) and 19.4% in the tailored message group (aRR, 1.52; 95% CI, 1.06-2.13) compared with the control group (12.7%). Among eligible children, rates of receiving the COVID-19 vaccine were 16.7% in the standard message group compared with 4.8% in the tailored message (aRR, 3.41; 95% CI, 1.14-9.58) and 3.7% in the control groups (aRR, 4.84; 95% CI, 1.44-15.12).Conclusions and RelevanceIn this randomized clinical trial, outreach messages delivered via electronic health record patient portals increased the rates of scheduling and completing WCC visits and receiving the COVID-19 vaccine, providing a useful tool to help restore WCC in populations whose care was delayed during the pandemic.Trial RegistrationClinicalTrials.gov Identifier: NCT04994691

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Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: A Randomized Controlled Trial

Abstract: Our outreach achieved a small but significant improvement in influenza vaccination rates. Registration: ClinicalTrials.gov Identifier NCT02266277 ( https://clinicaltrials.gov/ct2/show/NCT02266277 ).

Cited by 32 publications

References 21 publications

Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial

Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial

Effect of Patient Portal Reminders Sent by a Health Care System on Influenza Vaccination Rates

Effect of Electronic Outreach Using Patient Portal Messages on Well Child Care Visit Completion

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