Measuring the Effects of Reminders for Outpatient Influenza Immunizations at the Point of Clinical Opportunity

Abstract

To evaluate the influence of computer-based reminders about influenza vaccination on the behavior of individual clinicians at each clinical opportunity. Design:The authors conducted a prospective study of clinicians' influenza vaccination behavior over four years. Approximately one half of the clinicians in an internal medicine clinic used a computer-based patient record system (CPR users) that generated computer-based reminders. The other clinicians used traditional paper records (PR users).Measurements: Each nonacute visit by a patient eligible for an influenza vaccination was considered an opportunity for intervention. Patients who had contraindications for vaccination were excluded. Compliance with the guideline was defined as documentation that a clinician ordered the vaccine, counseled the patient about the vaccine, offered the vaccine to a patient who declined it, or verified that the patient had received the vaccine elsewhere. The authors calculated the proportion of opportunities on which each clinician documented action in the CPR and PR user groups. Results:The CPR and PR user groups had different baseline compliance rates (40.1 and 27.9 per cent, respectively; P < 0.05). Both rates remained stable during a two-year baseline period (P = 0.34 and P = 0.47, respectively). The compliance rates in the CPR user group increased 78 per cent from baseline (P < 0.001), whereas the rates for the PR user group did not change significantly (P = 0.18). Conclusions:Clinicians who used a CPR with reminders had higher rates of documentation of compliance with influenza-vaccination guidelines than did those who used a paper record. Measurements of individual clinician behavior at the point of each clinical opportunity can provide precise evaluation of interventions that are designed to improve compliance with guidelines.

Impact of EHR-Based Clinical Decision Support on Adherence to Guidelines for Patients on NSAIDs: A Randomized Controlled Trial

“…In fact, this is not the fi rst study to fi nd little benefi t from EHRbased clinical decision support. Although EHR-based reminders and prompts have generally shown a positive impact on preventive care measures, 12,14,[29][30][31][32][33][34][35][36][37][38][39][40] the results seen for management of chronic diseases have been more mixed. 14,41 Several studies have found benefi ts for diabetes care, 12,[42][43][44][45] appropriate prescribing for patients with hypertension, 46 and management of osteoporosis.…”

Impact of Decision Support in Electronic Medical Records on Lipid Management in Primary Care

“…These results may seem surprising, given that EMR interventions have been shown to improve preventive care, 13,14,16,17,19 and several studies have suggested improvements in chronic diseases such as diabetes. 18,19 Although a small study in a single cardiology office found both lipid testing and lipids at goal to increase after implementation of an EMR with disease management, 27,28 the study did not have a control group, and it is unclear how much of the improvement was due to improved documentation.…”

“…[4][5][6][7][8][9][10][11][12] One promising approach to improving care in clinical practice is through the use of electronic medical records (EMRs). Studies have found that EMRs improve preventive care [13][14][15][16][17] including lipid testing. 16,[18][19][20][21] However, recent studies have suggested that an EMR by itself may not necessarily lead to improved quality of care for chronic conditions.…”

Use of medical informatics for management of multiple sclerosis using a chronic-care model

“…Today, EMRs have an expanded purpose: "to recall observations, to inform others, to instruct students, to gain knowledge, to monitor performance and to justify interventions" [27]. The use of EMR systems results in more complete documentation that more effectively describes the appropriateness of clinical decisions as compared with paper record keeping [28]. Such systems are also more effective tools for provider behavior change [30].…”

“…CCRs promote evidence-based care for veterans with MS by suggesting appropriate interventions based on synthesized patient data (e.g., ICD codes, past interventions, laboratory results, and previous level of health) in underlying databases. This approach has been well evaluated for its role in improving rates of preventive health screening such as mammograms, vaccinations, and screening questionnaires [28][29][30][31]. CCRs have received less study for use in chronic care, but evaluations show that CCRs can help keep clinicians better "informed" and facilitate practice consistent with clinical practice guidelines in the management of chronic diseases such as diabetes [4][5][30][31][32].…”