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Effect of provider prompts on adolescent immunization rates: a randomized trial.
Acad Pediatr. 2015 Mar-Apr; 15(2):149-57.APed

Abstract

OBJECTIVE

Adolescent immunization rates are suboptimal. Experts recommend provider prompts at health care visits to improve rates. We assessed the impact of either electronic health record (EHR) or nurse- or staff-initiated provider prompts on adolescent immunization rates.

METHODS

We conducted a randomized controlled trial, allocating practices in 1 of 2 practice-based research networks (PBRN) to provider prompts or standard-of-care control. Ten primary care practices participated, 5 intervention and 5 controls, each matched in pairs on urban, suburban, or rural location and practice type (pediatric or family medicine), from a PBRN in Greater Rochester, New York (GR-PBRN); and 12 practices, 6 intervention, 6 controls, similarly matched, from a national pediatric continuity clinic PBRN (CORNET). The study period was 1 year per practice, ranging from June 2011 to January 2013. Study participants were adolescents 11 to 17 years attending these 22 practices; random sample of chart reviews per practice for baseline and postintervention year to assess immunization rates (n = 7,040 total chart reviews for adolescents with >1 visit in a period). The intervention was an EHR prompt (4 GR-PBRN and 5 CORNET practice pairs) (alert) that appeared on providers' computer screens at all office visits, indicating the specific immunizations that adolescents were recommended to receive. Staff prompts (1 GR-PBRN pair and 1 CORNET pair) in the form of a reminder sheet was placed on the provider's desk in the exam room indicating the vaccines due. We compared immunization rates, stratified by PBRN, for routine vaccines (meningococcus, pertussis, human papillomavirus, influenza) at study beginning and end.

RESULTS

Intervention and control practices within each PBRN were similar at baseline for demographics and immunization rates. Immunization rates at the study end for adolescents who were behind on immunizations at study initiation were not significantly different for intervention versus control practices for any vaccine or combination of vaccines. Results were similar for each PBRN and also when only EHR-based prompts was assessed. For example, at study end, 3-dose human papillomavirus vaccination rates for GR-PBRN intervention versus control practices were 51% versus 53% (adjusted odds ratio 0.96; 95% confidence interval 0.64-1.34); CORNET intervention versus control rates were 50% versus 42% (adjusted odds ratio 1.06; 95% confidence interval 0.68-1.88).

CONCLUSIONS AND RELEVANCE

In both a local and national setting, provider prompts failed to improve adolescent immunization rates. More rigorous practice-based changes are needed.

Authors+Show Affiliations

Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY. Electronic address: p_szilagyi@mednet.ucla.edu.Department of Pediatrics, Johns Hopkins University, Baltimore, Md.Division of Emergency and Urgent Care, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo.Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.Academic Pediatric Association, Atlanta, Ga.Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.Centers for Disease Control and Prevention, Atlanta, Ga.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

25748976

Citation

Szilagyi, Peter G., et al. "Effect of Provider Prompts On Adolescent Immunization Rates: a Randomized Trial." Academic Pediatrics, vol. 15, no. 2, 2015, pp. 149-57.
Szilagyi PG, Serwint JR, Humiston SG, et al. Effect of provider prompts on adolescent immunization rates: a randomized trial. Acad Pediatr. 2015;15(2):149-57.
Szilagyi, P. G., Serwint, J. R., Humiston, S. G., Rand, C. M., Schaffer, S., Vincelli, P., Dhepyasuwan, N., Blumkin, A., Albertin, C., & Curtis, C. R. (2015). Effect of provider prompts on adolescent immunization rates: a randomized trial. Academic Pediatrics, 15(2), 149-57. https://doi.org/10.1016/j.acap.2014.10.006
Szilagyi PG, et al. Effect of Provider Prompts On Adolescent Immunization Rates: a Randomized Trial. Acad Pediatr. 2015;15(2):149-57. PubMed PMID: 25748976.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of provider prompts on adolescent immunization rates: a randomized trial. AU - Szilagyi,Peter G, AU - Serwint,Janet R, AU - Humiston,Sharon G, AU - Rand,Cynthia M, AU - Schaffer,Stanley, AU - Vincelli,Phyllis, AU - Dhepyasuwan,Nui, AU - Blumkin,Aaron, AU - Albertin,Christina, AU - Curtis,C Robinette, PY - 2014/07/03/received PY - 2014/10/23/revised PY - 2014/10/23/accepted PY - 2015/3/10/entrez PY - 2015/3/10/pubmed PY - 2016/11/9/medline KW - EHR KW - HPV KW - Tdap KW - adolescent immunization KW - influenza KW - meningococcal KW - outreach KW - provider prompt SP - 149 EP - 57 JF - Academic pediatrics JO - Acad Pediatr VL - 15 IS - 2 N2 - OBJECTIVE: Adolescent immunization rates are suboptimal. Experts recommend provider prompts at health care visits to improve rates. We assessed the impact of either electronic health record (EHR) or nurse- or staff-initiated provider prompts on adolescent immunization rates. METHODS: We conducted a randomized controlled trial, allocating practices in 1 of 2 practice-based research networks (PBRN) to provider prompts or standard-of-care control. Ten primary care practices participated, 5 intervention and 5 controls, each matched in pairs on urban, suburban, or rural location and practice type (pediatric or family medicine), from a PBRN in Greater Rochester, New York (GR-PBRN); and 12 practices, 6 intervention, 6 controls, similarly matched, from a national pediatric continuity clinic PBRN (CORNET). The study period was 1 year per practice, ranging from June 2011 to January 2013. Study participants were adolescents 11 to 17 years attending these 22 practices; random sample of chart reviews per practice for baseline and postintervention year to assess immunization rates (n = 7,040 total chart reviews for adolescents with >1 visit in a period). The intervention was an EHR prompt (4 GR-PBRN and 5 CORNET practice pairs) (alert) that appeared on providers' computer screens at all office visits, indicating the specific immunizations that adolescents were recommended to receive. Staff prompts (1 GR-PBRN pair and 1 CORNET pair) in the form of a reminder sheet was placed on the provider's desk in the exam room indicating the vaccines due. We compared immunization rates, stratified by PBRN, for routine vaccines (meningococcus, pertussis, human papillomavirus, influenza) at study beginning and end. RESULTS: Intervention and control practices within each PBRN were similar at baseline for demographics and immunization rates. Immunization rates at the study end for adolescents who were behind on immunizations at study initiation were not significantly different for intervention versus control practices for any vaccine or combination of vaccines. Results were similar for each PBRN and also when only EHR-based prompts was assessed. For example, at study end, 3-dose human papillomavirus vaccination rates for GR-PBRN intervention versus control practices were 51% versus 53% (adjusted odds ratio 0.96; 95% confidence interval 0.64-1.34); CORNET intervention versus control rates were 50% versus 42% (adjusted odds ratio 1.06; 95% confidence interval 0.68-1.88). CONCLUSIONS AND RELEVANCE: In both a local and national setting, provider prompts failed to improve adolescent immunization rates. More rigorous practice-based changes are needed. SN - 1876-2867 UR - https://www.unboundmedicine.com/medline/citation/25748976/Effect_of_provider_prompts_on_adolescent_immunization_rates:_a_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1876-2859(14)00388-X DB - PRIME DP - Unbound Medicine ER -