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 before their
second birthday was significantly improved during the intervention period. Human papillomavirus
(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 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.
Keywords
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Article Info
Publication History
Published online: May 30, 2013
Accepted:
March 5,
2013
Received:
October 24,
2012
Identification
Copyright
© 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
