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.
Keywords
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Article Info
Publication History
Accepted:
October 23,
2014
Received:
July 3,
2014
Footnotes
During this study, Dr Humiston was a consultant to Immunization Action Coalition. The other authors declare that they have no conflict of interest.
Identification
Copyright
© 2015 Published by Elsevier Inc.
