TY - JOUR
T1 - Improving immunization delivery using an electronic health record
T2 - The immprove project
AU - Bundy, David G.
AU - Persing, Nichole M.
AU - Solomon, Barry S.
AU - King, Tracy M.
AU - Murakami, Peter N.
AU - Thompson, Richard E.
AU - Engineer, Lilly D.
AU - Lehmann, Christoph U.
AU - Miller, Marlene R.
N1 - Funding Information:
We gratefully acknowledge Meghan D'Angelo, Eston Harden, and Nancy Cournoyer for their contributions to this project, as well as the patients and staff of the Harriet Lane Clinic of the Johns Hopkins Children's Center. The National Library of Medicine of the National Institutes of Health funded this project via a grant to Dr Marlene R. Miller ( RC1LM010512 ).
PY - 2013
Y1 - 2013
N2 - 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.
AB - 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.
KW - Clinical decision support systems
KW - Immunizations
KW - Quality improvement
UR - http://www.scopus.com/inward/record.url?scp=84888329720&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84888329720&partnerID=8YFLogxK
U2 - 10.1016/j.acap.2013.03.004
DO - 10.1016/j.acap.2013.03.004
M3 - Article
C2 - 23726754
AN - SCOPUS:84888329720
SN - 1876-2859
VL - 13
SP - 458
EP - 465
JO - Academic pediatrics
JF - Academic pediatrics
IS - 5
ER -