Randomized study of online vaccine reminders in adult primary care

Information Systems Department, University of Iowa Hospitals and Clinics, Iowa City, USA.
Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/1999; 1999:755-9.
Source: PubMed


Online immunization reminders were implemented in an adult medicine setting in which all immunization history, vaccine ordering and charting were required online. Physicians were randomized to one of two arms in a cross-over design. Each arm was shown online recommendations for vaccines indicated by nationally accepted guidelines either during the first or during the second part of the study period. The main purpose of the study was to assess the impact of reminders on correct decisions related to prescribing vaccines. Online reminders had the following impact on physician behavior: 1) Physicians used the application almost 3 times as often when shown reminders. 2) Physicians in the reminder group were 27% less likely to order a vaccine in the reminder group (P- value 0.0005). 3) Compliance with guidelines was improved significantly for Tetanus and for Hepatitis B in several analyses. No such effects were found for Pneumoccocal, Measles, or Influenza vaccines.

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    • "Additional file 2 Table S2 shows that 20/41 (49%) CCDSSs were integrated with an electronic medical record [1,17,25,27,29,31,32,34-36,39,41-46,49,50,52,56,59] including at least five also integrated with a computerized order entry system [1,32,42,49,56] and 21/41 (51%) were stand-alone computer systems [15,16,18-22,24,26,28,30,33,37,38,40,47,48,51,53-55,57,58]. The data entry method varied across systems, with a non-practitioner decision-maker entering data on 29/39 (74%) studies [1,15,17,21,23-25,27,29,31,32,34-55,59] and automatic entry through electronic health records in 15/39 (38%) cases [1,17,27,29,31,34-36,41,42,46,49,50,56,59]. In all but one study [26], physicians used all PPC CCDSSs, either solely or shared with other healthcare providers including trainees [1,25,28,29,39,41,42,46-48,52], advanced practice nurses [1,17-19,30,50,59], physician assistants [18,19,33], and social workers [26]. "
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    Implementation Science 08/2011; 6(1):87. DOI:10.1186/1748-5908-6-87 · 4.12 Impact Factor
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    • "All four used system-initiated advice to prompt physicians about the therapeutic management of patients determined to be 'at risk' of cardiovascular events. [21,24,26,28] Five of the nine studies targeting vaccinations demonstrated statistically significant benefits in favour of CDSS for the majority of outcomes [20,21,36,40,41], and they too used system-initiated advice to increase vaccination rates. There were too few studies across the other clinical domains to draw any conclusions about the impact of CDSS in specific clinical areas. "
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    BMC Health Services Research 09/2009; 9(1):154. DOI:10.1186/1472-6963-9-154 · 1.71 Impact Factor
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    • "Within CPOE system, reminders about corollary orders presented when ordering 1 of 87 tests or treatments; written guidelines made available as in control % immediate compliance with relevant corollary orders 46.3% vs 21.9%, p < 0.0001 Tierney et al., 1993 18 68 teams/ 5219/17 Usual inpatient care, including use of computerized patient record system CPOE system, which displayed problem -specific menus of cost -effective orders and recommended against certain expensive orders Total charge per admission ($) Mean length of stay (days) 6077 vs 6964, p = 0.02 7.6 vs 8.5, p = 0.11 Tierney et al., 1988 19 112/~6077/6 Usual outpatient care, including use of CPOE system For 8 common outpatient tests, display of predicted probabilities of test abnormalities during order entry Patient study test charges per scheduled visit ($) Estimated probability of abnormality among ordered tests 11.18 vs 12.27, p < 0.05 24% vs 18%, p < 0. 0001 Flanagan et al., 1999 20 89/817/9 Usual outpatient care, including optional use of computer-based immunization charting and ordering system Computer-generated reminders for tetanus, hepatitis B, influenza, pneumococcal, and MMR vaccines presented in optional immunization charting and ordering system % of immunization charting system sessions resulting in the appropriate administration of tetanus, hepatitis B, influenza, pneumococcal, and MMR vaccines NS Rotman et al., 1996 21 37/2645 prescriptions/3 "
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    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 02/2003; 2003:361-5.
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