Impact of Electronic Health Record-Based Alerts on Influenza Vaccination for Children With Asthma
ABSTRACT The goal was to assess the impact of influenza vaccine clinical alerts on missed opportunities for vaccination and on overall influenza immunization rates for children and adolescents with asthma.
A prospective, cluster-randomized trial of 20 primary care sites was conducted between October 1, 2006, and March 31, 2007. At intervention sites, electronic health record-based clinical alerts for influenza vaccine appeared at all office visits for children between 5 and 19 years of age with asthma who were due for vaccine. The proportion of captured immunization opportunities at visits and overall rates of complete vaccination for patients at intervention and control sites were compared with those for the previous year, after standardization for relevant covariates. The study had >80% power to detect an 8% difference in the change in rates between the study and baseline years at intervention versus control practices.
A total of 23 418 visits and 11 919 children were included in the study year and 21 422 visits and 10 667 children in the previous year. The majority of children were male, 5 to 9 years of age, and privately insured. With standardization for selected covariates, captured vaccination opportunities increased from 14.4% to 18.6% at intervention sites and from 12.7% to 16.3% at control sites, a 0.3% greater improvement. Standardized influenza vaccination rates improved 3.4% more at intervention sites than at control sites. The 4 practices with the greatest increases in rates (>or=11%) were all in the intervention group. Vaccine receipt was more common among children who had been vaccinated previously, with increasing numbers of visits, with care early in the season, and at preventive versus acute care visits.
Clinical alerts were associated with only modest improvements in influenza vaccination rates.
Conference Paper: Parallel analysis of electrothermal phenomena in a dry type distribution[Show abstract] [Hide abstract]
ABSTRACT: In this paper we describe the steps taken to solve electrothermal problems in distributed configurations. For that purpose, we computed the 3D temperature distribution in a dry type transformer by solving the Poisson equation with source terms specific to the topology under scope, that is, heat generation by Joule losses and eddy currents, as well as natural cooling on the outside of the metal casing. Our approach is based on the assumption that heat transfer in the electrical device is predominantly diffusion. The solver used for this problem is the well-know BICCG (block incomplete Choleski conjugate gradient).Parallel Computing in Electrical Engineering, 2002. PARELEC '02. Proceedings. International Conference on; 02/2002
- PEDIATRICS 08/2009; 124(1):375-7. DOI:10.1542/peds.2009-0339 · 5.30 Impact Factor
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ABSTRACT: Electronic Health Records (EHR) are widely believed to improve quality of care and effectiveness of service delivery. Use of EHR to improve childhood immunization rates has not been fully explored in an ambulatory setting. To describe a pediatric practice's use of Electronic Health Records (EHR) in improving childhood immunization. A multi-faceted EHR-based quality improvement initiative used electronic templates with pre-loaded immunization records, automatic diagnosis coding, and EHR alerts of missing or delayed vaccinations. An electronic patient tracking system was created to identify patients with missing vaccines. Barcode scanning technology was introduced to aid speed and accuracy of documentation of administered vaccines. Electronic reporting to a local health department immunization registry facilitated ordering of vaccines. Immunization completion rates captured in monthly patient reports showed a rise in the percentage of children receiving the recommended series of vaccination (65% to 76%) (p<0.000). Barcode technology reduced the time of immunization documentation (86 seconds to 26 seconds) (p<0.000). Use of barcode scanning showed increased accuracy of documentation of vaccine lot numbers (from 95% to 100%) (p<0.000). EHR-based quality improvement interventions were successfully implemented at a community health center. EHR systems have versatility in their ability to track patients in need of vaccines, identify patients who are delayed, facilitate ordering and coding of multiple vaccines and promote interdisciplinary communication among personnel involved in the vaccination process. EHR systems can be used to improve childhood vaccination rates.Applied Clinical Informatics 01/2010; 1(3):221-31. DOI:10.4338/ACI-2009-12-CR-0028 · 0.39 Impact Factor