Measuring the Effects of Reminders for Outpatient Influenza Immunizations at the Point of Clinical Opportunity
- Affiliations of the authors: Northwestern University (PCT) and Northwestern Memorial Hospital (PCT, MPL, CN, SMG), Chicago, Illinois
- Correspondence and reprints: Paul C. Tang, MD, 1270 Carmel Terrace, Los Altos, CA 94024; e-mail: 〈 〉
- Received 11 August 1998
- Accepted 12 November 1998
Objective To evaluate the influence of computer-based reminders about influenza vaccination on the behavior of individual clinicians at each clinical opportunity.
Design The authors conducted a prospective study of clinicians' influenza vaccination behavior over four years. Approximately one half of the clinicians in an internal medicine clinic used a computer-based patient record system (CPR users) that generated computer-based reminders. The other clinicians used traditional paper records (PR users).
Measurements Each nonacute visit by a patient eligible for an influenza vaccination was considered an opportunity for intervention. Patients who had contraindications for vaccination were excluded. Compliance with the guideline was defined as documentation that a clinician ordered the vaccine, counseled the patient about the vaccine, offered the vaccine to a patient who declined it, or verified that the patient had received the vaccine elsewhere. The authors calculated the proportion of opportunities on which each clinician documented action in the CPR and PR user groups.
Results The CPR and PR user groups had different baseline compliance rates (40.1 and 27.9 per cent, respectively; P < 0.05). Both rates remained stable during a two-year baseline period (P=0.34 and P=0.47, respectively). The compliance rates in the CPR user group increased 78 per cent from baseline (P < 0.001), whereas the rates for the PR user group did not change significantly (P=0.18).
Conclusions Clinicians who used a CPR with reminders had higher rates of documentation of compliance with influenza-vaccination guidelines than did those who used a paper record. Measurements of individual clinician behavior at the point of each clinical opportunity can provide precise evaluation of interventions that are designed to improve compliance with guidelines.
This research was conducted and the paper written when Dr. Tang was a full-time employee of Northwestern Memorial Hospital. He is currently at the Palo Alto Medical Foundation and is a part-time employee of Epic Systems, the vendor of the CPR software.
This work was supported in part by High Performance Computing and Communications contract N01-LM-43509 from the National Library of Medicine.