Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 21, 2019
Open Peer Review Period: Oct 21, 2019 - Dec 4, 2019
Date Accepted: Aug 3, 2020
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Improving Rates of Early Season Influenza Vaccination using EHR Portal Messages and Interactive Voice Response Calls: Randomized Controlled Trial
ABSTRACT
Background:
Patient reminders for influenza vaccination, delivered via electronic health record (EHR) patient portal and interactive voice response (IVR) calls, offer an innovative approach to engaging patients and improving patient care.
Objective:
To test the effectiveness of portal and IVR outreach in improving rates of influenza vaccination, targeting patients in early September, shortly after vaccinations became available.
Methods:
This was a randomized controlled trial of EHR portal messages and IVR calls promoting influenza vaccination, with outreach conducted in September 2015. Participants included adult patients within a large multi-specialty group practice in central Massachusetts. Our main outcome was EHR-documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to: (a) receipt of a portal message promoting influenza vaccines, listing upcoming clinics and offering online scheduling of vaccine appointments (n=19,506) or (b) usual care (n=19,505). We randomized all non-portal users to receipt of IVR call (n=15,000) or usual care (n=43,596). Patients eligible and overdue for pneumococcal vaccine received messages including information on this vaccine. The intervention also solicited patient self-report on influenza vaccines completed outside the clinic. Self-reported influenza vaccination data was uploaded into the EHR to increase accuracy of existing provider-directed EHR clinical decision support (vaccine alerts) but was excluded from main analyses.
Results:
Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccination documented by November 2015 (P=.004). On multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, CI 1.02-1.12). Among nonportal users, 8.4% of those randomized to receive calls and 8.2% of usual care had documented vaccinations (P=.47) and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%) and over half of IVR calls placed (7,599/14,984; 50.7%) reached their intended target. Among portal message recipients, 25.4% of message openers (2,570/10,112) responded to a subsequent question on receipt of influenza vaccination; among IVR recipients 72.5% of those reached (5,513/7,599) responded to a similar question.
Conclusions:
Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination. IVR calls did not significantly improve vaccination rates among nonportal users. Rates of patient engagement with both modalities were favorable. Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT02266277
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