Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial
AuthorsWijesundara, Jessica G.
Ito Fukunaga, Mayuko
Barton, Bruce A.
Fisher, Lloyd D.
Garber, Lawrence D.
Mazor, Kathleen M.
Cutrona, Sarah L.
UMass Chan AffiliationsDepartment of Pediatrics
Department of Medicine
Meyers Primary Care Institute
Department of Population and Quantitative Health Sciences
Document TypeJournal Article
Keywordselectronic health records
Health Information Technology
Health Services Administration
Health Services Research
Influenza Virus Vaccines
MetadataShow full item record
AbstractBACKGROUND: Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. OBJECTIVE: The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. METHODS: Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record-documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were 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 vaccinations documented by November 2015 (P=.004). In 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, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) 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 interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) 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 (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. TRIAL REGISTRATION: ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277. Lloyd Fisher, Peggy Preusse, Devi Sundaresan, Lawrence Garber, Kathleen M Mazor, Sarah L Cutrona. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.09.2020.
Wijesundara JG, Ito Fukunaga M, Ogarek J, Barton B, Fisher L, Preusse P, Sundaresan D, Garber L, Mazor KM, Cutrona SL. Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial. J Med Internet Res. 2020 Sep 25;22(9):e16373. doi: 10.2196/16373. PMID: 32975529; PMCID: PMC7547389. Link to article on publisher's site
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/41577
RightsCopyright © Jessica G Wijesundara, Mayuko Ito Fukunaga, Jessica Ogarek, Bruce Barton, Lloyd Fisher, Peggy Preusse, Devi Sundaresan, Lawrence Garber, Kathleen M Mazor, Sarah L Cutrona. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.09.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
Showing items related by title, author, creator and subject.
Policy Brief: Addressing Social Determinants of Health through Community Health Workers: A Call to ActionLondon, Katharine; Damio, Grace; Ferrazo, Meredith; Perez-Escamalla, Rafael; Wiggins, Noelle (2018-01-30)This technical report was compiled by the Hispanic Health Council in partnership with Southwestern AHEC and a panel of Community Health Worker Policy Research Experts which included our Katharine London from the Center for Health Law and Economics. The report offers a number of policy recommendations for community health workers for communities that might benefit from community-based services. The report offers recommendations on; payment of community health workers; community health worker caseloads; community health worker recruitment; community health worker training; reflective and trauma-informed mentoring and supportive supervision of community health workers; integration of community health workers into care teams; documenting the effect of community heal worker services on social determination of health. The Hispanic Health Council believes a service design that effectively supports community health workers would incorporate the seven areas of policy recommendation included in this report.
A Public Health Framework for the State Mental Health Authority: A Call for Action by Massachusetts Consumers and Family MembersDelman, Jonathan (2006-01-01)During the Spring of 2006, Consumer Quality Initiatives (CQI) conducted 20 focus groups across the state, 12 with adults with mental illness, 3 with parents of youth with serious emotional disorder, 2 with youth with SED, 1 with family members of adult consumers, and 2 with youth in transition. Supported by a contract with Massachusetts Department of Mental Health (DMH), the goal was to assist DMH in framing the criteria for its upcoming reprocurement. Our findings reveal a frustration with an approach to health care delivery that focuses primarily on the provision of psychiatric care (egs, medication, therapy, hospitalization). We reviewed the focus group reports to identify the most significant themes, which clustered within eight broad categories.
Making the Case for Sustainable Funding for Community Health Worker Services: Talking to Payers and ProvidersLondon, Katharine (2018-01-27)In this presentation, Katharine London of the Center for Health Law and Economics makes her case for offering sustainable funding for community health worker services. Research has shown community health workers can have a distinct impact on health systems, helping them improve population health and contain costs, while also promoting health equity and community engagement. This presentation was designed to assist CHWs and other advocates in engaging with policymakers and payers to support CHW sustainability and develop a financial plan for their CHW work. It was presented as part of a CHW Sustainability event held at the Families USA’s annual conference, Health Action 2018: Staying Strong for America’s Families, in Washington, DC. See Katharine London's blog post on payment delivery methods for community health workers here.