Facebook Twitter YouTube



Comparing the Effectiveness of Automated Decision Support for Families, Clinicians, or Both On Adolescent Vaccine Receipt

Sunday, October 21, 2012: 10:15 AM
Room 270 (Morial Convention Center)
Alexander G. Fiks, MD, MSCE1, Stephanie Mayne, MHS2, Dean Karavite, MS3, Robert W. Grundmeier, MD4, Russell Localio, JD, PhD5, Kristen Feemster, MD, MPH6, Elena M. DeBartolo2 and Cayce C. Hughes, MPH2, (1)Center for Pediatric Clinical Effectiveness and Departments of Pediatrics, Pediatric Research Consortium, Center for Biomedical Informatics, PolicyLab at Children's Hospital of Philadelphia, Merion, PA, (2)Center for Pediatric Clinical Effectiveness, PolicyLab at The Children's Hospital of Philadelphia, Philadelphia, PA, (3)Center for Biomedical Informatics (CBMI), The Children's Hospital of Philadelphia, Philadelphia, PA, (4)Departments of Pediatrics, The Pediatric Research Consortium, Center for Biomedical Informatics at The Children's Hospital of Philadelphia, Philadelphia, PA, (5)Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, (6)Departments of Pediatrics, Center for Pediatric Clinical Effectiveness and the Division of Infectious Diseases at The Children's Hospital of Philadelphia, Philadelphia, PA

Purpose . The effective delivery of preventive health care depends upon clinician recommendation and family acceptance.  This study evaluated the effectiveness of targeting automated decision support to families, clinicians or both on adolescent vaccines receipt.

Methods . In the study, 22 primary care practices were randomized to receive the 3-pronged clinician-focused intervention (academic detailing based on electronic health record (EHR) data, EHR-based alerts, and feedback derived from EHR data). Within each practice, girls 11-17 years due for human papillomavirus (HPV) vaccine dose 1, 2 or 3 (primary outcomes), tetanus, diphtheria, and pertussis (Tdap), or meningococcal conjugate vaccine (MCV4) were randomized to receive family-focused decision support with automated, educational phone calls when vaccine was due (n=23,406 total).  Standardized for clinically relevant covariates, the study team measured time to receipt of each dose and vaccination rates at the end of the study. 

   Results . The results showed that, for HPV doses 1, 2, and 3, the highest vaccination rates and shortest time to vaccine receipt occurred in the group with both interventions. Standardized rates improved by 9% (95% confidence interval [CI] 4 to 13), 8% (95% CI, 0 to 14), and 13% (95% CI, 8 to 18) and time to vaccination was reduced by 151 days (95% CI, 44 to 209), 68 days (95% CI, 4 to 126), and 93 days (95% CI, 52 to 141) for HPV doses 1, 2, and 3, respectively for the combined compared to no intervention.   The clinician-focused group performed significantly better than the family-focused group for HPV dose 1 (6% higher, 95% CI, 2 to 10), but the reverse occurred for doses 2 and 3 (7% lower (95% CI, 1 to 15) and 6% lower (95% CI, 1 to 15)), respectively.  The intervention had little effect on outcomes for Tdap and MCV4 that had been available earlier and had higher baseline vaccination rates.

Table 1. Time to completion and final rates of vaccination

Intervention Arm

HPV11

HPV21

HPV31

Days to 15% complete

Final rate

Days to 50% complete

Final rate

Days to 50% complete

Final rate

Both

167

25%

110

73%

122

76%

Clinician only

176

24%

186

64%

183

67%

Family only

275

18%

127

71%

135

73%

Neither

318

16%

178

65%

215

63%

1 Includes only adolescents who had not received the dose at study start and were eligible for that dose.

    Conclusion . The study showed that the clinician-focused intervention was most effective for initiating the HPV vaccination series, while the family-focused intervention promoted completion. Automated decision support directed at both clinicians and families is needed to effectively promote HPV vaccine series receipt.  More broadly, decision support may be most effective for recently released vaccines with lower baseline rates of receipt.

Funded by AHRQ: Contract Number:290-07-10013-4