Abstract:
BACKGROUND:Despite the benefits of influenza vaccination, each year more than half of adults in the United States do not receive it. OBJECTIVE:To evaluate the association between an active choice intervention in the electronic health record (EHR) and changes in influenza vaccination rates. DESIGN:Observational study. PATIENTS:Adults eligible for influenza vaccination with a clinic visit at one of three internal medicine practices at the University of Pennsylvania Health System between September 2010 and March 2013. INTERVENTION:The EHR confirmed patient eligibility during the clinic visit and, upon accessing the patient chart, prompted the physician and their medical assistant to actively choose to "accept" or "cancel" an order for the influenza vaccine. MAIN MEASURES:Change in influenza vaccination order rates at the intervention practice compared to two control practices for the 2012-2013 flu season, comparing trends during the prior two flu seasons adjusting for time trends and patient and clinic visit characteristics. KEY RESULTS:The sample (n = 45,926 patients) was 62.9% female, 35.9% white, and 54.4% black, with a mean age of 50.2 years. Trends were similar between practices during the 2 years in the pre-intervention period. Vaccination rates increased in both groups in the post-intervention year, but the intervention practice using active choice had a significantly greater increase than the control (adjusted difference-in-difference: 6.6 percentage points; 95% CI, 5.1-8.1; P < 0.001), representing a 37.3% relative increase compared to the pre-intervention period. More than 99.9% (9938/9941) of orders placed during the study period resulted in vaccination. CONCLUSIONS:Active choice through the EHR was associated with a significant increase in influenza vaccination rates.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Patel MS,Volpp KG,Small DS,Wynne C,Zhu J,Yang L,Honeywell S Jr,Day SCdoi
10.1007/s11606-017-4046-6subject
Has Abstractpub_date
2017-07-01 00:00:00pages
790-795issue
7eissn
0884-8734issn
1525-1497pii
10.1007/s11606-017-4046-6journal_volume
32pub_type
杂志文章,多中心研究abstract:OBJECTIVE:To evaluate patient-provider agreement on whether weight and related behaviors were discussed during routine visits. DESIGN:Post-visit survey assessments of patients and providers. PARTICIPANTS:Obese patients make up the majority of all patients seen in primary care (PC). The patients and physicians were re...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
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更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. OBJECTIVE:To identify characteristics associated with HCs' PCMH capability. DESIGN:Cross-sectional analysis of a national dataset of Federally Quali...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
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更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:Standardized means to identify patients likely to benefit from language assistance are needed. OBJECTIVE:To evaluate the accuracy of the U.S. Census English proficiency question (Census-LEP) in predicting patients' ability to communicate effectively in English. DESIGN:We investigated the sensitivity and sp...
journal_title:Journal of general internal medicine
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doi:10.1007/s11606-008-0693-y
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:Heart failure (HF) is a leading cause of hospitalization. Clinical and socio-demographic factors have been associated with cardiac admissions, but little is known about the role of anxiety. We examined whether symptoms of anxiety were associated with cardiac hospitalizations at 12 months in HF patients. METH...
journal_title:Journal of general internal medicine
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doi:10.1007/s11606-011-1843-1
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abstract:INTRODUCTION:We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. A 58-year-old woman presented with an 18-month history of progressive dysphagia, chronic cough and 30-pound weight loss. Prior gastroenterologic and laryngologic ...
journal_title:Journal of general internal medicine
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更新日期:2008-02-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-007-0464-1
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:Racial/ethnic minority patients are more likely to report experiences with discrimination in the healthcare setting, potentially leading to reduced access to appropriate care; however, few studies evaluate reports of discrimination with objectively measured quality of care indicators. OBJECTIVE:To evaluate ...
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更新日期:2011-10-01 00:00:00
abstract:OBJECTIVE:To assess a new technique for the detection of free pleural fluid. DESIGN:118 consecutive inpatients with radiologic evidence of free pleural fluid and a control group of 175 randomly selected inpatients were examined over a three-year period in a prospective blind study by auscultatory percussion (AP) for e...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
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abstract::In 1989, the internal medicine residency training program at St. John's Episcopal Hospital changed from a standard one-in-four on-call system to a night float system of resident on call. Using a confidential questionnaire that assessed the opinions of medical nurses, the nurses were asked which system they preferred, ...
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更新日期:2010-09-01 00:00:00
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更新日期:2007-11-01 00:00:00
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更新日期:1988-05-01 00:00:00
abstract:BACKGROUND:The shortage of primary care providers and the provisions of the Affordable Care Act (ACA) have spurred discussion about expanding the number, scope of practice (SOP), and independence of primary care nurse practitioners (NPs). Such discussions in the media and among professional organizations may insinuate ...
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更新日期:2017-03-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2000-01-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2012-02-01 00:00:00
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journal_title:Journal of general internal medicine
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pub_type: 杂志文章,随机对照试验
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更新日期:2012-09-01 00:00:00
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更新日期:2016-08-01 00:00:00
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journal_title:Journal of general internal medicine
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journal_title:Journal of general internal medicine
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更新日期:2015-08-01 00:00:00
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更新日期:2010-09-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,多中心研究
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更新日期:2013-12-01 00:00:00