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Abstract：
BACKGROUND: Despite the high burden of pneumococcal disease, pneumococcal vaccine coverage continues to fall short of Healthy People 2020 goals. A quasi-experimental design was used to investigate the impact of pneumococcal-specific best-practice alerts (BPAs) with and without workflow redesign compared to health maintenance notifications only, on pneumococcal vaccination rates in at-risk and high-risk adults, and on series completion in immunocompetent adults aged 65+ years.
METHODS: This retrospective study used electronic health record and administrative data to identify pneumococcal vaccinations using cross sectional and historical cohorts of adults age 19+ years from 2013 to 2017 who attended clinics associated with the University of Utah Health. Difference-in-differences (DD) analyses was used to assess the impact of interventions across three observation periods (Baseline, Interim, and Follow Up). Adherence to the 2-dose vaccination schedule in older adults was measured through a longitudinal analysis.
RESULTS: In DD analyses, implementing both workflow redesign and the BPA raised the vaccination rate by 8 percentage points (pp) (P < 0.001) and implementing the BPA only raised the rate by 7 pp. (P < 0.001) among at-risk adults age 19-64 years, relative to implementing health maintenance notifications (i.e., usual care) only in comparison clinics. In high-risk adults age 19-64 years, the BPA with or without workflow redesign did not significantly affect vaccination rates from baseline to follow up relative to health maintenance notifications. Per DD analyses, the effect of the BPA was mixed in immunocompetent and immunocompromised adults age 65+ years. However, immunocompetent older adults attending a clinic that implemented the BPA plus health maintenance notifications and workflow redesign (all 3 interventions) had 1.94 times higher odds (Odds ratio (OR) 1.94; P = 0.0003, 95% CI 1.24, 3.01) to receive the second pneumococcal dose than patients attending a usual practice clinic (i.e., no intervention).
CONCLUSIONS: A pneumococcal BPA tool that reflects current guidelines implemented with and without workflow redesign improved vaccination rates for at-risk adults age 19-64 years and increased the likelihood of adults aged 65+ to complete the recommended 2-dose series. However, in other adult patient groups, the BPA was not consistently associated with improvements in pneumococcal vaccination rates.
METHODS: This retrospective study used electronic health record and administrative data to identify pneumococcal vaccinations using cross sectional and historical cohorts of adults age 19+ years from 2013 to 2017 who attended clinics associated with the University of Utah Health. Difference-in-differences (DD) analyses was used to assess the impact of interventions across three observation periods (Baseline, Interim, and Follow Up). Adherence to the 2-dose vaccination schedule in older adults was measured through a longitudinal analysis.
RESULTS: In DD analyses, implementing both workflow redesign and the BPA raised the vaccination rate by 8 percentage points (pp) (P < 0.001) and implementing the BPA only raised the rate by 7 pp. (P < 0.001) among at-risk adults age 19-64 years, relative to implementing health maintenance notifications (i.e., usual care) only in comparison clinics. In high-risk adults age 19-64 years, the BPA with or without workflow redesign did not significantly affect vaccination rates from baseline to follow up relative to health maintenance notifications. Per DD analyses, the effect of the BPA was mixed in immunocompetent and immunocompromised adults age 65+ years. However, immunocompetent older adults attending a clinic that implemented the BPA plus health maintenance notifications and workflow redesign (all 3 interventions) had 1.94 times higher odds (Odds ratio (OR) 1.94; P = 0.0003, 95% CI 1.24, 3.01) to receive the second pneumococcal dose than patients attending a usual practice clinic (i.e., no intervention).
CONCLUSIONS: A pneumococcal BPA tool that reflects current guidelines implemented with and without workflow redesign improved vaccination rates for at-risk adults age 19-64 years and increased the likelihood of adults aged 65+ to complete the recommended 2-dose series. However, in other adult patient groups, the BPA was not consistently associated with improvements in pneumococcal vaccination rates.
摘要：
背景：尽管肺炎球菌疾病的负担很高，肺炎球菌疫苗覆盖率继续低于2020年健康人的目标。与仅健康维护通知相比，使用准实验设计来调查有和没有工作流程重新设计的肺炎球菌特异性最佳实践警报（BPA）的影响。关于高危和高危成年人的肺炎球菌疫苗接种率，以及65岁以上有免疫能力的成年人的系列完成。
方法：这项回顾性研究使用电子健康记录和管理数据，使用2013年至2017年在犹他大学健康相关诊所就诊的19岁以上成年人的横断面和历史队列，确定肺炎球菌疫苗接种。差异(DD)分析用于评估干预措施在三个观察期的影响(基线，临时,并跟进）。通过纵向分析来衡量老年人对2剂疫苗接种时间表的依从性。
结果：在DD分析中，实施工作流程重新设计和双酚A将疫苗接种率提高了8个百分点(pp)(P<0.001),实施双酚A仅将疫苗接种率提高了7pp.（P<0.001）在19-64岁的高危成年人中，相对于实施健康维护通知(即，常规护理)仅在比较诊所。在19-64岁的高危成年人中，相对于健康维护通知,有或没有重新设计工作流程的双酚A对从基线到随访的疫苗接种率均无显著影响.根据DD分析，在65岁以上的免疫功能正常和免疫功能低下的成年人中,BPA的作用是混合的.然而,在实施BPA加健康维护通知和工作流程重新设计的诊所就诊的有免疫能力的老年人接受第二次肺炎球菌剂量的几率（赔率（OR）1.94；P=0.0003，95％CI1.24，3.01）比在常规诊所就诊的患者高1.94倍（即无干预)。
结论：在重新设计和不重新设计工作流程的情况下，反映当前指南的肺炎球菌BPA工具提高了19-64岁高危成年人的疫苗接种率，并增加了65岁以上成年人完成推荐的2剂系列的可能性。然而,在其他成年患者群体中，BPA与肺炎球菌疫苗接种率的改善并不一致.
方法：这项回顾性研究使用电子健康记录和管理数据，使用2013年至2017年在犹他大学健康相关诊所就诊的19岁以上成年人的横断面和历史队列，确定肺炎球菌疫苗接种。差异(DD)分析用于评估干预措施在三个观察期的影响(基线，临时,并跟进）。通过纵向分析来衡量老年人对2剂疫苗接种时间表的依从性。
结果：在DD分析中，实施工作流程重新设计和双酚A将疫苗接种率提高了8个百分点(pp)(P<0.001),实施双酚A仅将疫苗接种率提高了7pp.（P<0.001）在19-64岁的高危成年人中，相对于实施健康维护通知(即，常规护理)仅在比较诊所。在19-64岁的高危成年人中，相对于健康维护通知,有或没有重新设计工作流程的双酚A对从基线到随访的疫苗接种率均无显著影响.根据DD分析，在65岁以上的免疫功能正常和免疫功能低下的成年人中,BPA的作用是混合的.然而,在实施BPA加健康维护通知和工作流程重新设计的诊所就诊的有免疫能力的老年人接受第二次肺炎球菌剂量的几率（赔率（OR）1.94；P=0.0003，95％CI1.24，3.01）比在常规诊所就诊的患者高1.94倍（即无干预)。
结论：在重新设计和不重新设计工作流程的情况下，反映当前指南的肺炎球菌BPA工具提高了19-64岁高危成年人的疫苗接种率，并增加了65岁以上成年人完成推荐的2剂系列的可能性。然而,在其他成年患者群体中，BPA与肺炎球菌疫苗接种率的改善并不一致.
