title: Improved influenza and pneumococcal vaccination in rheumatology patients taking immunosuppressants using an electronic health record best practice alert.
abstract: OBJECTIVE
  To examine whether an electronic health record (EHR) best practice alert (BPA), a clinical reminder to help guideline adherence, improved vaccination rates in rheumatology patients receiving immunosuppressants. Guidelines recommend yearly influenza and pneumococcal vaccination with revaccination for patients age >65 years who are taking immunosuppressive medications.
  
  
  METHODS
  A vaccination BPA was developed based on immunosuppressant treatment, age, and prior vaccinations. At site 1, a hospital-based academic practice, physicians ordered vaccinations. At site 2, a community-based practice, physicians signed orders placed by nurses. Demographics, vaccination rates, and documentation (vaccination or no administration) were obtained. Chi-square and Fisher's exact test analysis compared vaccination and documentation rates for October 1 through December 31, 2006 (preBPA), and October 1 through December 31, 2007 (postBPA). Breslow-Day statistics tested the odds ratio of improvement across the years between the sites.
  
  
  RESULTS
  PostBPA influenza vaccination rates significantly increased (47% to 65%; P < 0.001), with significant improvement at both sites. PostBPA pneumococcal vaccination rates likewise significantly increased (19% to 41%; P < 0.001). PostBPA documentation rates for influenza and pneumococcal vaccinations also increased significantly. Site 2 (nurse-driven) had significantly higher preBPA vaccination rates for influenza (69% versus 43%; P < 0.001) than pneumococcal (47% versus 15%; P < 0.001).
  
  
  CONCLUSIONS
  The use of a BPA significantly increased influenza and pneumococcal vaccination and documentation rates in rheumatology patients taking immunosuppressants. A nurse-driven process offered higher efficacy. An EHR programmed to alert providers is an effective tool for improving quality of care for patients receiving immunosuppressants.
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania 17822, USA.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: Ledwich
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Harrington
authors.forename: William T
authors.initials: WT
authors.lastname: Ayoub
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sartorius
authors.forename: Eric D
authors.initials: ED
authors.lastname: Newman
mesh_terms: D000368:Aged; D019985:Benchmarking; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007252:Influenza Vaccines / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D011787:Quality of Health Care; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000276:immunology; D012219:Rheumatology / Q000592:standards*
chemical_list: D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines