title: Using computer decision support to increase maternal postpartum tetanus, diphtheria, and acellular pertussis vaccination.
abstract: OBJECTIVE
  To evaluate whether use of a computer-based clinical decision-support algorithm that used data stored in the electronic medical record increased administration of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine to postpartum women.
  
  
  METHODS
  We performed a before and after cohort study of postpartum women at an urban public teaching hospital. We compared the frequency of Tdap vaccination during the preintervention (October 1, 2008-January 14, 2009) and postintervention (January 15-April 30, 2009) time periods. We intervened by automating electronic presentation of preselected orders to physicians who provided postpartum care. The order was displayed when physicians ordered iron supplementation or patient discharge to a woman who met certain criteria. We evaluated whether patient characteristics were associated with receipt of vaccine.
  
  
  RESULTS
  Tetanus, diphtheria, and acellular pertussis vaccination was more likely for postpartum women postintervention compared with preintervention (147 of 248 [59%] compared with zero of 183 [0%]; difference=59%; 95% confidence interval [CI] 53-65%). Among 248 women who delivered during the postintervention period, those who met pharmacologic criteria for decision support rule activation were vaccinated more often than those who did not meet criteria (146 of 232 [63%] compared with one of 16 [6%]; difference=57%; 95% CI 43-70%). Race and ethnicity and cesarean delivery were not associated with vaccine receipt; however, there was a lower likelihood of vaccination among older women (P=.05 by a trend test across age quartiles).
  
  
  CONCLUSIONS
  We implemented a computer-based clinical decision-support algorithm that dramatically increased Tdap vaccination of postpartum women. Deployment of our algorithm in hospitals that have clinical decision support systems should increase rates of this important postpartum preventive intervention.
  
  
  METHODS
  II.
authors.affiliation: From the Collaborative Research Unit, Stroger Hospital of Cook County; the Department of Medicine, Rush Medical College; the Obstetrics and Gynecology Department, Stroger Hospital of Cook County; the Informatics Department, Stroger Hospital of Cook County; and the Immunization Program, Chicago Department of Public Health, Chicago, Illinois.
authors.forename: William E
authors.initials: WE
authors.lastname: Trick
authors.forename: Edward S
authors.initials: ES
authors.lastname: Linn
authors.forename: Zina
authors.initials: Z
authors.lastname: Jones
authors.forename: Clay
authors.initials: C
authors.lastname: Caquelin
authors.forename: Romina
authors.initials: R
authors.lastname: Kee
authors.forename: Julia Y
authors.initials: JY
authors.lastname: Morita
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D020000:Decision Support Systems, Clinical; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D008875:Middle Aged; D049590:Postpartum Period; D011247:Pregnancy; D014611:Vaccination
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines