DNP Graduates – D’Agostino

Susan D’Agostino, DNP
April 2012

Abstract Title:
Utilization of Electronic Health Record Provider Prompts To Maximize Adult Pertussis Immunization Rates

Adult immunizations are an essential part of patient care requiring strategies for improving delivery. The introduction of the electronic health record (EHR) and use of clinical reminders may assist health care practitioners to increase their adherence to preventive health maintenance schedules, including immunizations. Pertussis, commonly known as whooping cough, is a contagious but preventable bacterial infection. Annually, 50 million persons are affected and 300,000 deaths occur worldwide. Increased prevalence of pertussis may be attributable to the low rate of adults being vaccinated against the disease. Increases in reported cases are likely due to a combination of waning immunity six to ten years post-vaccination, improved sensitivity to recognizing symptoms among adults, and increased serologic testing and reporting. The purpose of this pilot study was to examine how the computerized clinical reminder may assist in improving adherence to adult pertussis immunization CDC guidelines. The study utilized a case control design, a type of epidemiological observational study in which subjects are not randomly assigned, but assigned to intervention or control groups. Data were extracted from (a) baseline patient EHRs (N = 352), (b) patient EHRs used for intervention and control (N = 120) and (3) physician scores on attitudes and knowledge surveys (N = 5) from two primary care practices affiliated with an urban teaching hospital. Additional questions examined if patient demographics, type of office visit, CPT codes, and health insurance coverage affected patterns in pertussis vaccinations. A higher percent of patients in the intervention group received the Tdap vaccination when compared to baseline and control groups (X2 = 10.44, P = .005). Average physician knowledge scores were almost identical between groups suggesting that physicians knowledge did not influence the likelihood of vaccinating their patients. The average score of physicians who did not immunize their patients had a more positive attitude score toward CPGs. Age, gender, type of office visit (sick or routine care), or type of health insurance coverage did not significantly influence Tdap vaccination rates but CPT codes showed a strong association. The EHR clinical reminder may influence health care providers’ adherence to CDC recommendations for administering adult pertussis immunizations.