Increasing Vaccine Uptake Among Veterans at the Atlanta VA Health Care System

Increasing Vaccine Uptake Among Veterans at the Atlanta VA Health Care System Through a Randomized Trial

The Office of Evaluation Sciences is collaborating with Emory University and the Atlanta VA Health Care System to increase adult immunizations uptake among veterans. The intervention targets patients of primary care providers (physicians, physician assistants and nurse practitioners) through a modification of the existing reminders in the VA electronic health record system. The team will evaluate the intervention using a randomized controlled trial.

Study Overview

• Status: Completed
• Conditions: Pneumonia; Pertussis; Tetanus; Diphtheria; Influenza
• Intervention / Treatment: Other: Modified clinical reminders

Detailed Description

The Office of Evaluation Sciences is collaborating with Emory University and the Atlanta VA Health Care System to increase adult immunizations uptake among veterans. The intervention targets patients of primary care providers (physicians, physician assistants and nurse practitioners) through a modification of the existing reminders in the VA electronic health record system.

The intervention includes a bundled vaccination reminder for influenza, pneumococcal and TDap vaccines, an immunization dashboard that relays a patient's vaccination status and history, and talking points for providers to use in their dialogues with patients. This intervention was designed to mitigate potential bottlenecks to vaccination, based on conversations and observations with facility clinicians.

The team will evaluate the intervention using a randomized controlled trial.

• Study Type: Interventional
• Enrollment (Actual): 67000
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Georgia
    • Decatur, Georgia, United States, 30033
      • Atlanta VA Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• All patients must have appointments with active primary care providers (physicians, physician assistants and nurse practitioners) in the Atlanta VA Health Care System

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; Providers assigned to the control group will receive unmodified vaccine reminders (as they already appear in the VA EHR system). Separate reminders will appear for the different vaccines of interest.
Experimental: Treatment; Providers in the treatment group will receive modified clinical reminders for the vaccines of interest. Reminders for the different vaccines of interest will be bundled into a single reminder, and other changes made to streamline the design and reduce provider burden. Other changes include an immunization dashboard that relays a patient's vaccination status and talking points for providers to use in their dialogues with patients.	Other: Modified clinical reminders; Clinical reminders for the vaccines of interest will be bundled into a single reminder, and other changes made to streamline the design and reduce provider burden. Other changes include an immunization dashboard that relays a patient's vaccination status and talking points for providers to use in their dialogues with patients.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of patients receiving one of more vaccines of interest when due for these vaccines	Percent of patients receiving of one or more of the influenza, pneumococcal (PCV13 or PPSV23) or Tdap/Td vaccines during the observation period, conditional on the patient being due for at least one of these vaccines at any appointment during the observation period	6 months
Percent of patients receiving the influenza vaccine when due for the vaccine	Percent of patients receiving the influenza vaccine during the observation period, conditional on the patient being due for the influenza vaccine at any appointment during the observation period	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of patients receiving Tdap/Td or pneumococcal vaccines when due	Percent of patients receiving Tdap/Td or pneumococcal vaccines during the observation period, conditional on the patient being due for at least one of these vaccines at any appointment during the observation period	6 months
Cost per additional individual vaccinated	Should these data be available, will assess the cost per additional individual vaccinated	6 months

Collaborators and Investigators

• Sponsor: Atlanta VA Medical Center
• Collaborators: Emory University; General Services Administration (GSA)
• Investigators: Principal Investigator: Pompa Debroy, MS, Office of Evaluation Sciences, U.S. General Services Administration; Principal Investigator: Russ Burnett, PhD, Office of Evaluation Sciences, U.S. General Services Administration; Principal Investigator: Saad Omer, MBBS, MPH, PhD, Emory University; Principal Investigator: Joseph M Wallace, Atlanta VA Health Care System; Principal Investigator: Vincent Marconi, MD, Atlanta VA Health Care System, Emory University

Publications and helpful links

General Publications

• Debroy P, Balu R, Burnett R, Johnson RA, Kappes HB, Wallace JM, Marconi VC. A cluster randomized controlled trial of a modified vaccination clinical reminder for primary care providers. Health Psychol. 2022 Oct 13. doi: 10.1037/hea0001218. Online ahead of print.

Helpful Links

• Project Analysis Plan

Study record dates

Study Major Dates

• Study Start (Actual): October 15, 2018
• Primary Completion (Actual): May 30, 2019
• Study Completion (Actual): June 30, 2019

Study Registration Dates

• First Submitted: April 25, 2019
• First Submitted That Met QC Criteria: May 13, 2019
• First Posted (Actual): May 15, 2019

Study Record Updates

• Last Update Posted (Actual): January 10, 2020
• Last Update Submitted That Met QC Criteria: January 7, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Keywords: Vaccination; Electronic Medical Records; Behavioral Economics; Nudge; EHR Reminders
• Additional Relevant MeSH Terms: Infections; Bacterial Infections; Bacterial Infections and Mycoses; Gram-Positive Bacterial Infections; Actinomycetales Infections; Corynebacterium Infections; Diphtheria
• Other Study ID Numbers: AtlantaVAMC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No