Systematic review and meta-analysis: Interventions to ...
Chapter 5 Supplement A
Contents
This supplement contains certain methodological details, as well as data from excluded and included studies.
Section S5.A.1. Detailed summary of methods
Section S5.A.2. Search strategy
Section S5.A.3. Quality assessment instrument
Table S5-A1: Downs and Black quality instrument for randomized and non-randomized studies
Section S5.A.3. Excluded and included studies
Table S5-A2: Excluded studies
Table S5-A3: Summary of reasons for exclusion
Table S5-A4: Included studies
Table S5-A4: Downs and Black scores assigned to included studies
Table S5-A6: Studies included in meta-analyses
Section S5.A.4. Referenced studies
S5.A.1. Detailed summary of methods
Data sources and searches
A health sciences librarian (DAS) searched medical literature databases (Medline, EMBASE, Cochrane Library, Scopus, Web of Science, AARP Ageline, PsychInfo, Social Policy and Practice, and CINAHL) from inception to August 2010 for potentially relevant citations (Supplement A.2). We complemented the electronic search with references from previous reviews and included studies.
Study selection
The title and abstract of each citation retrieved was screened for relevance. Full papers of relevant citations were examined for inclusion. English language studies published in peer-reviewed journals were included if they involved elderly adults or adults with chronic diseases; involved a quality improvement intervention (see below); featured a parallel control group; and reported influenza or pneumococcal vaccination rates. We focused exclusively on the community setting to maximize relevance for primary care. Studies taking place in acute or long-term care were excluded. Studies reporting sufficient data to estimate log odds ratios (OR) and standard errors were eligible for meta-analysis. Two reviewers (DL and JH) selected studies independently.
Data extraction and quality assessment
Data concerning study design, setting, patient characteristics, intervention characteristics, study quality, patient numbers, and odds ratios (OR) were extracted from included studies. Study quality was measured using the Downs and Black instrument. Data was extracted using standard forms, in duplicate by two reviewers (DL and JH), with disagreements resolved by consensus.
S5.A.2. Search strategy
MEDLINE
OVID (1950-present, including in-process citations)
August 13, 2010
1888 results total
1. exp Immunization/
2. (immuniz* or immunis*).ti,ab.
3. exp Immunization Programs/
4. vaccin*.ti,ab.
5. inoculat*.ti,ab.
6. Influenza Vaccines/ad [Administration & Dosage]
7. Pneumococcal Vaccines/ad [Administration & Dosage]
8. or/1-7
9. Influenza, Human/
10. pneumococcal infections/ or pneumonia, pneumococcal/
11. (influenza or pneumococcal or pneumonia).ti,ab.
12. or/9-11
13. 8 and 12
14. preventive health services/ or exp immunization programs/
15. (program* or intervention*).mp.
16. ((vaccinat* or immunis* or immuniz* or inoculat*) adj3 (rate or rates or uptake or delivery or distribution or coverage or status)).ti,ab.
17. quality assurance, health care/ or benchmarking/ or clinical audit/ or medical audit/ or nursing audit/ or total quality management/
18. (quality improvement or QI).mp.
19. patient care planning/ or case management/
20. Patient Care Team/
21. interdisciplinary communication/
22. Registries/
23. education, medical, continuing/ or education, nursing, continuing/ or education, pharmacy, continuing/
24. Reminder Systems/
25. Patient Education as Topic/
26. Self Care/
27. Medical Records Systems, Computerized/
28. (case management or patient registry or reminder* or patient education or self care or self management).ti,ab.
29. or/14-28
30. 13 and 29
31. limit 30 to (english language)
32. animals/
33. humans/
34. 32 not (32 and 33)
35. 31 not 34
36. randomized controlled trial.pt. or random*.tw. or control*.tw. or intervention*.tw. or evaluat*.tw. or compar*.tw. or impact.tw. or evaluat*.tw.
37. (time adj series).tw. or (pretest or pre test or posttest or post test).mp. or (before adj2 after).tw.
38. 36 or 37
39. 38 and 35
40. limit 39 to "all child (0 to 18 years)"
41. limit 39 to "all adult (19 plus years)"
42. 40 not (40 and 41)
43. 39 not 42
EMBASE
OVID (1980-Week 31, 2010)
August 13, 2010
2619 results total
1. immunization/ or mass immunization/ or vaccination/
2. (immuniz* or immunis*).ti,ab.
3. (vaccin* or inoculat*).ti,ab.
4. influenza/
5. Streptococcus pneumonia/
6. pneumococcal infection/
7. pneumonia/
8. Streptococcus infection/
9. (influenza or pneumocc* or pneumonia).ti,ab.
10. or/1-4
11. or/5-9
12. influenza vaccination/
13. 11 and 10
14. 13 or 12
15. vann jc.au.
16. ndiaye sm.au.
17. 16 or 15
18. preventive health service/
19. health program/
20. intervention.tw.
21. ((vaccinat* or immunis* or immuniz* or inoculat*) adj3 (rate or rates or uptake or delivery or distribution or coverage or status)).ti,ab.
22. quality control/ or medical audit/ or total quality management/
23. (quality improvement or QI).ti,ab.
24. patient care/ or case management/ or patient care planning/ or patient decision making/ or patient scheduling/
25. interdisciplinary communication/
26. exp information system/
27. continuing education/
28. patient education/
29. self care/
30. (case management or patient registry or reminder* or patient education or self care or self management).ti,ab.
31. or/18-30
32. 31 and 14
33. limit 32 to (english language)
34. (exp vertebrate/ or animal/ or exp experimental animal/ or nonhuman/ or animal.hw.) not exp human/
35. 33 not 34
36. randomized controlled trial/
37. controlled study/
38. (random* or experiment* or (time adj series) or (pre test or pretest or posttest or post test) or (before adj3 after)).tw.
39. (impact* or intervention* or effect* or chang* or evaluat* or compar* or control*).tw.
40. or/36-39
41. 35 and 40
42. limit 41 to (embryo or infant or child or preschool child or school child or adolescent )
43. limit 41 to (adult or aged )
44. 42 not (42 and 43)
45. 41 not 44
Cochrane Library
Wiley (to issue 3, 2010)
August 13, 2010
838 results
Cochrane SRs: 28
DARE: 6
CENTRAL: 722
Methods: 8
HTA: 2
Economic Evals: 72
1. (immuniz* or immunis* or inoculat* or vaccin*):ti,ab,kw and (influenza or pneumococc* or streptococc* or pneumonia):ti,ab,kw
2. (rate or rates or uptake or delivery or distribution or coverage or status):ti,ab,kw or "quality improvement" or qi or "quality management" or "case management" or "patient care" or interdisciplinary:ti,ab,kw or (registr* or audit or education or reminder* or "self care" or "self management" or "medical record" or program* or intervention*):ti,ab,kw
3. (#1 and #2)
CINAHL
Ebsco
August 30, 2010
121 results
S1. (MH "Immunization")
S2. TI ( (vaccin* or immunis* or immuniz* or inoculat*) ) or AB ( (vaccin* or immunis* or immuniz* or inoculat*) )
S3. (MH "Influenza")
S4. (MH "Pneumococcal Infections")
S5.A. (MH "Pneumonia")
S6. TI ( (influenza or pneumococc* or streptococc* or pneumonia) ) and AB ( (influenza or pneumococc* or streptococc* or pneumonia) )
S7. (MH "Influenza Vaccine/AD/SD")
S8. ((S1 OR S2) AND (S3 OR S4 OR S5 OR S6)) OR S7
Limiters
Exclude MEDLINE records.
Publication Type: Clinical Trial, Conference, Doctoral Dissertation, Masters Thesis, Nursing Interventions, Practice Guidelines, Proceedings, Protocol, Research.
Search modes - Boolean/Phrase Interface.
Scopus
Elsevier
August 13, 2010
1216 results
(((TITLE-ABS-KEY((pneumococcal W/3 immuniz*) OR (pneumococcal W/3 immunis*) OR (pneumococcal W/3 vaccinat*) OR (pneumonia W/3 immuniz*) OR (pneumonia W/3 immunis*) OR (pneumonia W/3 vaccinat*) OR (pneumonia W/3 inoculat*)) OR TITLE-ABS-KEY((influenza W/3 immuniz*) OR (influenza W/3 immunis*) OR (influenza W/3 vaccinat*) OR (influenza W/3 inoculat*))) AND (TITLE-ABS-KEY((program* OR intervention* OR "quality improvement" OR "quality management" OR audit OR case management OR "patient care" OR registry OR registries OR "patient education" OR "self care" OR "self management" OR reminder* OR medical record*)) AND SUBJAREA(mult OR medi OR nurs OR vete OR dent OR heal OR mult OR arts OR busi OR deci OR econ OR psyc OR soci)))
OR
((TITLE-ABS-KEY((vaccinat* W/2 rate*) OR (immuniz* W/2 rate*) OR (immunis* W/2 rate*) OR (inoculat* W/2 rate*)) AND TITLE-ABS-KEY(pneumocc* OR pneumonia OR influenza)) AND SUBJAREA(mult OR medi OR nurs OR vete OR dent OR heal OR mult OR arts OR busi OR deci OR econ OR psyc OR soci))
AND
(EXCLUDE(SUBJAREA, "VETE") OR EXCLUDE(SUBJAREA, "BIOC") OR EXCLUDE(SUBJAREA, "CENG") OR EXCLUDE(SUBJAREA, "ENVI") OR EXCLUDE(SUBJAREA, "BUSI") OR EXCLUDE(SUBJAREA, "ECON") OR EXCLUDE(SUBJAREA, "AGRI") OR EXCLUDE(SUBJAREA, "ENGI") OR EXCLUDE(SUBJAREA, "EART") OR EXCLUDE(SUBJAREA, "COMP") OR EXCLUDE(SUBJAREA, "MATH") OR EXCLUDE(SUBJAREA, "NEUR"))
AND
(EXCLUDE(DOCTYPE, "no") OR EXCLUDE(DOCTYPE, "le") OR EXCLUDE(DOCTYPE, "ed"))
Web of Science
ISI – Sciences & Social Sciences Index
August 13, 2010
997 results
Topic=((vaccination SAME influenza) OR (vaccination SAME pneumoccoc*) OR (vaccination SAME pneumonia) OR (immuni?ation SAME influenza) OR (immuni?ation SAME pneumoccoc*) OR (immuni?ation SAME pneumonia))
AND
Topic=((vaccination SAME rate*) or (immuni?ation SAME rate*) or (vaccination SAME status) or (immuni?ation SAME status) OR (vaccination SAME coverage) OR (immuni?ation SAME coverage) OR (vaccination SAME uptake) OR (immuni?ation SAME uptake))
AND
Topic=(random* or control* or intervention* or program* or evaluat* or effect* or compar* or impact or "time series" or (before SAME after) or chang*)
Refined by:
Subject Areas=( PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
OR MEDICINE, GENERAL & INTERNAL OR IMMUNOLOGY OR INFECTIOUS DISEASES OR
MEDICINE, RESEARCH & EXPERIMENTAL OR EDUCATION & EDUCATIONAL RESEARCH
OR GERIATRICS & GERONTOLOGY OR HEALTH CARE SCIENCES & SERVICES OR
HEALTH POLICY & SERVICES OR PERIPHERAL VASCULAR DISEASE OR
PHARMACOLOGY & PHARMACY OR GERONTOLOGY OR RESPIRATORY SYSTEM OR VIROLOGY OR NURSING OR PSYCHOLOGY, APPLIED OR PSYCHOLOGY, MULTIDISCIPLINARY OR PSYCHOLOGY, CLINICAL OR SOCIAL SCIENCES, INTERDISCIPLINARY OR SOCIAL SCIENCES, BIOMEDICAL OR CARDIAC & CARDIOVASCULAR SYSTEMS OR ONCOLOGY OR ENDOCRINOLOGY & METABOLISM )
Timespan=1995-2009. Databases=SCI-EXPANDED, SSCI.
PsycINFO
Ovid 1987-present
August 13 2010
261 results
1. immunization/
2. (vaccin* or immuniz* or immunis* or inoculat*).ti,ab.
3. 2 or 1
4. influenza/
5. pneumonia/
6. (influenza or pneumococc* or pneumonia).ti,ab.
7. or/4-6
8. 3 and 7
9. limit 8 to (peer reviewed journal and human)
10. limit 9 to ("0200 clinical case study" or "0400 empirical study" or "0410 experimental replication" or "0430 followup study" or "0450 longitudinal study" or "0600 field study" or "0800 literature review" or "0830 systematic review" or 1200 meta analysis or 1800 quantitative study or "2000 treatment outcome/randomized clinical trial")
11. limit 10 to "300 adulthood "
AARP Ageline
Ovid
August 13, 2010
223 results
1. (vaccin* or immuniz* or immunis* or inoculat*).mp. [mp=abstract, title, publication type, heading word, accession number]
2. (influenza or pneumonia or pneumococc* or streptocc*).mp. [mp=abstract, title, publication type, heading word, accession number]
3. 1 and 2
4. 3 not (child* or infant*).mp. [mp=abstract, title, publication type, heading word, accession number]
Social Policy and Practice
Ovid
August 13, 2010
75 results
Same search as Ageline
S5.A.3. Quality assessment instrument
Table S5-A1: Downs and Black quality instrument for randomized and non-randomized studies
|Reporting |Score |
|Is the hypothesis/aim/objective of the study clearly defined? |/1 |
|Are the main outcomes to be measured clearly described in the introduction or methods section? |/1 |
|Are the characteristics of the patients included in the study clearly described? |/1 |
|Are the interventions of interest clearly described? |/1 |
|Are the distributions of principal confounders in each group of subjects to be compared clearly described? |/2 |
|Are the main findings of the study clearly described? |/1 |
|Does the study provide estimates of the random variability in the data for the main outcomes? |/1 |
|Have all important adverse events that may be a consequence of the intervention been reported? |/1 |
|Have the characteristics of patients lost to follow-up been described? |/1 |
|Have actual probability values been reported for the main outcomes, except where p/= 65 | |vaccination between |1997 solo practitioners | |
|Site affiliation: Private |years) seen by a study | |treatment and control |RR = 0.89* | |
|practices |physiatrist. Patients seen by | |groups |95% CI [0.63, 1.26] | |
| |more than 1 physiatrist were | | | | |
|Number of practices or |excluded. | | |1997 group practitioners | |
|physicians: As above. | | | |RR = 1.26* | |
| |* Patient age and gender | | |95% CI [0.98, 1.60] | |
|Location: United States |distributions provided | | | | |
|(Washington) |separately for solo and group | | |1998 solo practitioners | |
| |practices, combined here. | | |RR = 1.34* | |
| |Sample composition reported for| | |95% CI [0.96, 1.88] | |
| |the first follow-up time after | | | | |
| |intervention implementation. | | |1998 group practitioners | |
| | | | |RR = 0.83* | |
| | | | |95% CI = [0.73, 1.36] |* Random effects log-binomial |
| | | | | |regression, adjusted for clustering |
| | | |Pneumococcal |Pneumococcal |within clinics, patient age, gender, |
| | | |Not targeted. |Not targeted. |and number of claims. |
| | | | | | |
| | | | |* See next column, at right. | |
|Cheney et al. 1987 (231) |Number of patients: Not |Preventive care checklist vs usual care |Influenza |Influenza |Checklists were effective reminders, |
| |reported. | |Proportion of eligible |Follow-up |and their use led to higher rates for |
|Design: Cluster RCT | |Intervention aim: Improve preventive care|patients receiving |Group 1: 46% |implementation of preventive care |
| |Group 1 |QI agent: Medical clinics |vaccination |Control: 22% |measures. The provision and use of the|
|Group allocation: |Not reported. | | | |checklist was associated with a |
|Internal medicine residents| |Group 1 |Odds ratio of receiving|Follow-up |significant improvement in the rate of|
|were randomly allocated to |Control group | |vaccination between |OR = 3.02* |immunizations. |
|treatment and control |Not reported, |Clinician reminders: Age and gender |treatment and control |P = 0.01** | |
|groups. | |specific preventive care checklists were |groups | | |
| |Eligibility criteria: |affixed to charts for each physician to | | | |
|Follow-up period: 9 months |Patients aged 60 years or |review. |Pneumococcal |Pneumococcal | |
| |older, attending the clinic | |Proportion of eligible |Follow-up | |
|Number of sites: 1 |during the study period. |Control group |patients receiving |Group 1: 20% | |
|outpatient internal | | |vaccination (period of |Control: 3% |* Unadjusted for clustering effects. |
|medicine clinic | |Usual care |surveillance) | |Calculated by present reviewers from |
| | | | |Follow-up |percentages |
|Site affiliation: | | | |OR = 8.08* | |
|University | | | |P < 0.02** |** Adjusted for clustering of patients|
| | | | | |within physicians. |
|Number of practices or | | | |*, ** - See next column, at | |
|physicians: 75 resident | | | |right. | |
|physicians* | | | | | |
| | | | | | |
|Location: United States | | | | | |
|(California) | | | | | |
| | | | | | |
|* 33 residents and 42 | | | | | |
|residents were allocated to| | | | | |
|treatment and control | | | | | |
|groups, respectively. | | | | | |
|Clayton et al. 1999 (232) |Number of patients: 4278 |Mailed patient reminder postcard vs usual|Influenza |Influenza |This study supports the reallocation |
| | |care |Proportion of eligible |Follow-up |of resources to more targeted |
|Design: |Group 1 | |patients receiving |Group 1: 2067/2631 (79%) |outreach. Postcard interventions |
|CCT |Number of patients: 2631 |Intervention aim: Improve vaccination |vaccination |Control: 2043/2647 (77%) |should be discontinued among seniors |
| |Female/male: 1481/1150 |rates | | |vaccinated the previous year, with |
|Group allocation: |Age (mean(sd)): 73.4 (6.16) |QI agent: Large HMO |Odds ratio of receiving|Follow-up |funds redirected to more intensive |
|Experimental study with | | |vaccination between |OR = 1.08 |outreach among those at highest risk |
|patients randomly allocated|Control group |Group 1 |treatment and control |P = 0.222 |of not accepting vaccination, i.e.: |
|to treatment and control |Number of patients: 2647 | |groups | |seniors not vaccinated the previous |
|groups. |Female/male: 1467/1180 |Patient education / reminders: A post | | |year. |
| |Age (mean(sd)): 73.5 (6.12) |card reminder was sent to patients. |Pneumococcal |Pneumococcal | |
|Follow-up period: 3 months | | |Proportion of eligible |Not targeted. | |
| |Eligibility criteria: |Control group |patients receiving | | |
|Number of sites: 1 large |HMO members aged 65 years or | |vaccination | | |
|health maintenance |older, enrolled in group model |All patients received the HMO’s standard | | | |
|organization |health centers. A concurrent |member educational materials. | | | |
| |control group was designed only| | | | |
|Site affiliation: Private |for patients who received | | | | |
|MCO |influenza vaccination the year | | | | |
| |before. | | | | |
|Number of practices or | | | | | |
|physicians: Not reported | | | | | |
| | | | | | |
|Location: United States | | | | | |
|(Multiple states in the | | | | | |
|Northeastern region) | | | | | |
|Cohen et al. 1982 (233) |Number of patients: 872 |Preventive care checklists vs usual care.|Influenza |Influenza |An improvement in residents’ attitudes|
| |Age and gender distributions | |Proportion of eligible |Follow-up* |towards and use of preventive |
|Design: |not reported. |Intervention aim: Improve preventive care|patients receiving |Group 1: 186/581 (32%) |procedures, including influenza and |
|Cluster-RCT | |QI agent: Medical clinic |vaccination |Control: 12/291 (4%) |pneumococcal vaccination, occurred in |
| |Group 1 | | | |clinics implementing a simple reminder|
|Group allocation: |Number of patients: 581 |Group 1 |Odds ratio of receiving|Follow-up |checklist. |
|Patient-physician practice| | |vaccination between |OR = 10.95 | |
|clusters (firms) at a |Control group |Clinician reminders: An age appropriate |treatment and control |P < 0.001 | |
|general medicine department|Number of patients: 291 |checklist was affixed to the patient |groups | | |
|were randomly allocated to | |chart before each visit. A research | | | |
|treatment and control |Eligibility criteria: |assistant completed the checklist after a|Pneumococcal |Pneumococcal | |
|groups. |Patients aged 65 years or |brief chart review. Final orders were |Proportion of eligible |Follow-up * | |
| |older. Patients eligible for |determined by the physician. |patients receiving |Group 1: 230/547 (42%) | |
|Follow-up period: 4 months |pneumococcal vaccination had | |vaccination |Control: 14/291 (5%) | |
| |not been previously vaccinated.|Clinician education: Seminars were held | | | |
|Number of sites: 1 academic| |on preventive care topics. |Odds ratio of receiving|Follow-up | |
|general medicine outpatient| | |vaccination between |OR = 14.36 | |
|department | |Control group |treatment and control |P < 0.001 | |
| | | |groups | | |
|Site affiliation: | |Clinician education, as above. | | | |
|University | | | |* These figures are | |
| | | | |unadjusted for potential unit| |
|Number of practices or | | | |of analysis errors. However, | |
|physicians: 3 firms, i.e.: | | | |authors performed sensitivity| |
|patient-physician practice | | | |analyses at the physician | |
|clusters.* | | | |level , with p < 0.001 | |
| | | | |reported. | |
|Location: United States | | | | | |
|(Ohio) | | | | | |
| | | | | | |
|* 2 firms were allocated to| | | | | |
|treatment, 1 firm was | | | | | |
|allocated to control. | | | | | |
|Cowan et al. 1992 (234) |Number of patients: 107 |Generic clinician reminder sheet vs usual|Influenza |Influenza |A reminder system consisting of |
| | |care |Proportion of eligible |Follow-up |generic age- and sex- specific |
|Design: |Group 1 | |patients receiving |Group 1: 11/30 (37%) |recommendation for the periodic health|
|Cluster RCT |Number of patients: 62 |Intervention aim: Improve preventive care|vaccination |Control: 9/24 (38%) |examination did not significantly |
| |Female/male: 35/27 |QI agent: Medical clinic | | |improve performance of preventive |
|Group allocation: |Age (mean(sd)): 60 (sd not | |Odds ratio of receiving|Follow-up |procedures by medical residents. |
|Experimental study with |reported) |Group 1 |vaccination between |OR = 0.96 | |
|randomized allocation of | | |treatment and control |P = 1.00 |Low performance may have been due to |
|medical residents to |Control group |Clinician reminders: A periodic health |groups | |the non-interactive nature of the fact|
|intervention and control |Number of patients: 45 |examination fact sheet, containing age | | |sheet, which was designed to provide |
|groups. |Female/male: 25/20 |and sex specific recommendation on seven |Pneumococcal |Pneumococcal |information only. |
| |Age (mean(sd)): 57 (sd not |periodic health examination actions, was |Proportion of eligible |Follow-up | |
|Follow-up period: Unclear. |reported) |attached to the front of every patient |patients receiving |Group 1: 3/29 (10%) | |
| | |chart. |vaccination |Control: 0/23 (0%) | |
|Number of sites: 1 academic|Eligibility criteria: | | | | |
|medical center |Vaccinations were provided for |Control group | |Follow-up | |
| |adults >65 years old. Patients | | |OR = 5.31* | |
|Site affiliation: |were only counted towards |Usual care. | |P = 0.25 | |
|University |pneumococcal vaccination rates | | | | |
| |if they had not been previously| | |* Division by zero avoided by| |
|Number of practices or |vaccinated. | | |adding 0.5 to cells with no | |
|physicians: 29 medical | | | |events. | |
|residents | | | | | |
| | | | | | |
|Location: United States | | | | | |
|(Illinois) | | | | | |
|Dalby et al. 2000 (235) |Number of patients: 142 |Preventive home visits by a nurse vs |Influenza |Influenza |Case management/ nurse visit quality |
| | |usual care |Proportion of eligible |Follow-up* |improvement intervention improved |
|Design: |Group 1 | |patients receiving |Group 1: 51/59 (90%) |vaccination rates among the elderly at|
|RCT |Number of patients: 73 |Intervention aim: Improve care of the |vaccination |Control: 29/54 (53%) |risk for health deterioration. |
| |Female/male: 52/21 |elderly | | | |
|Group allocation: |Age (mean(sd)): 79.1 (5.8) |QI agent: Medical clinic |Odds ratio of receiving|Follow-up |Combined rates of deaths and |
|Experimental study with | | |vaccination between |OR = 5.50 |admissions to an institution were |
|patients randomly assigned |Control group |Group 1 |treatment and control |P < 0.001 |similar between the 2 groups. Nursing |
|to treatment and control |Number of patients: 69 | |groups | |case management frequently uncovered |
|groups. |Female/male: 43/26 |Team change: A nurse visited the | | |new conditions, which may have led to |
| |Age (mean(sd)): 78.1 (5.3) |household of each community-dwelling |Pneumococcal |Pneumococcal |an increase in health services |
|Follow-up period: 14 months| |elderly patient. Nurses provided |Proportion of eligible |Follow-up* |utilization in the short term. |
| |Eligibility criteria: |influenza immunizations on home visits |patients receiving |Group 1: 48/59 (82%) | |
|Number of sites: 1 Ontario |Patients 70 years or older, |after the development of a care plan. |vaccination (period of |Control: 0/54 (0%) | |
|Health Service Organization|reporting functional | |surveillance) | | |
|(HSO), i.e.: a primary care|impairment, or admission to |Case management: Nurses reviewed each | |Follow-up | |
|practice in which medical |hospital, or bereavement in the|person’s medical record and completed an | |OR = 471.27 | |
|services are remunerated by|previous 6 months. |assessment addressing physical, | |P < 0.001 | |
|capitation. | |cognitive, emotional and social function,| | | |
| |Exclusions: Nursing home, |medication use, and safety and | | | |
|Site affiliation: Private |involved in other research |suitability of the home environment. A | | | |
|practice |study, or had participated in a|care plan was developed with the primary | | | |
| |pretest of the study survey |care physician, the patient, the | | | |
|Number of practices or |instrument. |patient’s family, caregivers, and other | | | |
|physicians: 2 physicians | |health care professionals. The | |* Follow-up rates were 81% | |
| | |intervention adhered to the “functional | |and 78% in the treatment and | |
|Location: Canada (Ontario) | |consequences theory” of gerontologic | |control groups. Results | |
| | |nursing, and aimed at minimizing the | |provided for patients | |
| | |negative effects of age-related changes | |completing the trial. | |
| | |and promoting positive function. | |** With substitution of 0.5 | |
| | |Follow-up visits and phone calls were | |for zero cells. | |
| | |provided as needed over 14 months. Nurses| | | |
| | |played an important role in integrating | | | |
| | |health and community services. | | | |
| | | | | | |
| | |Control group | | | |
| | | | | | |
| | |Usual care. | | | |
|Demakis et al. 2000 (236) |Number of patients: 12989 |Computerized reminder system vs usual |Influenza |Influenza |Higher adherence to standards of care,|
| |Age (mean(sd)): 65.9 (10.9) |care |Not targeted. |Not targeted. |including pneumococcal vaccination |
|Design: Cluster-RCT |Gender (female/male): | | | |recommendations, were obtained with |
| |1.6%/98.4% |Intervention aim: Improve preventive care|Pneumococcal |Pneumococcal |the reminder system. |
|Group allocation: Primary | |QI agent: Medical clinic |Proportion of eligible |Baseline* | |
|care residents at the study|Group 1 | |patients receiving |Group 1: 4% | |
|sites were allocated, |Number of patients: Not |Group 1 |vaccination |Control: 5% | |
|either in half-day blocks |reported. | | | | |
|or by clinical teams, | |Clinician reminders: Computer-generated | |Follow-up | |
|randomly to treatment or |Control group |clinical care reminders for each patient | |Group 1: 13% | |
|control group. |Number of patients: Not |were provided to the resident in the form| |Control: 4% | |
| |reported. |of a printed summary of health placed at | | | |
|Follow-up period: 17 months| |the beginning of the medical chart on the|Odds ratio of receiving|Follow-up | |
| |Eligibility criteria: Medical |day of a clinic visit. Participating |vaccination between |OR = 3.26** | |
|Number of sites: 12 VA |residents at the study site who|residents were also exposed to the |treatment and control |95% CI = [2.09, 5.09] | |
|medical centers |were involved in primary care. |reminders through computer terminals in |groups |P < 0.001 | |
| |Patients aged 65 years or |each examination room. | | | |
|Site affiliation: Veterans |higher, or those with high-risk| |Proportion of eligible |Follow-up | |
|Affairs |conditions (not specified) were|Control group |visits in which |Group 1: 8% | |
| |eligible for pneumococcal | |vaccination was |Control: 1% | |
|Number of practices or |vaccine once every 5 years. |Usual care. |provided | | |
|physicians: 275 resident | | | |OR = 7.85** | |
|physicians* | | | |95% CI = [3.83, 16.08] | |
| | | | |P < 0.001 | |
|Location: United States | | | | | |
|(Multiple states) | | | |* Refers to resident | |
| | | | |physician behavior during the| |
|* 153 and 146 residents | | | |2 months before the | |
|were allocated to treatment| | | |intervention was implemented,| |
|and control groups, | | | |not patient vaccination | |
|respectively. | | | |status in previous years. | |
| | | | |** Adjusted for clustering | |
| | | | |within physicians by GEE. | |
|Dietrich et al. 1989 (237) |Number of patients: 117 |Patient-held preventive care checklist |Influenza |Influenza |A small patient-oriented intervention |
| |(114 patients available at |and patient education mailings vs patient|Proportion of eligible |Baseline |was associated with improved cancer |
|Design: |analysis, enumerated below.) |reminder letter only |patients receiving |Group 1: 36/59 (61%) |early detection services for older |
|CCT | | |vaccination during |Control: 39/55 (71%) |patients, but not with improvements in|
| |Group 1 |Intervention aim: Improve preventive care| | |rates of blood pressure measurement or|
|Group allocation: |Number of patients: 59 |QI agent: Medical clinic | |Follow-up |influenza vaccination. |
|Experimental study with |Female/male: 40/19 | | |Group 1: Not reported | |
|patients randomly allocated|Age (mean(sd)): 73.0(6.1) |Group 1 | |Control: Not reported |The lack of effectiveness may be due |
|to treatment and control | | | | |to patient reminder letters in the |
|groups. |Control group |Patient reminders / education: Patients |Odds ratio of receiving|Follow-up |control group and ceiling effects, |
| |Number of patients: 55 |were mailed questionnaires about their |vaccination between |OR = Unable to calculate |respectively. |
|Follow-up period = 12 |Female/male: 37/18 |personal characteristics and their recent|treatment and control |P > 0.05 (NS) | |
|months |Age (mean(sd)): 75.4(7.0) |preventive health care; personal |groups | | |
| | |prevention checklists; and letters | | | |
|Number of sites: 1 |Eligibility criteria: |encouraging use of the checklists to |Pneumococcal |Pneumococcal | |
|community medical practice |Patients aged 65 years or older|track receipt of appropriate preventive |Not targeted. |Not targeted. | |
| |with office visits during the 3|care. Preventive care items were | | | |
|Site affiliation: Private |month enrollment period. |explained in detail. | | | |
|practice |Patients without telephone, or | | | | |
| |who were transient to the |Control group | | | |
|Number of practices or |clinic, blind, demented, or | | | | |
|physicians: Not reported |terminally ill were excluded. |Patient reminder / education: Patients | | | |
| | |received a reminder letter for influenza | | | |
|Location: United States | |vaccinations | | | |
|(New Hampshire) | | | | | |
|Fishbein et al. 2006 (238) |Number of patients: 600* |Patient self-assessment / provider |Influenza |Influenza |Administering the A/R tool increased |
| | |reminder tool vs usual care |Proportion of eligible |Baseline* |the proportion of same-day |
|Design: CBA |Group 1 | |patients receiving |Group 1: 56/175 (32%) |vaccinations for influenza at 2/3 |
| |Number of patients: 300* |Intervention aim: Improve vaccination |vaccination |Control: 38/165 (23%) |study sites, and increased the |
|Group allocation: Patients |Female (%): 70% |rates | | |proportion of same-day pneumococcal |
|were allocated in |Age (mean(sd)): 48 (sd not |QI agent: Medical clinics | |Follow-up – Vaccination |vaccinations at 1/3 study sites. |
|consecutive blocks to |reported) | | |during the day the A/R tool |Comparing intervention and control |
|treatment and control | |Group 1 | |was provided ** |patients all together, the |
|groups. |Control group | | |Group 1: 25/119 (21%) |intervention improved same-day |
| |Number of patients: 300* |Facillitated relay of patient | |Control: 31/127 (24%) |pneumococcal vaccinations. No |
|Follow-up period: 1 year |Female (%): 66% |information: Patient completed a | | |significant difference in vaccination |
| |Age (mean(sd)): 47 (sd not |paper-based self assessment/ provider | |Follow-up – 1 year after the |uptake during the period after the A/R|
|Number of sites: 3 family |reported. |reminder (A/R) tool. The tool is | |A/R tool was provided** |tool was administered was observed. |
|practice sites | |comprised of a series of yes/no questions| |Group 1: 24/94 (26%) | |
| |Eligibility criteria: Patients |that assess patients’ needs for 8 | |Control: 30/96 (31%) |Disappointing results may have been |
|Site affiliation: 1 |aged 18 years or older, not |immunizations (reduced to 6 at two of | | |due to the large number of |
|academic site, 1 private |acutely ill, providing written |three study sites). |Odds ratio of receiving|Follow-up – Vaccination |vaccinations (8) prompted by the A/R |
|practice, and 1 primary |consent. Influenza and | |vaccination between |during the day the A/R tool |tool. Providers flatly stated that |
|health centre |pneumococcal vaccinations were |Clinician reminders: The A/R tool |treatment and control |was provided** |they were not willing, or did not have|
| |recommended for patients aged |prompted clinicians to provide |groups |OR = 0.82 |the time, to consider all eight |
|Number of practices or |65 years or older, or those |recommended vaccinations. The A/R tool | |P = 0.57 |vaccinations. Authors also suggest |
|physicians: 16 physicians |with select chronic diseases. |also remained part of the patient chart | | |that the A/R tool would have become |
| | |after the initial visit at which it was | |Follow-up – 1 year after the |lost among other papers in the patient|
|Location: United States | |produced. | |A/R tool was provided** |chart after the initial visit. |
|(Louisiana, New Mexico, and|* Includes patients for whom | | |OR = 0.75 | |
|Georgia) |influenza and pneumococcal |Patient education: The A/R tool was | |P = 0.42 | |
| |vaccinations were not |accompanied by educational material | | | |
| |indicated. |concerning recommended vaccinations. |Pneumococcal |Pneumococcal | |
| | | |Proportion of eligible |Baseline* | |
| | |Control group |patients receiving |Group 1: 45/105 (43%) | |
| | | |vaccination |Control: 53/112 (47%) | |
| | |Usual care. Patients received information| | | |
| | |on physical activity instead of the A/R | |Follow-up – Vaccination | |
| | |tool. | |during the day the A/R tool | |
| | | | |was provided** | |
| | | | |Group 1: 23/60 (38%) | |
| | | | |Control: 8/59 (14%) | |
| | | | | |* Baseline results refer to those |
| | | | |Follow-up – 1 year after the |patients who had already been |
| | | | |A/R tool was provided** |vaccinated that season (influenza) or |
| | | | |Group 1: 5/37 (14%) |previously (pneumococcal). These |
| | | | |Control: 7/51 (14%) |patients were removed from the |
| | | | | |denominator of successive outcome |
| | | |Odds ratio of receiving|Follow-up – Vaccination |proportions. Baseline proportions do |
| | | |vaccination between |during the day the A/R tool |not represent previous years’ |
| | | |treatment and control |was provided** |vaccination status. |
| | | |groups |OR = 3.96 |** Results differed among intervention|
| | | | |P = 0.003 |sites. Overall results extracted here.|
| | | | | | |
| | | | |Follow-up – 1 year after the | |
| | | | |A/R tool was provided** | |
| | | | |OR – 0.98 | |
| | | | |P = 1.00 | |
| | | | | | |
| | | | |*, ** - See next column, at | |
| | | | |right. | |
|Frank et al. 2004 (239) |Number of patients: 10507 |Automated EMR reminder prompts vs usual |Influenza |Influenza |Reminders did not increase influenza |
| | |care |Proportion of |Follow-up |vaccination rates, but did increase |
|Design: |Group 1 | |patient-contacts with |Group 1: 245/935 (26%) |pneumococcal vaccination rates. |
|CCT |Number of patients: 5118 |Intervention aim: Improve preventive care|eligible patients |Control: 248/912 (27%) |Overall, reminders caused only a |
| |Female/male: 56% female |QI agent: Medical clinics |resulting in | |modest increase in opportunistic |
|Group allocation: |Age (mean(sd)): 36.0 (21.7) | |vaccination | |uptake. |
|Experimental study with | |Group 1 | | | |
|patients allocated to |Control group | |Odds ratio of a patient|Follow-up |A small effect may have been due to |
|treatment and control |Number of patients: 5389 |Clinician reminders: Physicians, all of |contact resulting in |OR = 0.95 |increased sensitivity of GPs to |
|groups by |Female/male: 57% female |whom were experienced EMR users, received|vaccination between |95% CI = [0.78, 1.18] |preventive care affecting the care of |
|quasi-randomization. |Age (mean(sd)): 35.4 (21.9) |on-screen preventive care prompts for |treatment and control |P = 0.64 |control patients, or to other |
| | |eligible patients. |groups | |characteristics in setting, evaluation|
|Follow-up period: Unclear |Eligibility criteria: | | | |design, or intervention design. |
| |GP visits of all adult patients|Control group | | |Information overload may also be a |
|Site affiliation: Private |attending the study general | |Pneumococcal | |mitigating factor. |
|practice |practice. Eligible visits for |Usual care |Proportion of |Pneumococcal | |
| |receiving influenza vaccination| |patient-contacts with |Follow-up | |
|Number of sites: 1 |occurred among patients > 65 | |eligible patients |Group 1: 58/2079 (3%) | |
|Sub-urban general practice |years old who had not yet | |resulting in |Control: 39/2370 (2%) | |
| |received the current season’s | |vaccination | | |
|Number of practices or |vaccination. Eligible visits | | | | |
|physicians: 10 physicians |for receiving pneumococcal | |Odds ratio of a patient| | |
| |vaccination occurred among | |contact resulting in |Follow-up | |
|Location: Australia (South |patients > 65 years old who had| |vaccination between |OR = 1.72 | |
|Australia) |not been previously vaccinated.| |treatment and control |95% CI = [1.10, 2.62] | |
| | | |groups |P = 0.01 | |
| | | | | | |
| | | | | | |
|Garcia-Aymerich et al. 2007|Number of patients: 113 |Integrated COPD care vs usual care |Influenza |Influenza |Integrated care, including |
|(240) |patients | |Proportion of eligible |Follow-up* |self-management education, |
| | |Intervention aim: Improve COPD care |patients receiving |Group 1: 19/21 (91%) |coordination among levels of care, and|
|Design: |Group 1 |QI agent: Academic department of |vaccination |Control: 32/41 (78%) |increased accessibility in COPD |
|RCT |Number of patients: 44 |pulmonary medicine | | |patients, was associated with |
| |Female/male: 11/33 | |Odds ratio of receiving|Follow-up |improvements in disease knowledge, |
|Group allocation: |Age (mean(sd)): 72 (10)* |Group 1 |vaccination between |OR = 2.67 |treatment adherence, and nutritional |
|Experimental study with | | |treatment and control |P = 0.442 |status. |
|patients randomized to |Control group |Case management: Patients received a |groups | | |
|treatment and control |Number of patients: 69 |comprehensive assessment at discharge, | | |No significant changes in lifestyle |
|groups. |Female/male: 5/64 |including evaluation of comorbidities, |Pneumococcal |Pneumococcal |variables, medical treatment, lung |
| |Age (mean(sd)): 73 (9)* |treatment adherence, and social support |Proportion of eligible |Follow-up* |function, or quality of life were |
|Follow-up period: 12 months| |needs. An individually tailored care plan|patients receiving |Group 1: 16/21 (76%) |detected. |
| |Eligibility criteria: |was developed between the patient, the |vaccinations |Control: 25/41 (61%) | |
|Number of sites: 1 |COPD patients discharged from a|case manager, and the primary care team. | | | |
|department of pulmonary |particular tertiary care |Patients were coached through logistical |Odds ratio of receiving|Follow-up | |
|medicine at an academic |hospital. All patients had been|and social support issues associated with|vaccination between |OR = 2.05 | |
|tertiary care center |admitted because of an acute |managing multiple chronic conditions. |treatment and control |P = 0.348 | |
| |exacerbation, and had required |Additionally, patients were taught to |groups | | |
|Site affiliation: |hospitalization for more than |identify symptoms or signs of an acute | | | |
|University |48 hours. Patients were |episode, and to call the case manager who| | | |
| |excluded if they resided in a |could either solve the problem over the | |* Study completion rates were| |
|Number of practices or |nursing home, or outside of |phone or initiate a home visit. No | |53% and 60% among treatment | |
|physicians: General |study area; had lung cancer or |further visits were initiated by the case| |and control patients. Results| |
|practices were involved in |advanced malignancies; faced |manager. Patients could initiate contact | |reported for patients | |
|the provision of care. |logistic limitations; or |by telephone, or through a web based call| |completing the study. | |
|Numbers were not reported. |suffered severe neurological or|center. | | | |
| |cardiovascular co-morbidities. | | | | |
|Location: Spain (Barcelona)| |Patient education / reminders: A 2 hour | | | |
| |* Age reported for patients |educational session covering | | | |
| |completing the study only. |self-management of COPD was administered | | | |
| | |at discharge by the study nurse. Topics | | | |
| |** Denominator of the |included knowledge of the disease, | | | |
| |pneumococcal vaccination |smoking cessation, physical activity, | | | |
| |outcome may included patients |nutrition, non-pharmacologic therapy, | | | |
| |with previous vaccinations. |correct use of pharmacological therapy, | | | |
| | |and self-management strategies for coping| | | |
| | |with exacerbations. | | | |
| | | | | | |
| | |Team change: Case management was provided| | | |
| | |by specially trained respiratory care | | | |
| | |nurses. Additionally, a joint visit of | | | |
| | |the specialist nurse and the primary care| | | |
| | |team was made | | | |
| | | | | | |
| | |Control group | | | |
| | | | | | |
| | |Usual care | | | |
|Goebel et al., 2005 (241) |Number of patients: 1796 |Standing orders for nurse vaccination vs |Influenza |Influenza |Standing orders for influenza |
| | |usual care |Proportion of eligible |Follow-up*, ** |vaccination are associated with higher|
|Design: |Group 1 | |patients receiving |Group 1: 575/912 (63%) |immunization rates in the ambulatory |
|Cluster RCS |Number of patients: 912 |Intervention aim: Improve vaccination |vaccination |Control: 336/884 (38%) |setting. |
| |Female/male: 693/219 |rates | | | |
|Group allocation: Physician|Age (mean(sd)): 79 (sd not |QI agent: Physician practices |Odds ratio of receiving|Follow-up*, ** |Results may be biased by imbalances in|
|practices allocated to |reported) | |vaccination between |OR = 2.78 |covariates among patient samples |
|treatment and control arms | |Group 1 |treatment and control |P < 0.0001 |between groups, as well as differences|
|by physician |Control group | |groups | |in clinician or practice |
|self-selection. |Number of patients: 884 |Team change: Nurses were tasked with | | |characteristics between the small |
| |Female/male: 510/374 |providing influenza vaccinations. |Pneumococcal |Pneumococcal |number of practices involved. |
|Follow-up period: 4 years |Age (mean(sd)): 74 (sd not |Physicians issued verbal or written |Not targeted. |Not targeted. | |
| |reported) |standing orders to their nurses to | | | |
|Number of sites: 1 | |administer the influenza vaccine. | |* Combined over 4 years. | |
|University ambulatory care |Eligibility criteria: | | |** Unadjusted for baseline | |
|center |Patients aged 65 years or older|Control group | |imbalances in age and gender.| |
| |treated by an attending | | | | |
|Site affiliation: |physician at the study site. |Usual care | | | |
|University | | | | | |
| | | | | | |
|Number of practices or | | | | | |
|physicians: 4 attending | | | | | |
|physicians (2 treatment | | | | | |
|practices, 2 control | | | | | |
|practices) | | | | | |
| | | | | | |
|Location: United States | | | | | |
|(Virginia) | | | | | |
|Grabenstein et al. 1993 |Number of patients: 551 |Vaccination advocacy by community |Influenza |Influenza |Community pharmacists improved |
|(242) |(482 patients available at |pharmacists via patient education letters|Proportion of eligible |Follow-up |vaccination rates by advising at-risk |
| |analysis, enumerated below.) |vs usual care |patients receiving |Group 1: 39/125 (31%) |patients of infection risk and |
|Design: RCT | | |vaccination |Control: 24/134 (18%) |describing where to be vaccinated. |
| |Group 1 |Intervention aim: Improve vaccination | | | |
|Group allocation: Patients |Number of patients: 242 |rates |Odds ratio of receiving|Follow-up | |
|were randomly allocated to |Female/male: 152/90 |QI agent: Community pharmacies |vaccination between |OR = 1.70 | |
|treatment and control |Age (mean(sd)): 66.9 (13.7) | |treatment and control |P = 0.013 | |
|groups. | |Group 1 |groups | | |
| |Control group | | | | |
|Follow-up period: 2 months |Number of patients: 240 |Patient education / reminders: Patients |Pneumococcal |Pneumococcal | |
| |Female/male: 159/81 |were mailed a letter on pharmacy |Not targeted. |Not targeted. | |
|Number of sites: 3 |Age (mean(sd)): 67.8 (14.6) |stationery, advising them of their | | | |
|pharmacies belonging to 1 | |infection risk and of influenza vaccine | | | |
|pharmacy chain. |Eligibility criteria: |availability. Letters were written in a | | | |
| |Patients fell into two sets: |manner consistent with the Health Beliefs| | | |
|Site affiliation: Private |Those receiving one of ten |Model, explaining influenza | | | |
|community pharmacies |medications in the preceding |susceptibility and severity, vaccine | | | |
| |six months from the study |efficacy, and providing information to | | | |
|Number of practices or |pharmacies. Medications were |mitigate barriers of fear or uncertainty.| | | |
|physicians: 3 pharmacies, |digoxin or nitroglycerin (heart|All patients, including control patients,| | | |
|as above. |disease); insulin, glipizide, |also received a reminder postcard 2 weeks| | | |
| |or glyburide (diabetes); and |later. | | | |
|Location: United States |theophylline or salbutamol | | | | |
|(North Carolina) |(chronic respiratory disease); |Control group | | | |
| |or patients aged 65 years or | | | | |
| |older receiving ibuprofen, |Patient education / reminders: Patients | | | |
| |naproxen, or sulindac in the |received a poison control pamphlet, as | | | |
| |preceding six months. Patient |well as a vaccination reminder postcard. | | | |
| |pharmacy records were screened | | | | |
| |to exclude patients with | | | | |
| |chronic diseases from this set.| | | | |
| |Patients residing in a nursing | | | | |
| |home, or patients otherwise | | | | |
| |incapable of responding to | | | | |
| |letter or survey, were | | | | |
| |excluded. | | | | |
|Grabenstein et al. 2001 |Number of patients: 4403* |Pharmacist vaccination vs limited, single|Influenza |Influenza |Vaccine delivery by pharmacists was |
|(243) |Female/male: 1212/878 |day, nurse-led pharmacy vaccination |Proportion of eligible |Baseline |associated with a 10.6% higher |
| |Age (mean(sd)): 64.8 (15.2) |clinics |patients receiving |All patients |influenza vaccination rate among |
|Design: |Group specific age and gender | |vaccination |Group 1: 689/1004 (69%) |respondents aged /= 65 years increased|
|Follow-up period: 1 year |Eligibility criteria: |eligible patients and administering |difference in change |Age >/= 65 |only slightly. This may have been due |
| |Patients aged 65 years or older|influenza vaccinations. |scores from baseline |Diff. = +4.7% ([-4.5%, |to a ceiling effect. |
|Number of sites: 1 large |receiving any prescription | |performance, treated as|+13.9%]) | |
|chain of commercial |medication, or patients 21 to |Delivery site change: Patients were able |a continuous outcome | |Pharmacists can identify and motivate |
|pharmacies |64 years old who received |to obtain vaccinations from pharmacists |for each pharmacy, |Age < 65 |pharmacy patrons at risk of influenza |
| |medications related to certain |in commercial community pharmacies. |diff. (mean (95% CI)). |Diff. = +10.6% ([0.0%, |to be vaccinated. |
|Site affiliation: |chronic diseases; medication | | |21.2%]) | |
|Commercial pharmacies |was received from a |Control group |Odds ratio of receiving| | |
| |participating pharmacy during | |vaccination between |Follow-up | |
|Number of practices or |October 1998. Patients were |Delivery site change: Each pharmacy |treatment and control |OR = 1.08 | |
|physicians: 24 pharmacies* |excluded if they were living in|hosted vaccination nurses for a single |groups |P = 0.48 | |
| |a nursing home. |day vaccination clinic during the Fall. | | | |
|Location: United States | | |Proportion of patients | | |
|(Washington and Oregon) |* 4430 patients were identified| |not vaccinated at |Follow-up | |
| |by database. However, only 2090| |baseline, receiving |All patients unvaccinated at | |
| |patients responded. Statistics | |vaccination at |baseline | |
| |provided for responders only. | |follow-up |Group 1: 111/315 (35%) | |
| | | | |Control: 67/146 (22%) | |
|* US states were allocated | | | | | |
|to treatment (Washington | | | |Unvaccinated at baseline, age| |
|state, 11 pharmacies) and | | | |>/= 65 | |
|control (Oregon state, 13 | | | |Group 1: 51/141 (36%) | |
|pharmacies) groups. | | | |Control: 24/107 (22%) | |
| | | | | | |
| | | | |Unvaccinated at baseline, | |
| | | | |aged < 65 | |
| | | | |Group 1: 60/174 (35%) | |
| | | |Odds ratio of receiving|Control: 43/173 (25%) | |
| | | |vaccination between | | |
| | | |treatment and control |Follow-up | |
| | | |groups, among patients |All patients unvaccinated at | |
| | | |unvaccinated at |baseline* | |
| | | |baseline |OR = 1.56 | |
| | | | |P = 0.03 | |
| | | | | | |
| | | | |Unvaccinated at baseline, age| |
| | | | |>/= 65* | |
| | | | |OR = 1.96 | |
| | | | |P = 0.03 | |
| | | | | | |
| | | | |Unvaccinated at baseline, age| |
| | | | |< 65* | |
| | | |Pneumococcal |OR = 1.62 | |
| | | |Not targeted. |P = 0.05 | |
| | | | | | |
| | | | |Pneumococcal | |
| | | | |Not targeted. | |
|Gutschi et al. 1998 (244) |Number of patients: 143 |Hospital pharmacist vaccination |Influenza |Influenza |The addition of follow-up letters |
| |(135 patients were available at|counseling vs hospital pharmacist |Proportion of eligible |Baseline |addressed to family physicians and/or |
|Design: |analysis, enumerated below.) |vaccination counseling and letter for |patients receiving |Control: 34% |community pharmacists did not increase|
|CCT | |community pharmacists vs hospital |vaccination |Group 1: 57% |vaccination rates among high risk |
| |Group 1 |pharmacist vaccination counseling and | |Group 2: 38% |patients receiving vaccination |
|Group allocation: |Number of patients: 44 |letters for community pharmacists and | | |counseling from hospital pharmacists. |
|Experimental study with |Female/male: 9/35 |physicians | |Follow-up | |
|patients randomly allocated|Age (mean(sd)): 59.6 (11.8) | | |Control: 29/44 (66%) |The follow-up letters may have been |
|to treatment and control | |Intervention aim: Improve vaccination | |Group 1: 35/44 (80%) |effective due to failure to enlist |
|groups. |Group 2 |rates | |Group 2: 33/47 (70%) |community health care providers. |
| |Number of patients: 44 |QI agent: Hospital pharmacy department | | |Community pharmacists, for example, |
|Follow-up period: 3 months |Female/male: 6/38 | | |Test of overall significance|often refused to accept the follow-up |
| |Age (mean(sd)): 62.0 (11.4) |Group 1 | |P = 0.347 |letter. |
|Number of sites: 1 | | | | | |
|pharmaceutical services |Group 3 |Patient education / reminders: A |Odds ratio of receiving|Follow-up | |
|department of a large |Number of patients: 47 |pharmacist assessed patents for, and |vaccination between |Group 1 | |
|tertiary care hospital |Female/male: 15/32 |counseled patients regarding the risks |treatment and control |OR = 2.01 | |
| |Age (mean(sd)): 59.5 (11.1) |and benefits of influenza and |groups |P = 0.23 | |
|Site affiliation: | |pneumococcal vaccination. | | | |
|University |Eligibility criteria: | | |Group 2 | |
| |Patients had just been |Clinician reminders: A follow-letter and | |OR = 1.22 | |
|Number of practices or |discharged after cardiac |pharmacy care plan was given to the | |P = 0.82 | |
|physicians: No particular |surgery at a university |patient and addressed to their community | | | |
|community providers were |hospital. |pharmacist. |Pneumococcal |Pneumococcal | |
|involved a priori in this | | |Proportion of eligible |Baseline | |
|study |Exclusion: Egg allergy, |Group 2 |patients receiving |Control: 14% | |
| |previous serious reaction to | |vaccination |Group 1: 14% | |
|Location: Canada (Ontario) |vaccine, receipt of both |Patient education / reminders, as above. | |Group 2: 11% | |
| |vaccines in the previous two | | | | |
| |years. |Clinician reminders: Follow-letters and | |Follow-up | |
| | |pharmacy care plans were given to the | |Control: 19/44 (43%) | |
| | |patient and addressed to patients’ | |Group 1: 16/44 (36%) | |
| | |community pharmacist and family | |Group 2: 22/47 (47%) | |
| | |physician. | | | |
| | | | |Overall test of significance | |
| | |Control | |P = 0.594 | |
| | | | | | |
| | |Patient education / reminders, as above. |Odds ratio of receiving|Follow-up | |
| | | |vaccination between |Group 1 | |
| | | |treatment and control |OR = 0.75 | |
| | | |groups |P = 0.66 | |
| | | | | | |
| | | | |Group 2 | |
| | | | |OR = 1.16 | |
| | | | |P = 0.83 | |
|Harari et al. 2008 (245) |Number of patients: 2503 |Comprehensive patient health risk survey |Influenza |Influenza |Integration of an evidence-based |
| |(2006 patients were available |leading to computer generated patient and|Proportion of eligible |Follow-up |delivery instrument (HRA-O) for the |
|Design: |for analysis, enumerated |GP feedback vs usual care |patients receiving |Group 1: 788/939 (84%) |promotion of health in older people |
|RCT |below.) | |vaccination |Control: 916/1066 (86%) |into the current IT driven system of |
| | |Intervention aim: Improve preventive care| |Non-participating site: 65% |three British primary care group |
|Group allocation: |Group 1 |QI agent: Medical clinics | | |practice did not improve self-reported|
|Experimental study, with |Number of patients: 940 | |Odds ratio of receiving|Follow-up |health risk variables over 12 months, |
|patients randomly allocated|Female/male: 526/414 |Group 1 |vaccination between |Group 1 vs control |other than increased pneumococcal |
|to treatment or control |Age (mean(sd)): 74.7(6.3) | |treatment and control |OR = 0.8 |vaccination take-up. |
|groups. Patients from the | |Patient education / reminders: Patients |groups |P = 0.12 | |
|same household were |Control group |were mailed a questionnaire (HRA-O) | |Group 1 vs non-participating |The authors suggest that contamination|
|allocated to the same |Number of patients: 1066 |comprised of sections on health behavior,| |site |may have obscured the intervention |
|group. |Female/male: 564/502 |preventive care uptake, and self-reported| |P < 0.0001 |effect, since all health care workers |
| |Age (mean(sd)): 74.2 (6.0) |health. Based on questionnaire results, | | |received preventive care education. |
|Follow-up period: 1 year | |patients were mailed individualized |Pneumococcal |Pneumococcal |This explanation is supported by much |
| |Eligibility criteria: |advice on modifying health risks, a |Proportion of eligible |Follow-up |lower vaccination rates in the |
|Number of sites: 3 |Patients aged 65 years or |preventive health checklists, sources of |patients receiving |Group 1: 308/939 (33%) |non-participating practice. |
|computerized GP practices |older. Patients were excluded |support, and other information. The 20-35|vaccination |Control: 291/1066 (28%) | |
| |if they were nursing home |page individualized report was | | |Supplementary reinforcement involving |
|Site affiliation: Private |residents, required help with |accompanied by a letter from the |Odds ratio of receiving|Follow-up |direct professional/patient follow-up |
|practices |activities of daily living, had|patient’s practice, asking patients to |vaccination between |Group 1 vs control |contact may be necessary to achieve |
| |dementia, had a terminal |discuss issues with their GP or practice |treatment and control |OR = 1.2 |benefit. |
|Number of practices or |illness, or could not speak |nurse. Non-responders were issued a |groups |P = 0.04 | |
|physicians: 18 general |English. |reminder card 6 months later. | |Group 1 vs non-participating | |
|practitioners * | | | |site | |
| | |Facilitated relay of clinical | |P = non-significant | |
|Location: United Kingdom | |information: Information from the patient| | | |
|(London) | |questionnaire was forwarded to GPs, who | | | |
| | |selected relevant data elements for entry| | | |
| | |into the patient’s EMR. | | | |
| | | | | | |
|* Outcomes were measured at| |Clinician reminders: The EMR was | | | |
|an additional, | |programmed to issue electronic prompts | | | |
|non-participating GP group | |when the patient record was accessed, | | | |
|practice with 8 | |based on the health risks detected in the| | | |
|practitioners to check for | |patient survey. | | | |
|contamination. | | | | | |
| | |Clinician education: GPs and practice | | | |
| | |nurses participated in training and | | | |
| | |review sessions on current preventive | | | |
| | |care and health behavior recommendations.| | | |
| | | | | | |
| | |Control group | | | |
| | | | | | |
| | |Clinician education: GPs and practice | | | |
| | |nurses participated in training and | | | |
| | |review sessions on current preventive | | | |
| | |care and health behavior recommendations.| | | |
|Harris et al. 1990 (246) |Number of patients: 112* |Patients exposed to a computer clinician |Influenza |Influenza |Computer prompting appears to improve |
| |Female/male: 112/0 |reminder system vs usual (episodic) care |Proportion of eligible |Baseline*, ** |performance of preventive care |
|Design: RCS |Age (mean): 65 | |patients receiving |Group 1: 23/34 (68%) |procedures. However, the patient |
| | |Intervention aim: Improve preventive care|vaccination |Control: 22/71 (31%) |population was self-selected into |
|Group allocation: Patients |Group 1 |QI agent: Medical clinic | | |intervention and control groups. |
|self-selected into a group |Number of patients: 62* | | |Follow-up *** |Intervention patients had longer |
|enrolled in continuous |Female/male: 62/0 |Group 1 | |Group 1: 51/62 (83%) |associations with the practice, |
|care, and an episodic | | | |Control: 15/50 (29%) |visited the practice more frequently, |
|consultative care group. |Control group |Clinician reminders: Following patient | | |and more high risk illnesses, all of |
|Patients in the former |Number of patients: 50* |enrollment, a specially trained nurse |Odds ratio of receiving|Follow-up *** |which are predictors of vaccination. |
|group were subject to the |Female male: 50/0 |reviewed patients’ medical records for |vaccination between |OR = 10.82 |This study suffers high risk of bias. |
|intervention. | |past performance of recommended |treatment and control |P < 0.001 | |
| |Eligibility criteria: Women |preventive care procedures. Clerical |groups | | |
|Follow-up period: 12 months|aged 50 years or older, who had|personnel entered the nurse’s review | | |* Baseline results were reported for a|
| |visited the practice at least |information into the practice |Pneumococcal |Pneumococcal |period during which a nurse reminder |
| |twice in the preceding year. |computerized mini-medical record. On |Proportion of eligible |Baseline*, ** |system had been implemented. |
|Number of sites: 1 |Men were excluded. |subsequent patient visits, a |patients receiving |Group 1: 5/18 (29%) |** Numerous patients crossed between |
|university-based general | |computer-generated encounter form |vaccination (period of |Control: 4/39 (10%) |groups during the study period. |
|medicine clinic | |automatically listed “due” procedures. |surveillance) | |*** Covariates known to be predictive |
| |* This study analyzed before | | |Follow-up *** |of vaccination varied significantly |
|Site affiliation: |and after cross-sectional |Control group | |Group 1: 11/33 (33%) |between groups. ORs calculated by |
|University |samples of patients. During the| | |Control: 0/25 (0%) |present reviewers, by substituting 0.5|
| |follow-up period, 150 patients |Usual care, i.e.: episodic consultations | | |for zero cells. |
|Number of practices or |were eligible for all |with clinic physicians. | |Follow-up*** | |
|physicians: 24 faculty |preventive care activities, of | | |OR = 25 | |
|physicians and 70 resident |which 112 patients were | | |P = 0.001 | |
|physicians |eligible for influenza | | | | |
| |vaccination. | | |*, **, and *** notes: See | |
|Location: United States | | | |next colum. | |
|(North Carolina) | | | | | |
|Harris et al. 2009 (247) |Number of patients: 249 |Patient-held evidence-based care manual |Influenza |Influenza |Providing summaries of evidence to |
| | |vs usual care with a COPD information |Proportion of eligible |Baseline |COPD patients did not lead to improved|
|Design: CBA |Group 1 |pamphlet |patients receiving |Group 1: 110/125 (88%) |application of evidence in medical |
| |Number of patients: 125 | |vaccination at baseline|Control: 108/124 (87%) |care. Lack of an effect may have been |
|Group allocation: Two |Female/male: 56/69 |Intervention aim: Improve COPD care | | |due to deployment of a COPD pamphlet |
|geographic regions in |Age (mean(sd)): 73.6 (sd not |QI agent: University research team |Change in proportion of| |among control patients, which provided|
|metropolitan Adelaide were |reported) | |eligible patients |Follow-up |similar recommendations and coverage |
|allocated to treatment and | |Group 1 |receiving vaccination |Patients above median SES |of content, without referencing |
|control arms. |Control group | |from baseline |Group 1: +7% |research support. |
| |Number of patients: 124 |Patient education / reminders: Patients | |Control: -1% | |
|Follow-up period: 12 months|Female/male: 59/65 |were provided with a manual summarizing | |P = 0.83* | |
| |Age (mean(sd)): 73.1 (sd not |Cochrane reviews of evidence about COPD | | | |
|Number of sites: One |reported) |treatments, along with additional | |Patients below median SES | |
|university research group | |background information. Text was | |Group 1: +7% | |
|delivered the intervention |Eligibility criteria: Patients |delivered in plain language, small page | |Control: +5% | |
|in 2 metropolitan areas |discharged from hospital for |size, large print, question-and-answer | |P = 0.98* | |
| |COPD or attending respiratory |format, and with illustrations. Tips or |Pneumococcal | | |
|Site affiliation: |outpatient clinics for COPD, |suggests regarding questions patients |Not targeted. |Pneumococcal | |
|University |with moderate to severe disease|could ask of their physicians were also | |Not targeted. | |
| |according to the Global |provided. | | | |
|Number of practices or |Initiative for Chronic | | | | |
|physicians: Not reported. |Obstructive Lung Disease (GOLD)|Control group | | | |
| |criteria. | | |* Calculated from ANCOVA on | |
|Location: Australia (South | |Usual care, with patients receiving a | |the change scores, with | |
|Australia) |Exclusions: Lung cancer, |single sheet foldout pamphlet covering | |adjustment for baseline | |
| |dementia, other major or |numerous COPD topics without referencing | |performance and a propensity | |
| |unstable illness, inability to |research evidence. | |score derived from baseline | |
| |read English or lack of access | | |patient characteristics. | |
|Herman et al. 1994 (248) |Number of patients: 1202 |Preventive team care with patient |Influenza |Influenza |Vaccination rates improved |
| | |educational materials vs patient |Proportion of eligible |Baseline*, *** |statistically and clinically |
|Design: |Group 1 |educational materials only vs usual care |patients receiving |Group 1: 76/243 (31%) |significantly for influenza and |
|Cluster-RCT |Number of patients: 387 | |vaccination |Group 2: 113/242 (47%) |pneumococcal vaccination in the |
| |Female/male: 261/126 |Intervention aim: Improve vaccination | |Control: 93/271 (34%) |clinical team offering preventive team|
|Group allocation: |Age (mean(sd)): 72.9 (6.1) |rates | | |care. Using standing orders, the |
|Experimental study with | |QI agent: Medical clinics | |Follow-up*, *** |clinic nurses doubled the rates of |
|practice groups allocated |Group 2 | | |Group 1: 134/243 (55%) |immunizations. |
|to treatment and control |Number of patients: 389 |Group 1 | |Group 2: 108/242 (45%) | |
|groups. |Female/male: 278/111 | | |Control: 113/271 (42%) |Patient education did not increase |
| |Age (mean(sd)): 73.8 (6.6) |Clinician education: All study providers | | |vaccination rates over provider |
|Follow-up period: 6 months | |were provided with educational materials |Odds ratio of receiving|Follow-upt |education alone. |
| |Control |and opportunities for attendance at |vaccination between |Group 1 vs Control | |
|Number of sites: 1 |Number of patients: 426 |lectures on preventive services for the |treatment and control |OR = 1.72 |The rates at which eligible patients |
|outpatient general medicine|Female/male: 293/133 |older patient. Materials consisted of |groups |P < 0.001 |were offered vaccination were still |
|clinic at a major public |Age (mean(sd)): 73.5 (6.6) |background papers and succinct guidelines| | |low compared with national targets. |
|hospital affiliated with an| |related to routine preventive services. | |Group 2 vs Control |Patient refusal of vaccination was |
|academic school |Eligibility criteria: | | |OR = 1.23 |also higher in the team care |
| |Clinic patients aged 65 years |Patient education / reminders: | |P = Not significant |intervention group. |
|Site affiliation: |or older attending the |Educational materials were given to | | | |
|University |ambulatory medicine clinic for |patients by the nurse at each clinic | |Group 1 vs Group 2 | |
| |any visit between October 1, |visit. Nurses provided the National | |OR = 1.53 | |
|Number of practices or |1989 and March 31, 1990; seen |Institute on Aging’s Age Page “Shots for | |P = 0.001 |* Denominator composed of patients who|
|physicians: 3 practice |by the resident physician, a |Safety”, as well as material from the | | |had attended the practice during 2 |
|groups, each with 21 to 23 |nurse practitioner, or a nurse |Ohio Department of Health recommending |Pneumococcal |Pneumococcal |consecutive influenza seasons, i.e.: |
|residents, 1 nurse, and 1 |for either a medication refill |annual vaccination. |Proportion of eligible |Baseline |baseline and intervention |
|nurse practitioner. |or education visit. | |patients receiving |Group 1: 73/387 (19%) |periods.Covariate distribution is |
|Residents had been randomly| |Team change: A protocol was developed to |vaccination |Group 2: 97/389 (25%) |similar to that of the overall sample.|
|allocated to groups. |Exclusion: Contraindication to |allow nurses to vaccinate patients before| |Group 3: 131/426 (31%) | |
| |vaccination |they were seen by the physician or nurse | | |** Denominator composed of patients |
|Location: United States | |practitioner. A health maintenance flow | |Follow-up**, *** |without previous pneumococcal |
|(Ohio) | |sheet was attached to each patient’s | |Group 1: 68/314 (22%) |vaccination. |
| | |chart and updated during the study | |Group 2: 15/292 (5%) | |
| | |period. | |Control: 10/295 (3%) |***Statistically significant racial |
| | | | | |imbalances detected between groups. |
| | |Group 2 |Odds ratio of receiving|Follow-up t | |
| | | |vaccination between |Group 1 vs Control |t From logistic regression analyses |
| | |Clinician education and patient education|treatment and control |OR = not reported |adjusted for baseline vaccination |
| | |/ reminders, as above. |groups |P = 0.001 |history, age, gender, race, |
| | | | | |physician’s level of training, or |
| | |Control group | |Group 2 vs Control |physician’s attitudes. |
| | | | |OR = not reported | |
| | |Clinician education, as above. | |P = not significant | |
| | | | | | |
| | | | |Group 1 vs Group 2 | |
| | | | |OR = Not reported | |
| | | | |P = 0.0001 | |
| | | | | | |
|Hermiz et al. 2002 (249) |Number of patients: 177 |Home visits by community nurses after |Influenza |Influenza |Home follow-up by a community nurse of|
| | |hospital discharge vs usual GP care |Proportion of eligible |Follow-up |patients discharged from hospital |
|Design: CCT |Group 1 | |patients receiving |Group 1: 48/67 (72%) |after an acute exacerbation of COPD |
| |Number of patients: 84 |Intervention aim: Improve care of COPD |vaccination |Control: 60/80 (75%) |did not improve vaccination rates. |
|Group allocation: Patients |Female/male: 43/41 |QI agent: Community nurses | | |Total functional status, use of the |
|were randomly allocated to |Age (mean(sd)): 67.1 (sd not | |Odds ratio of receiving|Follow-up |emergency department, GP visits, |
|treatment and control |reported) |Group 1 |vaccination between |OR = 0.84 |re-admission to hospital, and |
|groups. | | |treatment and control |P = 0.65 |satisfaction also did not differ |
| |Control group |Team change: Community nurses provided |groups | |between groups during the follow-up |
|Follow-up period: 3 months |Number of patients: 93 |two home visits per patient. The first | | |period. Patient knowledge and some |
| |Female/male: 50/43 |occurred within a week of a patient’s |Pneumococcal |Pneumococcal |aspects of functional status improved.|
|Number of sites: 1 tertiary|Age (mean(sd)): 66.7 (sd not |discharge from hospital, and included a |Proportion of eligible |Follow-up | |
|care hospital |reported) |health assessment, COPD education, |patients receiving |Group 1: 42/67 (63%) |The ineffectiveness of the |
| | |problem identification and disease |vaccination |Control: 42/80 (53%) |intervention may have been due to |
|Site affiliation: |Eligibility criteria: Patients |management advice. Nurses worked with | | |severe disease. Patients were selected|
|University |aged 30 to 80 years old, |patients to develop care plans |Odds ratio of receiving|Follow-up |from those requiring hospitalization, |
| |discharged to the community |documenting problem areas, education |vaccination between |OR = 1.52 |and 19/147 patients died during the 3 |
|Number of practices or |from emergency or in-patient |provided, and referral to other services.|treatment and control |P = 0.28 |months of follow-up. |
|physicians: Not reported. |care for COPD at the study |Care plans were mailed to each patient’s |groups | | |
| |hospital. |GP. At the second visit, one month later,| | | |
|Location: United Kingdom |Exclusions: Insufficient |nurses reviewed patients’ progress and | | | |
|(Liverpool) |English speaking skills, |need for further follow-up. | | | |
| |resident in a nursing home, | | | | |
| |confused or demented, and |Patient education: Nurses provided verbal| | | |
| |resident outside the hospital |and written education on COPD, smoking | | | |
| |catchment region. |cessation, management of activities of | | | |
| | |daily living, exercise, drug use, health | | | |
| | |maintenance, and when to seek medical | | | |
| | |intervention. | | | |
| | | | | | |
| | |Case management: Community nurses set up | | | |
| | |care plans with patients, including | | | |
| | |referral to other services. An additional| | | |
| | |follow-up visit was provided. | | | |
| | | | | | |
| | |Control group | | | |
| | | | | | |
| | |Usual care. | | | |
|Hoey et al. 1982 (2) |Number of patients: 783 |Nurse vaccinations vs usual care |Influenza |Influenza |Outpatient general medicine clinic |
| |Age / gender distributions not | |Proportion of eligible |Follow-up |nurses were able to vaccinate a |
|Design: |reported. |Intervention aim: Improve vaccination |patients receiving |Group 1: 152/435 (35%) |substantial proportion of eligible |
|CBA | |rates |vaccination |Control: 8/348 (2%) |patients. Vaccination rates may have |
| |Group 1 |QI agent: Medical clinics | | |been further improved if clinic nurses|
|Group allocation: |Number of patients: 435 | |Odds ratio of receiving|Follow-up |had more time. |
|Mornings and afternoons at | |Group 1 |vaccination between |OR = 22.83 | |
|a large general medicine |Control group | |treatment and control |P < 0.001* | |
|polyclinic were allocated |Number of patients: 348 |Team change: Nurses reviewed patient |groups | | |
|to treatment and control | |charts for vaccination indications, | | | |
|groups. |Eligibility criteria: Patients |inquired about contraindications, |Pneumococcal |Pneumococcal | |
| |attending the study polyclinic.|administered vaccine, and checked inject |Proportion of eligible |Not targeted. | |
|Follow-up period: 6 weeks |Eligibility criteria for |sites after 20 minutes. |patients receiving | | |
| |vaccination were not reported. | |vaccination | | |
|Number of sites: 1 | |Control group | | | |
|university-affiliated | | | |* Calculated by present | |
|general medicine outpatient| |Usual care. | |reviewers. | |
|polyclinic | | | | | |
| | | | | | |
|Site affiliation: | | | | | |
|University | | | | | |
| | | | | | |
|Number of practices or | | | | | |
|physicians: Not reported. | | | | | |
| | | | | | |
|Location: Canada (Quebec) | | | | | |
|Hogg et al. 1998 (250) |Number of patients: 1971 |Customized preventive care reminder |Influenza |Influenza |No differences in influenza |
| |patients in 719 families |letters vs form letters vs usual care |Proportion of eligible |Follow-up |vaccination were detected between |
|Design: CCT | | |patients receiving |Patients aged 65 years or |groups. However, taking all |
| |Group 1 |Intervention aim: Improve preventive care|vaccination |older |recommended preventive procedures |
|Group allocation: Patients’|Number of patients: 613 |QI agent: Medical clinics | |Group 1: 6/30 (20%) |together, those receiving the |
|families were randomly |Percent male per family | | |Group 2: 8/48 (17%) |customized letters obtained more |
|allocated to treatment and |(mean(sd)): 50.1% (24.6%) |Group 1 | |Control: 9/47 (19%) |preventive procedures than patients in|
|control groups. |Age per family (mean(sd)): 37.5| | |P = 0.11 |the control group, while those |
| |(18.7) |Patient education / reminders: | | |receiving the form letter did not. |
|Follow-up period: 6 months | |Computer-generated individualized letters| |Patients with chronic disease| |
| |Group 1 |were sent to patients reminding them of | |Group 1: 3/17 (18%) | |
|Number of sites: 1 rural |Number of patients: 676 |outstanding preventive care procedures. | |Group 2: 1/11 (9%) | |
|family medicine teaching |Percent male per family |The tone of each letter was positive and | |Group 3: 3/20 (15%) | |
|clinic |(mean(sd)): 47.7% (26.4%) |nonthreatening. Letters included dates on| |P = 0.75 | |
| |Age per family (mean(sd)): 41.9|which participants had last received the | | | |
|Site affiliation: |(19.8) |recommended procedures, and were | |Follow-up | |
|University | |generated from the computerized medical |Odds ratio of receiving|Patients aged 65 years or | |
| |Control group |record. |vaccination between |older | |
|Number of practices or |Number of patients: 682 | |treatment and control |Group 1 | |
|physicians: Not reported. |Percent male per family |Group 2 |groups |OR = 1.06 | |
| |(mean(sd)): 47.7% (29.6%) | | |P = 1.00 | |
|Location: Canada (Quebec) |Age per family (mean(sd)): 41.6|Patient education / reminders: Patients | |Group 2 | |
| |(18.9) |received a form letter outlining all the | |OR = 0.84 | |
| | |recommended preventive procedures for all| |P = 0.79 | |
| |Eligibility criteria: Patients |ages and sexes. The letter was identical | | | |
| |registered at the site for at |to the individualized letter received by | |Patients with chronic disease| |
| |least 1 year, who had attended |patients in Group 1, except the date of | |Group 1 | |
| |the clinic at least once in the|previous procedures was not provided. | |OR = 1.21 | |
| |preceding 2 years. Patients | | |P = 1.00 | |
| |eligible for influenza |Control group | |Group 2 | |
| |vaccination were aged 65 years | | |OR = 0.57 | |
| |or older, or had high-risk |Usual care. | |P = 1.00 | |
| |diseases (e.g.: COPD, | | | | |
| |diabetes). | | |Pneumococcal | |
| | | | |Not targeted. | |
| | | |Pneumococcal | | |
| | | |Not targeted. | | |
|Hull et al. 2002 (251) |Number of patients: 1261* |Telephone appointments scheduled by |Influenza |Influenza |General practices can boost |
| |patients from 1206 households |practice receptionists vs usual care |Proportion of eligible |Follow-up |immunization rates for influenza |
|Design: | | |patients receiving |Group 1: 328/660 (50%) |vaccination among the fit older |
|CCT |Group 1 |Intervention aim: Improve vaccination |vaccination |Control: 288/658 (44%) |population by about 6% using a |
| |Number of patients: Not |rates | | |telephone call from practice |
|Group allocation: |reported |QI agent: Medical practices |Odds ratio of receiving|Follow-up |receptionists. This effect was |
|Experimental study with |Female/male: 53.9% female | |vaccination between |OR = 1.29* |achieved in addition to national and |
|households randomly |Age (mean(sd)): 69.2 (sd not |Group 1 |treatment and control |P = 0.026* |community advertising and mail |
|allocated to treatment and |reported) | |groups | |campaigns. |
|control groups. | |Patient education / reminders: | | | |
| |Control group |Receptionists called households, |Pneumococcal |Pneumococcal |Costs of the intervention were |
|Follow-up period: 2 months |Number of patients: Not |recalling eligible patients to receive |Not targeted. |Not targeted. |estimated. |
| |reported |their flu vaccinations. | | | |
|Number of sites: 3 inner |Female/male: 53.3% female | | | | |
|city general practices |Age (mean(sd)): 69.3 (sd not |Control group | | | |
| |reported) | | | | |
|Site affiliation: Private | |Usual care. | | | |
|practices |Eligibility criteria: | | |* Adjusted for clustering | |
| |Patents aged between 65 and 74 | | |within clinic and households.| |
|Number of practices or |years. Patients with chronic | | | | |
|physicians: As above. |disease, and those who had been| | | | |
| |subject to similar | | | | |
|Location: United Kingdom |interventions in previous years| | | | |
|(East London and Essex) |were excluded. | | | | |
| | | | | | |
| |* Patient numbers in Hull et | | | | |
| |al. 2002 (251) are not | | | | |
| |internally consistent. Patients| | | | |
| |in the outcome denominators | | | | |
| |exceed total patients reported | | | | |
| |in the patient flow diagram. | | | | |
|Hutchison et al., 1989 |Number of patients: 1211 |Computer-generated nurse/physician |Influenza - All |Influenza - All patients |The clinician reminder intervention |
|(252) |Age and gender not reported. |reminders vs usual care |patients |Baseline - 1984-85 |was associated with a dramatic percent|
| | | |Proportion of eligible |Group 1: 60/593 (10%) |rise in influenza immunization rates |
|Design: |Group 1 |Intervention aim: Improve influenza |patients receiving |Control: 171/618 (28%) |among elderly patients fro 1984-85 to |
|CBA |Number of patients: 593 |vaccination rates |vaccination during | |1985-86. This association was observed|
| | |QI agent: Health Services Organizations |influenza season |Follow-up - 1985-86 |in the community setting, |
|Group allocation: Similar |Control group | | |Group 1: 159/593 (27%) |corroborating results from studies of |
|Ontario HSOs were selected,|Number of patients: 618 |Group 1 | |Control: 178/618 (29%) |clinician reminders in academic |
|by study investigators, to | | | | |primary care. |
|be treatment and control |Eligibility criteria: Patients|Clinician reminders: A nurse/physician | |Percent increase | |
|sites. |aged 65 years or older, |reminder message was printed on the | |Group 1: 165% |Compliance with the intervention |
| |enrolled in the practice since |computer-generated encounter form for |Percent increase |P < 0.0001* |emerged as an issue, with |
|Follow-up period: 1 year |September 1, 1982. Residents of|each eligible patient and attached to the|1984-85 to 1985-86 |Control: 4.1% |approximately half of eligible |
|Number of sites: 2 Health |long-term care facilities were |front of the patient's chart. Patients | |P = 0.56* |attendees receiving vaccine or having |
|Services Organizations |excluded. |who received or refused vaccine were | | |a documented refusal. The authors |
|(HSOs)* | |deleted from the reminder system for the | |Follow-up** |suggested that clinician compliance |
| | |remainder of the intervention period. | |OR = 0.91 |may be improved by increasing the |
|Site affiliation: Private | | |Odds ratio of receiving|P = 0.44 |visual impact of the reminder. |
|community delivery system | |Control group: Usual care |vaccination between | | |
| | | |treatment and control | |The intervention and control practices|
|Number of practices or | | |groups |Influenza - Patients with |were not alike, especially with |
|physicians: Not reported | | | |chronic disease |respect to baseline vaccination rates.|
| | | |Influenza - Patients |Baseline - 1984-85 |Risk of bias is substantial. An odds |
|Location: Canada (Ontario) | | |with chronic disease |Group 1: 22/162 (14%) |ratio cannot be calculated. |
| | | |Proportion of eligible |Control: 67/204 (33%) | |
| | | |patients receiving | |Other primary care providers may wish |
| | | |vaccination during |Follow-up - 1985-86 |to take advantage of opportunities to |
|* 1 treatment site, 1 | | |influenza season |Group 1: 56/162 (35%) |employ and test similar innovations |
|control site. | | | |Control: 74/204 (36%) |under "real conditions". |
| | | | | | |
| | | | |Percent increase | |
| | | | |Group 1: 155% | |
| | | |Percent increase |P < 0.0001* | |
| | | |1984-85 to 1985-86 |Control: 10% | |
| | | | |P = 0.37* | |
| | | | | | |
| | | | |Follow-up** | |
| | | | |OR = 0.93 | |
| | | |Odds ratio of receiving|P = 0.74 | |
| | | |vaccination between | | |
| | | |treatment and control | | |
| | | |groups |Influenza - Office attendees | |
| | | | |only | |
| | | |Influenza - |Baseline - 1984-85 | |
| | | |Office-attendees only |Group 1: 60/378 (16%) | |
| | | |Proportion of eligible |Control: 171/392 (44%) | |
| | | |patients receiving | | |
| | | |vaccination during |Follow-up - 1985-86 | |
| | | |influenza season |Group 1: 159/385 (42%) | |
| | | | |Control: 178/379 (47%) | |
| | | | | | |
| | | | | |* Single-tailed Z test comparing |
| | | | | |before and after proportions within |
| | | | | |group. |
| | | |Percent increase |Percent increase |** Odds ratios from this study were |
| | | |1984-85 to 1985-86 |Group 1: 162% |not entered into meta-analysis due to |
| | | | |P < 0.0001* |substantial baseline imbalance between|
| | | | |Control: 8% |groups. |
| | | | |P = 0.39* | |
| | | | | | |
| | | |Odds ratio of receiving|Follow-up** | |
| | | |vaccination between |OR = 0.79 | |
| | | |treatment and control |P = 0.13 | |
| | | |groups | | |
| | | | | | |
| | | |Pneumococcal |Pneumococcal | |
| | | |Not targeted/ |Not targeted. | |
| | | | | | |
| | | | |*, ** - See next column. | |
|Ives et al. 1994 (253) |Number of patients: 3884 |Multi-component demonstration with |Influenza |Influenza |Providing free immunizations through |
| |Female/male: 2205/1679 |insurance coverage extensions and |Proportion of eligible |Baseline |Medicare will increase immunization |
|Design: |Group-specific age and gender |capitated clinician reimbursement vs |patients receiving |Group 1: 41.2% |rates among the elderly. The elderly |
|CCT |distribution not reported. |insurance coverage extension and FFS |vaccination |Group 2: 41.3% |are more likely to receive flu shots |
| | |clinician reimbursement vs simple | |Control: 40.6% |provided through physicians’ offices |
|Group allocation: |Group 1 – Capitation (CAP), |vaccination prompts | | |than through hospital-based clinics. |
|Experimental study with |with delivery via hospital | | |Follow-up | |
|patients randomly allocated|preventive care clinic |Intervention aim: Improve preventive care| |Group 1: 335/558 (64%) | |
|to treatment and control |Number of patients: 1347 |QI agent: State Medicare agency | |Group 2: 463/670 (69%) | |
|groups. |(558 patients in analysis) | | |Control: 412/761 (54%) | |
| | |Group 1 - CAP | | | |
|Follow-up period: 1 year |Group 1 – Fee for service (FFS)| | |Follow-up | |
| |payment to community physicians|Patient education / reminders: Patients | |Group 1 and 2 vs control | |
|Number of sites: 1 Medicare|Number of patients: 1312 |completed a 1.5 hour health risk | |Study reports significant | |
|demonstration project |(670 patients in analysis) |appraisal (HRA)interview. Physiological | |difference in proportions (p | |
| | |parameters were measured. Based on the | |< 0.0001). | |
|Site affiliation: |Control group |findings from the interview, participants| | | |
|Government, Medicare |Number of patients: 1225 |were mailed color-coded vouchers | |Group 1 vs group 2 | |
| |761 patients in analysis |redeemable for various preventive care | |Study reports significant | |
|Number of practices or | |interventions. | |difference in proportions (p | |
|physicians: 8 hospitals, 94|Eligibility criteria: | | |= 0.042). | |
|primary care providers |Medicare beneficiaries aged 65 |Financial incentive – clinicians: | | | |
| |to 79 years old, |Hospitals were reimbursed $150 for each |Odds ratio of receiving|Follow-up | |
|Location: United State |community-dwelling, ambulatory,|patient at initial screening. |vaccination between |Group 1 vs control | |
|(Pennsylvania) |without a diagnosis of a | |treatment and control |OR = 1.45* | |
| |life-threatening cancer within |Financial incentive – patients: Vouchers |groups |95% CI = [1.15, 1.83] | |
| |the previous 5 years. |were funded by the Medicare demonstration| | | |
| | |project. | |Group 2 vs control | |
| | | | |OR = 1.95* | |
| | |Delivery site change: Hospitals provided | |95% CI = [1.56, 2.44] | |
| | |vaccination through capitated preventive | | | |
| | |care clinics. |Pneumococcal |Pneumococcal | |
| | | |Not targeted. |Not targeted. | |
| | |Group 2 – FFS | | | |
| | | | | | |
| | |Patient education / reminders and patient| |* Adjusted for gender, age, | |
| | |financial incentives, as above. | |education, marital status, | |
| | | | |insurance, healthcare | |
| | |Financial incentive – clinicians: | |utilization, and health | |
| | |Physicians and hospitals were reimbursed | |status. | |
| | |for voucher services through a fee-for | | | |
| | |service arrangement. | | | |
| | | | | | |
| | |Control group | | | |
| | | | | | |
| | |Patient received vaccination prompts | | | |
| | |following HRA appraisals. | | | |
|Jacobson et al. 1999 (254) |Number of patients: 433 |Education brochure used to pre-activate |Influenza |Influenza |Patient-physician communication and |
| | |patients in advanced of the physician |Not targeted. |Not targeted. |quality of preventive care can be |
|Design: |Group 1 |visit vs usual care | | |enhanced through the use of a simple, |
|CCT |Number of patients: 221 | |Pneumococcal |Pneumococcal |low-literacy, inexpensive, education |
| |Female/male: 161/60 |Intervention aim: Improve vaccination |Proportion of eligible |Follow-up |vehicle that activates patients’ |
|Group allocation: |Age (mean(sd)): 64.2 (13.1) |rates |patients receiving |Group 1: 44/221 (20%) |participation in the health-care |
|Experimental study with | |QI agent: Medical clinic |vaccination |Control: 8/212 (4%) |interaction. |
|patients randomly allocated|Control group | | | | |
|to patient and control |Number of patients: 212 |Group 1 |Odds ratio of receiving|Follow-up |Vaccination rates increased more than |
|groups. |Female/male: 139/73 | |vaccination between |OR = 6.34 |5-fold. Patient-clinician |
| |Age (mean(sd)): 61.9 (12.2) |Patient education / reminders: A single |treatment and control |P < 0.001 |communication, i.e.: proportion of |
|Follow-up period: Not | |page educational brochure was developed, |groups | |visits in which the clinician |
|reported. |Eligibility criteria: |with text describing eligibility criteria| | |recommended the vaccine, increased |
| |Patients attending clinic for |for and the benefits of vaccination. The | | |approximately 4-fold. |
|Site description: |routine primary care visit, who|brochure was attached to the chart of | | | |
|Ambulatory care clinic of a|are aged 65 years or older, or |eligible patients. Patients were asked to| | | |
|large inner city teaching |have chronic heart disease, |read the brochure before seeing their | | | |
|hospital |lung disease, or diabetes. |physicians. | | | |
| |Patients had not received | | | | |
|Site affiliation: Private |pneumococcal vaccination in the|Control group | | | |
|community delivery system, |previous 5 years. | | | | |
|university/ teaching |Exclusions: Received |Patients received a similar brochure | | | |
| |pneumococcal vaccine in the |about nutrition. | | | |
|Number of sites: 1 hospital|previous 5 years, walk-in | | | | |
| |visits, first visits, | | | | |
|Number of practices or |medication-refill visits | | | | |
|physicians: 1 ambulatory |without a physician | | | | |
|care clinic, with 148 |interaction, blind patients, | | | | |
|physician / residents, 2 |clinically documented dementia,| | | | |
|physician assistants, and 6|non-English speaking. | | | | |
|nurse practitioners | | | | | |
| | | | | | |
|Location: United States | | | | | |
|(Georgia) | | | | | |
|Jans et al. 2000 (255) |Number of patients: 607 |Quality improvement system with |Influenza |Influenza |Implementation of a quality system |
| | |educational sessions and performance |Proportion of eligible |Follow-up* |improved physician compliance with |
|Design: |Group 1 |feedback vs usual care |patients receiving |Group 1: 61% (R [42%, 81%]) |several recommendations given in |
|Cluster CBA |Number of patients: 455 | |vaccination, taken as a|Control: 50% (R [20%, 82%]) |guidelines on management of patients |
| |Female/male: 278/177 |Intervention aim: Improve care of COPD |continuous score for |P > 0.2** |with asthma and COPD over time. |
|Group allocation: |Age (% > 60): 16% |and asthma |each physician (median | |However, improvement does not appear |
|Experimental study, with | |QI agent: Medical clinics |(range)) |Pneumococcal |to be reflected in between-group |
|medical clinics allocated |Control group | | |Not targeted. |comparisons with concurrent control |
|to treatment and control |Number of patients: 152 |Group 1 |Pneumococcal | |practices. |
|groups. |Female/male: 90/62 | |Not targeted. |* Outcome survey response | |
| |Age (% > 60): 15% |Clinician education: Frank discussions of| |rates were 61% in the | |
|Follow-up period: 1 year | |controversial aspects of Dutch treatment | |treatment group and 72% in | |
| |Eligibility criteria: |guidelines were held during eleven | |the control group. | |
|Number of sites: 19 general|Patients between 16 and 70 |90-minute educational meetings over a 15 | |** Mann-Whitney U Test | |
|practice clinics * |years of age, with a diagnosis |month period. | | | |
| |of asthma or COPD, who were not| | | | |
|Site affiliation: Private |under the care of a specialist |Audit and feedback: Physicians received | | | |
|practices |pulmonologist. Patients were |data on the care given to patients with | | | |
| |required not to have a disease |asthma or COPD. Discrepancies between | | | |
|Number of practices or |expected to influence |actual care and recommendations were | | | |
|physicians: 21 physicians |short-term survival, or another|discussed. Experiences were shared among | | | |
| |disease affecting lung |peers. | | | |
|Location: Netherlands |function. | | | | |
| | |Control group | | | |
|* Clinics were allocated to| | | | | |
|treatment (14 practices | |Usual care. | | | |
|with 16 physicians) and | | | | | |
|control (5 practices with 5| | | | | |
|physicians) groups | | | | | |
|Johnson et al. 2003 (256) |Number of patients: 20755 |Community media campaign with patient |Pneumococcal |Pneumococcal |Both community education and reminder |
| |Age and gender distribution not|reminder letters vs community media |Proportion of eligible |Follow-up |campaigns increased immunization |
|Design: CBA |reported. |campaign without reminder letters vs |patients receiving |Group 1: 1175/10381 (11.3%) |awareness and recent pneumococcal |
| | |reminder letters only vs usual care |vaccination |Group 2: 617/5741 (10.8%) |immunizations. Community-wide |
|Group allocation: |Mass media campaign | | |Group 3: 1355/10374 (13.1%) |education campaign augmented the |
|Experimental study with |Group 3 – reminders |Intervention aim: Improve vaccination | |Control: 481/6091 (7.9%) |effect of the mailed reminders. |
|media market regions in a |Number of patients: Approx. |rates | | |However, the additive effect was |
|US state allocated to |6639 |QI agent: Non-profit foundation | |Follow-up |relatively small. |
|treatment and control |Group 2 – no reminders | | |Media vs no media | |
|groups for a community |Number of patients: Approx. |Group 1 – Reminders only |Odds ratio of receiving|OR = 1.14 | |
|media intervention, and |3735 | |vaccination |95% CI = [1.07, 1.22] | |
|patients randomly allocated| |Patient education / reminders: Reminder | | | |
|to treatment and control |No mass media campaign |letters and a brochure were mailed to a | |Group 1 vs Control1 | |
|groups for a patient |Group 1 - reminders |sample of Medicare beneficiaries. | |OR = 1.49 | |
|reminder intervention |Number of patients: Approx. | | |95% CI = [1.33, 1.67] | |
|nested within media market |6540 |Group 2 – Media only | | | |
|groups. |Control – no reminders | | |Group 2 vs Control2 | |
| |Number of patients: Approx. |Patient education / reminders as above, | |OR = 1.40 | |
|Follow-up period: 3 months |3841 |except without the reminder letters. | |95% CI = [1.24, 1.59] | |
| | | | | | |
|Number of sites: A |Eligibility criteria: |Group 3 – Media + reminders | |Group 3 vs Group 13 | |
|non-profit state-wide |Medicare beneficiaries aged 65 | | |OR = 1.18 | |
|foundation conducted the |years or older |Patient education / reminders: A | |95% CI = [1.08, 1.28] | |
|interventions on a Medicare| |community-wide mass media campaign | | | |
|contract, in two geographic| |promoting pneumococcal vaccination was | |Group 3 vs Group 24 | |
|“media market” regions in | |implemented. The campaign involved 30 | |OR = 1.25 | |
|Montana* | |second television advertisements, | |95% CI = [1.13, 1.38] | |
| | |newspapers advertisements, posters, and | | | |
|Site affiliation: | |brochures. Organizers recruited members | |Influenza | |
|Non-profit foundation, | |of the health care and business community| |Not targeted. | |
|government, Medicare | |to display campaign materials. Reminder |Influenza | | |
| | |letters and a brochure were also mailed |Not targeted. |Interpretations | |
|Number of practices or | |to a sample of Medicare beneficiaries. | |1 Reminder vs no reminder in | |
|physicians: Not reported | | | |a usual care environment. | |
| | |Control – Usual care | |2 Community media campaign vs| |
|Location: United States | | | |no media campaign in a usual | |
|(Montana) | |Usual care | |care environment | |
| | | | |3 Community media campaign vs| |
|* Media market regions were| | | |no media campaign in a | |
|allocated to treatment (1 | | | |reminder environment | |
|region) and control (1 | | | |4 Reminder vs no reminder in | |
|region) groups for a mass | | | |a community media campaign | |
|media education campaign. | | | |environment. | |
|Johnson et al. 2005 (257) |Number of patients: 1042 |Integrated disease management for heart |Influenza |Influenza |Participants in a comprehensive, |
| | |failure program vs usual care |Proportion of eligible |Baseline |integrated disease management program |
|Design: |Group 1 | |patients receiving |Group 1: 263/521 (51%) |aimed at improving self-management |
|RCS |Number of patients: 521 |Intervention aim: Improve care of heart |vaccination |Control: 259/521 (50%) |skills experiences significantly fewer|
| |Female/male: 308/213 |failure | | |cardiac-related hospital admissions, |
|Group allocation: |Age (% > 65): 75% |QI agent: Commercial disease management | |Follow-up |cardiac-related bed days, and invasive|
|Observational study, with | |organization | |Group 1: 284/521 (55%) |medical procedures compared with a |
|patients self-selected into|Control group | | |Control: 236/521 (45%) |matched cohort group. A significantly |
|treatment and control |Number of patients: 521 |Group 1 | | |greater proportion of the intervention|
|groups. |Female/male: 307/214 | |Odds ratio of receiving|Follow-up |participants had influenza |
| |Age (% > 65): 78% |Patient education / reminders: In |vaccination between |OR = 1.45 |vaccinations. |
|Follow-up period: 12 months| |addition to the health plan’s usual |treatment and control |P = 0.003 | |
| |Eligibility criteria: |activities, scheduled nurse education |groups | | |
|Number of sites: 1 |Adult Blue Cross HMO, |sessions and 24 hour nurse counseling and| | | |
|Commercial disease |point-of-service, or |symptom advice were offered by telephone.|Pneumococcal |Pneumococcal | |
|management organization |Medicare+Choice members with |Printed action plans, workbooks, |Proportion of eligible |Baseline | |
|contracted by a large HMO |heart failure. Patients were |individualized assessment letters, |patients receiving |Group 1: 30/521 (6%) | |
| |not already participants in a |medication compliance reminders, and |vaccination |Control: 29/521 (6%) | |
|Site affiliation: |local heart failure disease |vaccination reminders were mailed to | | | |
|Commercial disease |management program. |patients. | |Follow-up | |
|management organization, | | | |Group 1: 61/521 (12%) | |
|private MCO |Exclusion: Patients not |Case management: A registered nurse | |Control: 44/521 (8%) | |
| |enrolled in the health plan 3 |provided a range of accessible services | | | |
|Number of practices or |months prior and 3 months after|to heart failure patients, including risk| |Follow-up | |
|physicians: Not reported |the study period, cancer, AIDS,|stratification, and educational services.| |OR = 1.44 | |
| |transplant recipients, renal |Case managers coordinated support with | |P = 0.080 | |
|Location: United States |failure / dialysis, living in a|patients’ health care plans. | | | |
|(Ohio) |skilled nursing facility, |Interventions took place primarily via | | | |
| |participated in the disease |telephone. | | | |
| |management program less than | | | | |
| |90 days (treatment cohort) |Clinician reminders: Nurse case managers | | | |
| | |communicated to physician alerts about | | | |
| | |signs and symptoms of decompensation. And| | | |
| | |gaps between patient-reported practice | | | |
| | |and guideline recommendations. | | | |
| | | | | | |
| | |Team change: Nurse case management, as | | | |
| | |above. | | | |
| | | | | | |
| | |Control group | | | |
| | | | | | |
| | |Patient education / reminders: | | | |
| | |Educational materials, immunization, and | | | |
| | |health screening reminders were mailed to| | | |
| | |patients. Health plan members identified | | | |
| | |as noncompliant for health screenings | | | |
| | |received additional mailings and | | | |
| | |automated phone calls. | | | |
|Karuza et al. 1995 (258) |Number of patients: Not |Small group consensus process vs usual |Influenza |Influenza |The small-group consensus buy-in |
| |reported. |care |Proportion of eligible |Baseline |process was effective in increasing |
|Design: |(Analysis occurred at the | |patients receiving |Group 1: 48% (24%) |physician compliance with the |
|Cluster RCT |physician level. Physician |Intervention aim: Improve vaccination |vaccination, taken as a|Control: 57% (21%) |influenza vaccination guideline in |
| |characteristics reported |rates |continuous score for |P>0.70* |group practices. |
|Group allocation: |below.) |QI agent: Medical clinics |each physician | | |
|Randomized allocation of | | |(mean(sd)) |Follow-up |Physicians’ attitudes toward |
|physician practice groups |Group 1 |Group 1 | |Group 1: 63% (21%) |prevention and knowledge about |
|to treatment and control |Average patient age per | | |Control: 46% (21%) |influenza vaccination were not |
|groups. |physician: 74 |Continuous quality improvement (or | |P 0.1 (Wilconxon rank sum |guidelines tested. |
|treatment and control |Number of patients: Not |Group 1 |(median) |test) | |
|groups. |reported. | | | | |
| | |Clinician reminders: A computer program |Pneumococcal | | |
|Follow-up period: Unclear |Eligibility criteria: |automatically generated a |Proportion of eligible |Pneumococcal | |
| |Physicians were included if |diabetes-specific clinical encounter form|encounters in which |Follow-up | |
|Number of sites: 1 family |they practiced at the study |based on data from the patients’ |vaccination is |Group 1: 19.8% | |
|medicine clinic |clinic and saw at least 6 |electronic medical record. The form |provided, taken as a |Control: 0.0% | |
| |different diabetic patients |included care recommendations advising |continuous performance | | |
|Site affiliation: |over at least 12 clinical |the clinician on procedures and studies |score per physician |Test of significance | |
|University |encounters during the study |that should be ordered. |(median) |P > 0.1 (Wilconxon rank sum | |
| |period. | | |test) | |
|Number of practices or | |Control group | | | |
|physicians: 30 primary care| | | | | |
|clinicians (family | |Usual care. | | | |
|physician faculty members | | | | | |
|and family medicine | | | | | |
|residents)* | | | | | |
| | | | | | |
|Location: United States | | | | | |
|(North Carolina) | | | | | |
| | | | | | |
|* 16 and 14 clinicians were| | | | | |
|allocated to treatment and | | | | | |
|control groups, | | | | | |
|respectively. | | | | | |
|Lukasik et al. 1987 (273) |Number of patients: 243 |Telephone patient outreach vs vaccination|Influenza |Influenza |A practice immunization policy |
| |Age and gender distributions |prompting at usual visits only |Proportion of eligible |Baseline - 1983 |combined with a simple telephone |
|Design: CCT |not reported. | |patients receiving |Group 1: 9/92 (10%) |outreach program improved vaccination |
| | |Intervention aim: Improve vaccination |vaccination |Control: 8/98 (8%) |rates in primary care. |
|Group allocation: Patients |Group 1 |rates | | | |
|were randomly allocated to |Number of patients: 120 |QI agent: Medical clinics | |Baseline – 1984 | |
|treatment and control | | | |Group 1: 8/109 (7%) | |
|groups. |Control group |Group 1 | |Control: 5/111 (5%) | |
| |Number of patients: 123 | | | | |
|Follow-up period: 1 year | |Patient education / reminders: Clinical | |Follow-up | |
| |Eligibility criteria: Active |staff telephoned patients. Patients were | |Group 1: 61/120 (51%) | |
|Number of sites: 1 academic|registered patient in the |told that the influenza vaccine was | |Control: 33/123 (27%) | |
|family medical practice |practice, aged 65 years or |available and that they could receive it | | | |
| |older. |during a regular appointment, or during a|Odds ratio of receiving|Follow-up | |
|Site affiliation: |Exclusions: Chronically |nurse-led vaccination clinic. Staff were |vaccination between |OR = 2.82 | |
|University |hospitalized, nursing home |provided with a list of 5 patients per |treatment and control |P = 0.0002 | |
| |patients, and housebound |week, which could be increased if all |groups | | |
|Number of practices or |patients, and patients unable |patients had been telephoned. | | | |
|physicians: 1 attending |to communicate by telephone. | |Pneumococcal |Pneumococcal | |
|physician, 2 residents, 2 | |Control group |Not targeted. |Not targeted. | |
|nursing staff | | | | | |
| | |Patient education / reminders: All | | | |
|Location: Canada (Ontario) | |patients attending the practice, | | | |
| | |including intervention group patients, | | | |
| | |were informed by nursing staff that the | | | |
| | |vaccine was available. Physicians | | | |
| | |followed up on vaccinations during each | | | |
| | |visit. | | | |
|Maljanian et al., 2005 |Number of patients: 507 |Disease management program with intensive|Influenza |Influenza |This study examined the incremental |
|(274) |(336 patients were available at|telephone education and follow-up versus |Proportion of eligible |Baseline |effect of an intensive telephone |
| |analysis, enumerated below.) |disease management program alone |patients receiving |Not reported |intervention added on to a |
|Design: | | |vaccination during | |hospital-based diabetes disease |
|CCT |Group 1 |Intervention aim: Improve diabetes care |influenza season |3 months* |management program already known to |
| |Number of patients: 176 |QI agent: Disease management program | |Group 1: 33/62 (53%) |promote glycemic control. The addition|
|Group allocation: |Female/male: 99/77 | | |Control: 37/91 (41%) |of the telephone intervention improved|
|Experimental study with |Age (mean(sd)): 57.0 (12.1) |Group 1 | |No significant differences. |adherence for foot and eye exams, and |
|patients randomly allocated|years | | | |for pneumonia vaccinations, but did |
|to treatment and control | |Patient education: Three 4-hr educational| |12 months* |not result in additional improvements |
|groups. |Control group |classes covering diverse diabetes health | |Group 1: 95/176 (36%) |in other ADA guidelines, in glycemic |
| |Number of patients: 160 |promotion topics were provided to | |Control: 75/160 (47%) |control, HRQoL, diabetes QoL, |
|Follow-up period: 12 months|Female/male: 80/80 |patients. Intervention group patients | |No significant differences. |depression symptoms, or in patient |
| |Age (mean(sd)): 59.2 (13.4) |received a series of 12 weekly phone | | |satisfaction. |
|Number of sites: 1 |years |calls to reinforce education and |Odds ratio of receiving|12 months | |
|hospital-based disease | |self-management skills. Calls were |vaccination between |OR = 1.33 | |
|management program |Eligibility criteria: Patients|delivered by a trained research nurse, |treatment and control |P = 0.23 | |
| |with type 1 or type 2 diabetes |and focused on glycemic control, |groups | | |
|Site affiliation: Private |referred to the hospital-based |prevention of complications, and | | | |
|disease management |disease management program. |exacerbation of co morbidities. Calls |Pneumococcal |Pneumococcal | |
|organization |Individuals without telephones,|were 5-7 minutes each, excepting the |Proportion of eligible |Baseline | |
| |or who were unable to complete |first call, which was 15-20 minutes in |patients receiving |Not reported | |
|Number of practices or |interviews or surveys in |length. |vaccination during | | |
|physicians: Not reported |English or Spanish were | |influenza season |3 months | |
| |excluded. |Team change: Patients had individual | |Group 1: 28/106 (26%) | |
|Location: United States | |visits with a registered nurse and | |Control: 10/97 (10%) | |
|(Connecticut) | |nutritionist. | |P < 0.005 | |
| | | | | | |
| | |Case management: Diabetes team members | |12 months | |
| | |provided written evaluations and | |Group 1: 42/106 (40%) | |
| | |recommendations to the patient's primary | |Control: 23/97 (24%) | |
| | |care provider, and scheduled follow-up as| |P < 0.02 | |
| | |needed. | | | |
| | | |Odds ratio of receiving|3 months | |
| | |Control group |vaccination between |OR = 2.74 | |
| | | |treatment and control |P < 0.015 | |
| | |Team change and case management, as |groups * | | |
| | |above. | |12 months | |
| | | | |OR =1.96 | |
| | |Patient education: As above, without the | |P < 0.039 | |
| | |telephone component. | | | |
| | | |* Calculated by |* Denominators at 3 months | |
| | | |logistic regression |were comprised of patients | |
| | | |adjusting for baseline |attending an office visit | |
| | | |BMI, glycemic control, |during the influenza season. | |
| | | |and vaccination status.|Denominators at 12 months | |
| | | | |were "cumulative", comprised | |
| | | | |of all patients remaining in | |
| | | | |the study. | |
|Margolis et al. 1988 (275) |Number of patients: 218 |Standing orders policy vs usual care |Influenza |Influenza |An organization standing orders |
| |Age and gender distributions | |Proportion of eligible |Follow-up* |intervention resulted in substantial |
|Design: Cluster RCS |not reported. |Intervention aim: Improve vaccination |patients receiving |Group 1: 43/97 (44%) |improvement in the influenza vaccine |
| | |rates |vaccination |Control: 18/106 (17%) |ordering rate, and in the proportion |
|Group allocation: Outcomes |Group 1 |QI agent: Medical center | | |of patients vaccinated at the study |
|in patients at a general |Number of patients: 101 | |Odds ratio of receiving|Follow-up |sites. |
|medicine clinic that had | |Group 1 |vaccination between |OR = 3.89 | |
|implemented the study |Control group | |treatment and control |P < 0.001 |This study may suffer from vaccination|
|intervention were compared |Number of patients: 117 |Team change: Clinic nurses identified and|groups | |status ascertainment bias. |
|with those among patients | |immunized eligible patients prior to each| | |Intervention site nurses may have been|
|attending non-intervention |Eligibility criteria: Patients |physician visit. |Pneumococcal |Pneumococcal |more vigilant at inquiring for and |
|sub-specialty clinics |aged 65 years or older, | |Not targeted. |Not targeted. |recording vaccination status, since |
|during the study period. |attending the study clinics |Control group | | |more patients in the treatment group |
| |between November 15 and | | | |were recorded as having received |
|Follow-up period: 1 month |December 15, 1986. |Usual care. | |* Number of patients |vaccine elsewhere. |
| | | | |vaccinated at a study site | |
|Number of sites: 1 VA | | | |during the study period – 10%| |
|medical centre | | | |to 25% of patients had | |
| | | | |received influenza | |
|Site affiliation: Veterans | | | |vaccinations elsewhere. | |
|Affairs | | | | | |
| | | | | | |
|Number of practices or | | | | | |
|physicians: 1 general | | | | | |
|medicine clinic and an | | | | | |
|unreported number of | | | | | |
|sub-specialty clinics* | | | | | |
| | | | | | |
|Location: United States | | | | | |
|(Minnesota) | | | | | |
| | | | | | |
|* Patients at the general | | | | | |
|medicine clinic were | | | | | |
|compared with those | | | | | |
|attending the sub-specialty| | | | | |
|clinics | | | | | |
|Margolis et al. 1992 (276) |Number of patients: 600 |Multi-component strategy vs usual care |Influenza |Influenza |A multi-component vaccination strategy|
| |Age (mean(sd)): 72 (sd not | |Proportion of eligible |Baseline |stressing organizational change, and |
|Design: |reported) |Intervention aim: Improve vaccination |patients receiving |Overall* |nurse- and patient-oriented education |
|CBA | |rates |vaccination (95% CI) |Group 1: 125/180 (69%) |successfully increased vaccination |
| |Group 1 |QI agent: Medical clinics | |Control: 124/215 (58%) |rates. |
|Group allocation: |Number of patients: 300 | | | | |
|Experimental study with | |Group 1 | |Follow-up |This strategy, originally deployed in |
|medical clinics chosen by |Control group | | |Overall* ** |an academic Veterans Affairs setting, |
|investigators for |Number of patients: 300 |Team change: Hospital policy was adjusted| |Group 1: 199/281 (71%) |was successfully generalized to the |
|similarity between | |to allow nurses to vaccinate without a | |Control: 157/276 (57%) |community setting. |
|treatment and control |Eligibility criteria: |signed physician’s orders. |Odds ratio of receiving| | |
|sites. |Patients aged >65 years | |vaccination between |Follow-up** | |
| | |Clinician reminders: Nurses were prompted|treatment and control |Overall | |
|Follow-up period: 1 year | |to vaccinate by stamped reminders on |groups |OR = 1.84 | |
| | |clinic progress notes. Nurses were | |P < 0.001 | |
|Number of sites: 1 staff | |trained during in-service education |Pneumococcal | | |
|model non-profit private | |sessions. |Not targeted |Pneumococcal | |
|HMO | | | |Not targeted. | |
| | |Patient education / reminder: An | | | |
|Site affiliation: Private | |informational letter was mailed to all | |* Calculated by present | |
|managed care organization | |eligible patients. | |reviewers. | |
| | | | |** Heterogeneity present | |
|Number of practices or | |Clinician education: In-service education| |between study sites. | |
|physicians: 4 primary care | |sessions were held to train nurse | | | |
|clinics* | |vaccinators. | | | |
| | | | | | |
|Location: United States | |Control group | | | |
|(Minnesota) | | | | | |
| | |Usual care. | | | |
|* Clinics were allocated to| | | | | |
|treatment (2 clinics) and | | | | | |
|control (2 clinics) groups.| | | | | |
|McCaul et al. 2002 (277) |Number of patients: 23733 |Reminder letters vs reminder letters with|Influenza |Influenza |Neither the gain-framed message nor |
| | |a gain-framed educational component vs |Proportion of eligible |Follow-up |the loss-framed message improved |
|Design: |Group 1s 1, 2, 3, and 4 |reminder letters with a loss-framed |patients receiving |Group 1: 798/3258 (25%) |vaccination rates compared with the |
|Cluster RCT |Number of patients: 15837 |educational component vs action letters |vaccination |Group 2: 766/3260 (24%) |brief reminder. |
| |Female/male: 9107/6730 |vs usual care | |Group 3: 799/3262 (25%) | |
|Group allocation: |Age (mean(sd)): Not reported | | |Group 4: 1708/657 (28%) |The action-plan approach was very |
|Experimental study with | |Intervention aim: Improve vaccination | |Control: 1548/7896 (20%) |effective, producing significantly |
|state counties randomly |Control group |rates | | |higher vaccination rate than the |
|allocated to treatment and |Number of patients: 7896 |QI agent: State Medicare peer review |Odds ratio of receiving|Follow-up |no-treatment control condition. |
|control groups, and |Female/male: 4476/3420 |organization |vaccination between |Group 1 | |
|patients allocated within |Age (mean(sd)): Not reported | |treatment and control |OR = 1.33, p < 0.001 | |
|select state counties. | |Group 1 (Reminder only) |groups |Group 2 | |
| |Eligibility criteria: | | |OR = 1.26, p < 0.001 | |
|Follow-up period: 6 months |Patients aged 65 years and |Patient education / reminders: A letter | |Group 3 | |
|Number of sites: 1 Medicare|older, who had not billed |was sent to eligible patients reminding | |OR = 1.33, p < 0.001 | |
|peer review organization |Medicare for influenza |patients that they should receive the flu| | | |
|for the state of North |vaccination the year before. |shot, the flu shot is safe, and that | |Reminder mailings (Groups 1, | |
|Dakota |Study investigators excluded |Medicare will pay for the flu shot. | |2, and 3) vs control | |
| |patients for whom the | | |OR = 1.31 | |
|Site affiliation: |intervention mailings were |Group 2 (Reminder + gain-framed | |P < 0.01* | |
|State-wide public payer |returned undelivered. |education) | | | |
| | | | |Action mailings (Group 4) vs | |
|Number of practices or | |Patient education / reminders: The | |control | |
|physicians: 49 state | |reminder letter was accompanied by an | |OR = 1.61 | |
|counties* | |insert, featuring the picture and | |P < 0.01* | |
| | |testimonial of a woman who had received a| | | |
|Location: United States | |flue shot the previous year and not |Pneumococcal |Pneumococcal | |
|(North Dakota) | |gotten the flu. The insert described the |Not targeted. |Not targeted. | |
| | |benefits of vaccination. | | | |
| | | | | | |
| | |Group 3 (Reminder + loss-framed | |* Unit of analysis was | |
|* Counties were randomized | |education) | |accounted for in secondary | |
|to Groups 1, 2, and 3 (17 | | | |sensitivity analyses and | |
|counties); Group 4 (12 | |Patient education / reminders: The | |found not to differ from the | |
|counties); and controls (20| |reminder letter was accompanied by the | |results presented here. | |
|counties) | |picture and testimonial of a woman who | | | |
| | |had not received a flu shot the previous | | | |
| | |year and had spent several days in bed, | | | |
| | |sick with the flu. The insert described | | | |
| | |the risks of not getting vaccinated. | | | |
| | | | | | |
| | |Group 4 (Action letters) | | | |
| | | | | | |
| | |Patient education / reminders: Patients | | | |
| | |received a letter indicating the times | | | |
| | |and places during which health units | | | |
| | |would be holding flu shot clinics. | | | |
| | | | | | |
| | |Control group | | | |
| | | | | | |
| | |Usual care. | | | |
|McDonald et al. 1984 (278) |Number of patients: 4555* |Computer generated reminders vs usual |Influenza |Influenza |The usage of preventive care was at |
|Supplemented with data from| |care |Proportion of eligible |Follow-up |least twofold greater among physicians|
|McDonald et al. 1992 (136).|Group 1 | |patients receiving |Group 1: 44%(27%) |in the study group than among control |
| |Number of patients: 2319* |Intervention aim: Improve preventive care|vaccination, taken as a|Control: 20% (22%) |group physicians. |
| | |QI agent: General medicine service at a |continuous performance | | |
|Design: |Control group |large teaching hospital |score for each provider|Test of significance |Neither the number of years of |
|Cluster RCT |Number of patients: 2236* | |(mean(sd))* |P < 0.0005 |training nor a faculty assessment of |
| | |Group 1 | | |clinical ability predicted resident |
|Group allocation: |Eligibility criteria: | |Proportion of eligible | |response rates. Attitudes about the |
|Experimental study with |All patients attending a |Clinician reminders: Patient specific |patients receiving |Follow-up year 1 |reminder system and the degree to |
|physicians randomly |general medicine clinic. |reminders were generated, by computer, |vaccination, |Group 1: 469/2319 (20%) |which residents read reminder reports |
|allocated to treatment and |Pneumococcal and influenza |from each patient’s EMR and attached to |considering only |Control: 225/2236 (10%) |were correlated, and predictive of |
|control groups. |vaccinations were indicated for|patient charts prior to each visit. |patients who attended | |preventive care response rates. |
| |patients aged 65 years or | |the clinic in the Fall,|Follow-up year 2 | |
|Follow-up period: 3 years |older, chronic lung disease, |Control group |when vaccination had |Group 1: 457/2319 (20%) |Computer reminder messages had no |
| |asthma, diabetes mellitus, | |become available ** |Control: 267/2236 (12%) |overall effect on measures of patient |
|Number of sites: 1 general |congestive heart failure, or |Usual care | | |morbidity. However, a follow-up study |
|medicine teaching clinic |severe renal or hepatic | | |Follow-up year 3 |(McDonald et al. 1992 (136)) showed an|
| |failure. Patients were eligible| | |Group 1: 388/2319 (17%) |association between the study |
|Site affiliation: |for pneumococcal vaccination if| |Odds ratio of receiving|Control: 193/2236 (9%) |intervention and a reduction in Winter|
|University |they did not have a previously | |vaccination between | |morbidity. After having tested |
| |recorded vaccination. | |treatment and control |Follow-up year 1 |alternative explanations for this |
|Number of practices or | | |groups ** |OR = 2.27, P < 0.0001 |association, the authors attributed |
|physicians: 115 residents, | | | | |the improvement to increased influenza|
|11 faculty, and 4 | | | |Follow-up year 2 |vaccination rates among |
|nurse-practitioners* | | | |OR = 1.81, P < 0.0001 |intervention-group patients. |
| | | | | | |
|Location: United States | | |Pneumococcal |Follow-up year 3 | |
|(Indiana) |* Reported from McDonald et al.| |Proportion of eligible |OR = 2.13, P < 0.0001 | |
| |1992 (136) | |patients receiving | | |
|* Clinician teams were | | |vaccination, taken as a|Pneumococcal | |
|randomly assigned to study | | |continuous performance |Follow-up | |
|groups, numbers not | | |score for each provider|Group 1: 50% (31%) | |
|reported. | | |(mean(sd))* |Control: 11% (19%) | |
| | | | | | |
| | | |Proportion of eligible |Test of significance | |
| | | |patients receiving |P < 0.0005 | |
| | | |vaccination ** | | |
| | | | | | |
| | | | |Follow-up year 1 | |
| | | | |Group 1: 861/2319 (37%) | |
| | | | |Control: 225/2236 (10%) | |
| | | | | | |
| | | | |Follow-up year 2 | |
| | | | |Group 1: 1203/2319 (52%) | |
| | | | |Control: 392/2236 (18%) | |
| | | | | | |
| | | |Odds ratio of receiving|Follow-up year 3 | |
| | | |vaccination between |1373/2319 (59%) | |
| | | |treatment and control |Control: 496/2236 (22%) | |
| | | |groups ** | | |
| | | | |Follow-up year 1 | |
| | | |* Visually extracted |OR = 5.28, P < 0.0001 | |
| | | |from a graph in | | |
| | | |McDonald et al. 1984 |Follow-up year 2 | |
| | | |(278). |OR = 5.07, P < 0.0001 | |
| | | |** Data from McDonald | | |
| | | |et al. 1992 (136). |Follow-up year 3 | |
| | | |These data are not |OR = 5.09, P < 0.0001 | |
| | | |adjusted for a | | |
| | | |potential unit of | | |
| | | |analysis error. | | |
|McDowell et al. 1986 (279) |Number of patients: 1420 |Patient reminder letters vs patient |Influenza |Influenza |All three approaches to reminding |
|Supplemented with data from|Age and gender distributions |reminder telephone calls from a nurse vs |Proportion of eligible |Follow-up – Intervention year|patients were effective in |
|McDowell et al. 1990 (138) |not reported for each study |clinician reminder prompts vs usual care |patients receiving |Group 1:84/265 (35%) |significantly improving the rates |
| |group | |vaccination |Group 2: 77/226 (37%) |achieved without a reminder. |
|Design: | |Intervention aim: Improve vaccination | |Group 3: 46/218 (23%) | |
|CCT |Group 1 |rates | |Control: 21/230 (10%) |Personal reminders by the physician |
| |Number of patients: 265 |QI agent: Medical practices | |Non-participants: 17/481 (4%)|and telephone reminders by the nurse |
|Group allocation: | | | | |were more effective than reminders by |
|Experimental study with |Group 2 |Group 1 | |Follow-up – Intervention year|letter. |
|patients’ families randomly|Number of patients: 226 | | |OR compared to controls | |
|allocated to treatment and | |Patient education / reminders: Patients |Odds ratio of receiving|Group 1: 4.62, p < 0.001 |Despite the reminders, influenza |
|control groups. |Group 3 |were sent a single letter encouraging |vaccination between |Group 2: 5.14, p < 0.001 |vaccination rates remained low. |
| |Number of patients: 218 |them to receiving the vaccine. The letter|treatment and control |Group 3: 2.66, p = 0.001 | |
|Follow-up period: 3 months | |was computer generated and customized |groups | |Telephone and physician reminders were|
| |Control group |from the EMR, and signed by the patient’s| |Test of significance for |more cost-effective than mailings at |
|Number of sites: 1 academic|Number of patients: 230 |physician and the practice nurse. | |control vs non-participant |lower physician and nursing salaries. |
|family medicine centre | | | |patients | |
| |Non-participants |Group 2 | |P < 0.005 |In a follow-up study, McDowell et al. |
|Site affiliation: |Number of patients: 481 | | | |(138) analyzed patterns of |
|University | |Patient education / reminders: Patients | |Influenza – Post-intervention|immunization uptake among individual |
| |Eligibility criteria: |were called by the practice nurse and | |(Reminders had ceased) |patients over the pre-intervention |
|Number of practices or |Patients aged 65 years or |informed that they should obtain an | | |year, the intervention year, and an |
|physicians: 6 practices* |older. |influenza vaccination. |Influenza – |Follow-up – Post-intervention|additional post-intervention year. |
| | | |Post-intervention |year* |They found that the intervention |
|Location: Canada (Ontario) | |Group 3 |(Reminders had ceased) |Experimental groups: 116/622 |effect was short-lived, and also |
| | | |Proportion of eligible |(19%) |detected a decrease in immunization |
| | |Clinician reminders: Computer generated |patients receiving |Control groups: 100/564 (18%)|rates among patients who had been |
|* 4 of 6 practices | |reminders were generated and attached to |vaccination | |previously immunized. McDowell et al. |
|participated in this study.| |each patient’s visit chart. | |OR = 1.09 |suggest that this may be evidence of |
|The two non-participant | | | |P = 0.60 |an adverse dependence on technology, |
|practices contributed | |Control group | | |and that use of clinician reminders |
|“non-contaminated” outcome | | | | |must be careful to educate and support|
|data. | |Usual care. |Odds ratio of receiving| |self-management. |
| | | |vaccination between |Pneumococcal | |
| | |Non-participant characteristics: |treatment and control |Not targeted. | |
| | | |groups | |* From previous column: Results from |
| | |Usual care. | |* See next column, at right. |the follow-up study reported in |
| | | |Pneumococcal | |McDowell et al. 1990 (138). This study|
| | | |Not targeted. | |included patients remaining after an |
| | | | | |addition year of data collection and |
| | | | | |analysis, when the intervention had |
| | | | | |been ceased. |
|Moran et al. 1992 (280) |Number of patients: 409 |Single patient reminder letter vs two |Influenza |Influenza |The majority of high-risk patients |
| |Female/male: not reported |sequential patient reminder letters vs |Proportion of eligible |Follow-up |identified by the electronic patient |
|Design: | |usual care |patients receiving |Group 1: 54/135 (40%) |registry failed to seek influenza in |
|CCT |Group 1 | |vaccination at |Group 2: 41/138 (30%) |response to reminder letters, even |
| |Number of patients: 135 |Intervention aim: Improve vaccination |follow-up |Control: 52/136 (38%) |when immunization was free. |
|Group allocation: |Age (>65): 66 (49%) |rates | | | |
|Experimental study with | |QI agent: Health clinic |Odds ratio of receiving|Follow-up |Immunizations proportions in the |
|random allocation of |Group 2 | |vaccination between |Group 1 vs Control |intervention groups were not |
|patients to treatment and |Number of patients: 138 |Group 1 |treatment and control |OR = 1.08 |significantly different from the |
|control groups. |Age (>65): 68 (49%) | |groups |P = 0.80 |control group. |
| | |Patient education / reminders: Patients | | | |
|Follow-up period: 3 months |Control group |were mailed a single letter saying that | |Group 2 vs Control |There is no evidence of a “dose |
| |Number of patients: 136 |immunization was medically indicated, did| |OR =0.68 |response” to two sequential reminders.|
|Number of sites: 1 urban |Age (>65): 68 (50%) |not cause influenza, could result in | |P = 0.33 | |
|health center | |minor side effects, and was free and | | |Patients with appointments were more |
| |Eligibility criteria: |available without an appointment. | |Group 1 vs Group 2 |likely to receive immunization than |
|Site affiliation: Unclear |Patients aged >65 years or | | |OR = 1.58 |patients seen on a walk-in basis or |
| |those with a diagnosis of |Group 2 | |P = 0.23 |during “health fairs”. |
|Number of practices or |chronic disease recorded in the| | | | |
|physicians: Not reported |clinic EMR. |As above, except patients were mailed a | |Overall test of significance | |
| | |second identical letter 1 month later. | |P > 0.10 (NS) | |
|Location: United States | | | | | |
|(State unclear) | |Control group |Pneumococcal |Pneumococcal | |
| | | |Not targeted. |Not targeted. | |
| | |Usual care. | | | |
|Moran et al. 1996 (281) |Number of patients: 797 |Mailed education brochure vs lottery-type|Influenza |Influenza |The odds of immunization for patients |
| | |patient incentive vs mailed education |Proportion of eligible |Baseline* |in the group mailed the educational |
|Design: CCT |Group 1 |brochure and lottery-type patient |patients receiving |Group 1: 25/79 (32%) |brochure were almost twice as great as|
| |Number of patients: 198 |incentive vs usual care |vaccination |Group 2: 38/82 (46%) |those of control patients, while the |
|Group allocation: |Female/male: 128/70 | | |Group 3: 27/70 (39%) |odds of immunization for those mailed |
|Experimental study, with |Age (mean(sd)): 65 (15.9) |Intervention aim: Improve vaccination | |Control: 37/97 (38%) |the lottery incentive were |
|patients randomly allocated| |rates | | |approximately one and one half times |
|to treatment and control |Group 2 |QI agent: Medical clinic |Odds ratio of receiving|Follow-up |as great. |
|groups. |Number of patients: 198 | |vaccination between |All patients | |
| |Female/male: 129/69 |Group 1 |treatment and control |Group 1: 71/198 (36%) |Surprisingly, patients in the group |
|Follow-up period: 3 months |Age (mean(sd)): 65 (17.2) | |groups |Group 2: 57/198 (29%) |mailed both interventions were less |
| | |Patient education / reminders: | |Group 3:52/199 (26%) |likely to be immunized than those in |
|Number of sites: 1 adult |Group 3 |Educational brochures were mailed to | |Control: 41/202 (20%) |the single intervention groups. |
|medicine service at an |Number of patients: 199 |patients. Brochure content emphasized the| | |Additionally, patients expressed |
|urban community health |Female/male: 133/66 |seriousness of influenza, provided | |Diabetic patients |reservations and suspicion about the |
|center |Age (mean(sd)): 68 (15.2) |information about important decision | |Group 1: 11/28 (39%) |incentive. An adverse interaction |
| | |factors, and contained information about | |Group 2: 11/24 (45%) |between incentive and education based |
|Site affiliation: Private |Control group |where and when the vaccination could be | |Group 3: 5/17 (29%) |interventions may be at play. |
|community delivery system, |Number of patients: 202 |obtained. | |Control: 9/25 (36%) | |
|university/teaching |Female/male: 134/68 | | | |The marginal cost effectiveness of the|
| |Age (mean(sd)): 66 (16.6) |Group 2 | |Follow-up |educational brochure was less than $4 |
|Number of practices or | | | |All patients** |per additional immunization over those|
|physicians: 9 physicians |Eligibility criteria: |Financial incentive – patients: A lottery| |Group 1 |in the control group. |
| |Ambulatory patients, aged 65 |notice was sent to patients, informing | |OR = 2.29, P = 0.0004 | |
|Location: United States |years or older, or patients |them that patients receiving immunization| |Group 2 | |
|(Massachusetts) |with chronic diseases; seen |would be eligible to win one of three | |OR = 1.68, P = 0.0308 | |
| |within the preceding 5 months. |grocery store gift certificates. | |Group 3 |* Previous vaccination history |
| |Pneumococcal vaccination | | |OR = 1.41, P = 0.1527 |available only for a smaller subset of|
| |outcomes measure among all |Group 3 | | |patients. |
| |patients regardless of previous| | |Patients with known previous |** Adjusted for age, pulmonary |
| |vaccination status. |Patient education / reminders and patient| |vaccination history*** |disease, and diabetes. |
| | |financial incentives, as above. | |Group 1 |*** Adjusted for previous vaccination |
| | | | |OR = 3.95, P/= 75): 379 | | |Follow-up | |
|treatment and control | |Group 1 | |Group 1: 72% | |
|groups. |Control group | | |Control: 52% | |
| |Number of patients: 960 |Financial incentive – clinicians: | | | |
|Follow-up period: 2 years |Female/male: 581/379 |Physicians received an annual capitated |Odds ratio of receiving|Follow-up | |
| |Age (>/= 75): 383 |payment from HCFA of $53 for a preventive|vaccination between |OR = 2.37 | |
|Number of sites: 10 primary| |care visit, and $47 for a health |treatment and control |P < 0.001 | |
|care practices, 3 of which |Eligibility criteria: Active |promotion counseling visit. The |groups | | |
|were audited for |patients at a study site (i.e.:|preventive care package included | | | |
|vaccination outcomes.* |received medical service in the|influenza vaccination, FOBT, and |Pneumococcal |Pneumococcal | |
| |previous 2 years), aged 65 |depression screening, among other |Proportion of eligible |Baseline | |
|Site affiliation: |years or older. Patients were |services. The health promotion package |patients receiving |Group 1: 33% | |
|University, private |enrolled in Medicare Part A and|featured nurse counseling in a variety of|vaccination |Control: 29% | |
|community delivery system, |Part B coverage, were community|health and wellness areas. | | | |
|private practices |living, and were not enrolled | | |Follow-up* | |
| |in an HMO. |Financial incentive – patients: Services | |Group 1: 80% | |
|Number of practices or | |under the capitated packages were | |Control: 35% | |
|physicians: 19 physicians | |provided free of charge to patients. | | | |
|practiced at the 3 audit | | |Odds ratio of receiving|Follow-up * | |
|sites | |Clinician reminders: Practices were |vaccination between |OR = 7.43 | |
| | |prompted monthly by the research team to |treatment and control |P < 0.001 | |
|Location: United States | |schedule special prevention appointments |groups | | |
|(North Carolina) | |for patients who were “due” for | |* This value may include | |
| | |preventive services. | |previously vaccinated | |
| | | | |patients. | |
|* Sites included academic | |Team change: Nurses carried out most of | | | |
|and community practices | |the preventive care procedures, including| | | |
|staffed by general | |vaccinations. | | | |
|internists and family | | | | | |
|physicians. | |Control group | | | |
| | | | | | |
| | |Usual care. | | | |
|Mullooly et al. (1987) |Number of patients: 2217 |Mailed patient reminder letters vs usual |Influenza |Influenza |A single mailed cue increased the |
|(283) | |care |Proportion of eligible |Follow-up |vaccination among high-risk elderly by|
| |Group 1 | |patients receiving |Group 1: 430/1105 (39%) |28 percent. However, the majority of |
|Design: |Number of patients: 1105 |Intervention aim: Improve vaccination |vaccination |Control: 335/1112 (30%) |patients were not vaccinated. |
|CCT |Female/male: 531/574 |rates | | | |
| |Age (mean(sd)): Not reported |QI agent: Private MCO |Risk difference between|Follow-up | |
|Group allocation: | | |treatment and control |Diff: 8.9% | |
|Experimental study with |Control group |Group 1 |groups |95% CI = [4.9, 12.7] | |
|patients randomly allocated|Number of patients: 1112 | | | | |
|to treatment and control |Female/male: 586/526 |Patient education / reminders: Patients |Odds ratio of receiving|Follow-up | |
|groups. |Age (mean(sd)): Not reported |received a personalized letter stressing |vaccination between |OR = 1.48 | |
| | |the importance of influenza vaccination |treatment and control | | |
|Follow-up period: 8 months |Eligibility criteria: |for high-risk elderly individuals who had|groups | | |
| |Patients aged 65 or older, |been hospitalized during the past year. | | | |
|Number of sites: 1 large |discharged from hospital with | |Pneumococcal |Pneumococcal | |
|HMO |chronic disease. |Control group |Not targeted. |Not targeted. | |
| | | | | | |
|Site affiliation: Private |Exclusion: |Usual care | | | |
|MCO |None reported | | | | |
| | | | | | |
|Number of practices or | | | | | |
|physicians: Not reported | | | | | |
| | | | | | |
|Location: United States | | | | | |
|(numerous states in the | | | | | |
|Northwest region) | | | | | |
|Nexoe et al. 1997 (284) |Number of patients: 585 |Mailed patient reminder cards and free |Influenza |Influenza |“Spontaneous” influenza vaccination |
| |Age and gender distribution not|vaccination vs mailed patient reminder |Proportion of eligible |Follow-up |rates were low in the studied |
|Design: |reported |cards and patient-pay vaccinations vs |patients receiving |Group 1: 140/195 (72%) |high-risk population. Postal |
|CCT | |usual care |vaccination |Group 2: 95/195 (49%) |invitations improved the rates, and |
| |Group 1 | | |Control: 48/195 (25%) |full reimbursement improved the rates |
|Group allocation: |Number of patients: 195 |Intervention aim: Improve vaccination | | |further. |
|Experimental study with | |rates |Odds ratio of receiving|Follow-up | |
|patients randomly allocated|Group 1 |QI agent: Medical practices |vaccination between |Group 1 | |
|to treatment and control |Number of patients: 195 | |treatment and control |OR = 7.80 | |
|groups. | |Group 1 |groups |P < 0.001 | |
| |Control group | | | | |
|Follow-up period: |Number of patients: 195 |Patient education / reminders: Mailed | |Group 2 | |
|Approximately 3.5 months | |reminders were sent to patients inviting | |OR = 2.91 | |
| |Eligibility criteria: |them to receiving influenza vaccination. | |P < 0.001 | |
|Number of sites: 13 general|Patients aged 65 years or |Reminders were personalized with the | | | |
|practices |older, or patients with a |patient’s name and the GP’s signature. |Pneumococcal |Pneumococcal | |
| |chronic disease. | |Not targeted. |Not targeted. | |
|Site affiliation: Private |Patient group may have included|Patient financial incentive: Influenza | | | |
|practices |nursing home residents, number |vaccination provided for free. | | | |
| |not reported. | | | | |
|Number of practices or | |Group 2 | | | |
|physicians: As above. | | | | | |
| | |Patient education / reminders as above, | | | |
|Location: Denmark | |except without patient financial | | | |
| | |incentive – patients paid the usual GP | | | |
| | |vaccination fee of US $40-60. | | | |
| | | | | | |
| | |Control group | | | |
| | | | | | |
| | |Usual care – no patient reminders. | | | |
| | |Patients paid US $40-60 for each | | | |
| | |vaccination. | | | |
|Nichol et al. 1990 (285) |Number of patients: 1375 |Multifactoral intervention with nurse-led|Influenza |Influenza |A multifactoral intervention centered |
| |(Number of patients responding |vaccination clinics vs usual care |Proportion of eligible |Follow-up … |around expanded roles for clinic |
|Design: Cluster PCS |to the outcome survey out of | |patients receiving |… among patients aged 65 |nurses in promoting vaccinations |
| |1893 sampled. Survey responders|Intervention aim: Improve vaccination |vaccination |years or older |improved vaccination rates compared to|
|Group allocation: A |enumerated below.) |rates | |Group 1: 108/176 (61%) |comparison clinics that had |
|Veterans Affairs Medical | |QI agent: Medical center | |Control: 132/377 (35%) |implemented little or no programs to |
|Center (VAMC) implementing |Group 1 | | | |improve vaccinations. Study |
|the intervention was |Number of patients: 378 |Group 1 | |… Among patients with |investigators decided not to direct |
|compared to similar VAMCs |Age (mean(sd)): 60.2 (27.2) | | |diabetes |interventions toward physicians due to|
|during the study period. | |Team change: Nurses gave influenza | |Group 1: 28/45 (62%) |perceived ceiling effects related to |
| |Control group |vaccinations to outpatients without a | |Control: 41/129 (31%) |physician receptivity. |
|Follow-up period: 1 year |Number of patients: 997 |signed physician’s order. Nurses were | | | |
| |Age (mean(sd)): Mean age ranged|asked to offer vaccination to all | |… Among any patient with a |A large proportion of vaccinated |
|Number of sites: 4 VA |from 56.4 to 59.1 at the 3 |patients regardless of risk status. In | |“high risk” indication for |patients received their vaccinations |
|medical centers* |comparison sites. |addition to staffing a vaccination | |vaccination |at an outside community site (36% in |
| | |station during regular clinic hours, | |Group 1: 28/45 (62.2%) |the intervention group vs 46% in the |
|Site affiliation: |Eligibility criteria: Patients |nurses held a 2-week walk-in vaccination | |Control: 41/129 (31.8%) |control sites, p = 0.05). |
|University, Veterans |on the study site outpatient |clinic. | | | |
|Affairs |rosters. All patients, | |Odds ratio of receiving|Follow-up … | |
| |regardless of high-risk status,|Clinician reminders: Nurses were reminded|vaccination between |… Among patients aged 65 | |
|Number of practices or |were targeted for vaccination |to offer patients influenza vaccination |treatment and control |years or older | |
|physicians: Not reported. |at the intervention site. |by stamps placed on progress notes by |groups |OR = 2.95* | |
| |Analyses were stratified by |clinic clerks. | |P < 0.005 | |
|Location: United States |vaccination indication. | | | | |
|(Midwestern region) | |Patient education / reminders: All | |… Among patients with | |
| | |outpatients received a letter encouraging| |diabetes | |
| | |them to receive influenza vaccination if | |OR = 3.55* | |
| | |they fell into a high risk category. The | |P < 0.005 | |
|* 1 VAMC comprised the | |letter advertised the dates, hours, and | | | |
|intervention site. The | |locations of the nurse-led walk-in | |… Among any patient with a | |
|other 3 VAMCs comprised the| |vaccination clinic. | |“high risk” indication for | |
|concurrent comparison | | | |vaccination | |
|sites. | |Control group | |ORs ranged from 3.05 to 3.52 | |
| | | | |depending on the comparison | |
| | |Usual care, with publicity provided | |site. Comparisons were | |
| | |through clinic posters and waiting room | |reported as statistically | |
| | |materials. At one control site, a brief | |significant, with p < | |
| | |reminder was mailed to select high-risk | |0.00001. | |
| | |outpatients, and an influenza vaccination| | | |
| | |clinic was held for patients with |Pneumococcal |Pneumococcal | |
| | |appointments several hours each day. |Not targeted. |Not targeted. | |
|Nowalk et al. 2010 (286) |Number of patients: 12222 |Workplace vaccination clinics with |Influenza |Influenza |An incentive for vaccination, an |
| | |“Choice” sites offering intra-nasal |Proportion of eligible |Employees aged 18-49 |intensified advertising campaign, and |
|Design: |Group 1 |live-attenuated vaccine (LAV) vs |patients receiving |Baseline |offering a choice of influenza |
|Cluster-RCT |Number of patients: 3757 |“Choice-plus” sites offering LAV with |vaccination |Group 1: 38.6% |vaccines improved vaccination rates in|
| |Female/male: 39.2% (18.6%)* |increased employee outreach and $5 | |Group 2: 36.4% |the workplace and may be used across a|
|Group allocation: |Age (proportion of employees |financial incentives vs usual care with | |Control: 34.8% |variety of non-healthcare business |
|Experimental study with |aged 18-49): 72.7% (12.2%)* |trivalent vaccine (TIV) | | |types and sizes. |
|employers randomly | | | |Follow-up – 4 months | |
|allocated to treatment and |Group 2 |Intervention aim: Improve vaccination | |Group 1: 40.9% | |
|control groups |Number of patients: 4387 |rates | |Group 2: 46.1% | |
| |Female/male: 49.8% (17.6%)* |QI agent: Employers | |Control: 38.5% | |
|Follow-up period: Unclear |Age (proportion of employees | | | | |
|(approximately 4 months) |aged 18-49): 75.1% (12.4%)* |Group 1: “Choice” sites with intra-nasal | |Employees aged 50+ | |
| | |LAV | |Baseline | |
|Number of sites: 54 |Control group | | |Group 1: 47.9% | |
|employers * |Number of patients: 4078 |Patient education / reminders: | |Group 2: 49.3% | |
| |Female/male: 39.4% (18.1%)* |Implemented an e-mail/voicemail script, | |Group 3: 48.1% | |
|Site affiliation: Employers|Age (proportion of employees |and disseminated posters and fliers that | | | |
|in non-health related |aged 18-49): 75.1% (11.0%)* |clearly stated the availability of both | |Follow-up – 4 months | |
|sectors, with a previous | |trivalent vaccine and live attenuated | |Group 1: 57.2% | |
|relationship to a | |(intra-nasal) vaccine. | |Group 2: 70.4% | |
|particular health care |Eligibility criteria: | | |Control: 54.5% | |
|services contract |Employer sites were those |Delivery site change: Worksite seasonal | | | |
|organization |having previously hosted a |influenza vaccination clinics targeting |Odds ratio of receiving|Follow-up – 4 months* | |
| |vaccination clinic, delivered |employees aged 18-49. |vaccination between |All ages | |
|Number of practices or |by a single third-party health | |treatment and control |Group 1 vs control | |
|physicians: Not reported. |care services consultant, in |Group 2: “Choice-plus” sites with |groups |OR = 1.05 (95% CI [0.70, | |
| |which less than 5% of the |intra-nasal LAV, increased employee | |1.57]), p = 0.808. | |
|Location: United States |influenza vaccine previously |outreach, and a small financial | |Group 2 vs control | |
|(Various states) |given was of the intranasal |incentive. | |OR = 1.40 (95% CI [1.02, | |
| |form. Those eligible to receive| | |1.94]), p = 0.041. | |
|* 18 employer sites in each|vaccine were workers aged 18-49|Patient education / reminders: As for | | | |
|group. |(live-attenuated vaccine) or |group 1, except with increased numbers of|Pneumococcal |Pneumococcal | |
| |workers of any age. |fliers and E-mails according to a |Not targeted. |Not targeted. | |
| |Exclusions: Employer sites |standardized plan. | | | |
| |unable to provide data on | | | | |
| |number of employees and |Financial incentives – patients: All | |* ORs reported from | |
| |influenza vaccinations from the|vaccinated employees received a $5 gift | |hierarchical logistic | |
| |previous season, employers in |card. | |regression, adjusted for | |
| |the health care sector, sites | | |employee gender and age; and | |
| |at which the baseline |Delivery site change: As in Group 1. | |employer intervention | |
| |vaccination rate. | | |compliance and other | |
| | |Control group: Regular worksite | |characteristics, including | |
| |* Mean proportion per employer |immunization clinic, with LAV only for | |vaccination rate during the | |
| |(sd). |those patients specifically requesting | |previous year. | |
| | |it. | | | |
| | | | | | |
| | |Patient education / reminders: Regular | | | |
| | |promotional materials, without | | | |
| | |LAV-specific advertising. | | | |
| | | | | | |
| | |Deliver site change: As in Group 1. | | | |
|Nuttall et al. 2003 (287) |Number of patients: 90 |Mailed reminder letters vs patient |Influenza |Influenza |The three modalities (reminder only, |
| |Age and gender distributions |reminder letters and educational leaflets|Proportion of eligible |Follow-up |reminder and education, reminder and |
|Design: |not reported. |vs patient reminder letters and home |patients receiving |Group 1: 7/30 (23%) |visit) are not different in their |
|CCT | |visits from a vaccination advocate |vaccination |Group 2: 12/30 (40%) |effect on influenza vaccination rates.|
| |Group 1 | | |Control: 8/30 (27%) | |
|Group allocation: |Number of patients: 30 |Intervention aim: Improve vaccination | | |An analysis of patients within age |
|Experimental study with |Age (% >/= 72 years) = 50%* |rates | |Overall test of significance |strata (aged /= 72 |
|patients randomly allocated| |QI agent: Medical clinic | |P = 0.329 |years) was performed. Uptake appeared |
|to treatment and control |Group 2 | | | |higher in patients aged >/= 72 years |
|groups. |Number of patients: 30 |Group 1 |Odds ratio of receiving|Follow-up |who received a personal visit (Group |
| |Age (% >/= 72 years) = 50%* | |vaccination between |Group 1 |3) vs patients receiving a reminder |
|Follow-up period: 11 months| |Patient education/ reminders: Patients |treatment and control |OR = 0.84 |letter only or a reminder letter and a|
| |Control group |received a letter from the East |groups |P = 1.00 |leaflet (Groups 1 and 2). However, |
| |Number of patients: 30 |Lancashire Health Authority inviting them| | |this finding was not statistically |
|Number of sites: 1 GP |Age (% >/= 72 years) = 50%* |to attend their GP practice for influenza| |Group 2 |significant. |
|practice | |vaccination. Patients also received a | |OR = 1.83 | |
| |Eligibility criteria: |leaflet entitled “Flu Jab – Beat Flu, Use| |P = 0.61 | |
|Site affiliation: Private |Patients aged 65-90 years in a |a Jab”, published by the UK Department of| | | |
|practice |single GP practice, who had |Health. |Pneumococcal |Pneumococcal | |
| |failed to attend the practice | |Not targeted. |Not targeted. | |
|Number of practices or |for influenza vaccination the |Group 2 | | | |
|physicians: Not reported |previous year. Confused | | | | |
| |patients, and patients with egg|Patient education / reminders: Patients | | | |
|Location: United Kingdom |allergy were excluded. |received a reminder letter, as above. | | | |
|(East Lancashire) | |Patients also received a visit from a | | | |
| |* Randomization was stratified |researcher. At patient visits, facts | | | |
| |on age /= 72 |taken from the “Flu Jab – Beat Flu, Use a| | | |
| |years. |Jab” leaflet were provided in a | | | |
| | |one-on-one basis. | | | |
| | | | | | |
| | |Control group | | | |
| | | | | | |
| | |Patient education / reminders: Patients | | | |
| | |received a letter from the East | | | |
| | |Lancashire Health Authority inviting them| | | |
| | |to attend their GP practice for influenza| | | |
| | |vaccination. | | | |
|Ohmit et al. 1995 (288) |Number of patients: 4211* |Clinician education, patient reminder, |Influenza |Influenza |The community intervention program had|
| | |mass media campaign, and vaccination |Odds ratio of receiving|Follow-up – 1990-91 |a significant and important impact on |
|Design: |Group 1 |clinic outreach vs usual care |vaccination associated |Patients from the community |increasing the likelihood of |
|Cluster RCT |Not reported | |with living in an |OR = 2.02 |immunization among elderly persons |
| | |Intervention aim: Improve vaccination |intervention region |P30% | |
|Location: United States |enrollment. |regarding practice improvement, and | |Group 1: +2.51% | |
|(New York) | |discuss potential methods for improving | |Control: +2.55% | |
| | |performance. | |P = 0.943 | |
|* Medical practices were | | | | | |
|allocated to treatment and | |Control group | |HV practices with baseline | |
|control, stratified by high| | | |vaccination rate 5%| | |
|AA 118 100 | | |from baseline |Follow-up | |
|HV 582 150 | | | |AA practices | |
| | | | |Group 1: 33.9% | |
|** Includes physicians in a| | | |Control: 22.0% | |
|non-randomized arm, results| | | |P = 0.052 | |
|of which are not reproduced| | | | | |
|here. | | | |HV practices with baseline | |
| | | | |vaccination rate >30% | |
| | | | |Group 1: 25.0% | |
| | | |* Outcomes for the HV |Control: 21.8% | |
| | | |practices without |P = 0.554 | |
| | | |stratification by | | |
| | | |baseline performance |HV practices with baseline | |
| | | |are available as well. |vaccination rate /= 65 |to practice and using audit, feedback,|
|Design: |cardiovascular disease, 4327 |performance feedback |vaccination |Group 1: 48.6% |and discussion of barriers to change |
|Cluster RCT |patients with diabetes, 169 | | |Control: 44.7% |and how to overcome these, improved |
| |patients with splenectomy, and |Intervention aim: Improve vaccination | | |pneumococcal vaccination rates in |
|Group allocation: |27580 patients aged 65 years or|rates | |Diabetic patients |coronary and diabetic patients in this|
|Experimental study with |older; Categories may not be |QI agent: Medical clinics | |Group 1: 58.9% |trial. |
|random allocation of |mutually exclusive) | | |Control: 58.2% | |
|general practices to | |Group 1 | | |The study did not demonstrate an |
|treatment and control |Group 1 | | |Cardiovascular disease |improvement in influenza vaccination |
|groups. |Age (>65): 16.1% |CQI or similar: Practice care teams | |patients |rates. |
| |Female/male: Not reported. |received education and feedback of | |Group 1: 58.0% | |
|Follow-up period: 6 months | |practice vaccination rates to the | |Control: 59.4% | |
| |Control group |practice team, followed by a discussion | | | |
|Site description: General |Age (>65): 15.9% |about current practice policy and | |Splenectomy patients | |
|practices involved in |Female/male: Not reported. |potential solutions. | |Group 1: 64.5% | |
|participating practice | | | |Control: 55.1% | |
|networks |Eligibility criteria: |Clinician education: A GP provided | | | |
| |Patients aged 65 years or |evidence-based information, framed around| |Follow-up | |
|Site affiliation: Private |older, or patients with |a dialogue about perceived barriers to | |Patents aged >/= 65 | |
|practices |diabetes, cardiovascular |vaccination within the organization, to | |Group 1: 69.3% | |
| |disease, or splenectomy. |the practice-care team. | |Control: 70.1% | |
|Number of sites: 2 (1 | | | | | |
|Primary Care Trust and 1 | |Patient education / reminders: Poster | |Diabetic patients | |
|Collaborative Research | |campaigns, waiting room brochures, and | |Group 1: 74.4% | |
|Network) | |reminder/recall were implemented by some | |Control: 70.2% | |
| | |practices. | | | |
|Number of practices or | | | |Cardiovascular disease | |
|physicians: 30* | |Clinician reminders: Vaccination prompts | |patients | |
| | |and chart templates were implemented by | |Group 1: 76.1% | |
|Location: United Kingdom | |some practices. | |Control: 72.5% | |
|(West Lincolnshire and | | | | | |
|Trent) | |Audit and feedback: All study providers | |Splenectomy patients | |
| | |received baseline information about their| |Group 1: 80.6% | |
|* GP practices were | |vaccination rates after the educational | |Control: 58.0% | |
|allocated to treatment (15 | |session. | | | |
|practices) and control (15 | | |Odds ratio of receiving|Follow-up | |
|practices) groups. | |Control group |vaccination between |Patents aged >/= 65 | |
|Practice-level covariates | | |treatment and control |OR = 0.99, P = 0.42 | |
|provided. Significant | |Audit and feedback, as above. |groups* | | |
|differences were detected | | | |Diabetic patients | |
|in number of dispensing | | | |OR = 1.07, P = 0.08 | |
|practices; differences in | | | | | |
|number of partners and list| | | |Cardiovascular disease | |
|size seem apparent, despite| | | |patients | |
|statistical | | | |OR = 1.06, P = 0.09 | |
|non-significance. | | | | | |
| | | | |Splenectomy patients | |
| | | | |OR = 1.22, P = 0.38 | |
| | | | | | |
| | | |Pneumococcal |Pneumococcal | |
| | | |Proportion of eligible |Baseline | |
| | | |patients receiving |Diabetic patients | |
| | | |vaccination |Group 1: 43.3% | |
| | | | |Control: 40.6% | |
| | | | | | |
| | | | |Cardiovascular disease | |
| | | | |patients | |
| | | | |Treatment: 30.6% | |
| | | | |Control: 33.2% | |
| | | | | | |
| | | | |Splenectomy patients | |
| | | | |Treatment: 79.0% | |
| | | | |Control: 86.0% | |
| | | | | | |
| | | | |Follow-up | |
| | | | |Diabetic patients | |
| | | | |Treatment: 58.8% | |
| | | | |Control: 47.4% | |
| | | | | | |
| | | | |Cardiovascular disease | |
| | | | |patients | |
| | | | |Treatment: 44.8% | |
| | | | |Control: 39.7% | |
| | | | | | |
| | | | |Splenectomy patients | |
| | | | |Treatment: 85.5% | |
| | | | |Control: 90.7% | |
| | | | | | |
| | | |Odds ratio of receiving|Follow-up | |
| | | |vaccination between |Diabetic patients | |
| | | |treatment and control |OR = 1.18, P65 age |
|groups. |Number of patients: 4503* | | |OR = 1.20*** |group. |
| |Female/male: 2787/1716 |Patient education / reminders: Patients | |95% CI: [1.06, 1.35] | |
|Follow-up period: 3 months |Age (mean(sd)): 75.4 (sd not |were sent a reminder letter adapted from | | | |
| |reported) |the Health Belief Model. The letter also |Pneumococcal |Pneumococcal | |
|Number of sites: 1 medical | |contained signatures from the principal |Not targeted. |Not targeted. | |
|care foundation working |Eligibility criteria: |investigator, the state health | | | |
|with the HCFA conducted the|Medicare beneficiaries aged 65 |commissioner, and the medical director of| |* Approximately 25% patients | |
|trial was conducted in ten |years or older, without |Medicare for Indiana. An additional page | |did not respond to the |** Based on Medicare claims data (9011|
|Indiana counties. |evidence of having died, had |of information about influenza and | |outcomes survey. Outcomes for|patients), adjusting for age, county |
| |billed a Medicare service in |vaccination summarized from CDC materials| |non-responders were imputed |density, gender, and age-gender |
|Site affiliation: |the previous year, and were not|was appended. | |from outcomes from further |interaction. |
|Government, Medicare, |members of an HMO. | | |telephone follow-up of |*** Based on survey data (6941 |
|non-profit foundation |Exclusion: |Control group | |randomly selected |patients), adjusted for age, gender, |
| | | | |non-responders. |comorbidities, age-gender interaction,|
|Number of practices or |* Outcomes survey returned by |Usual care. | | |density of county |
|physicians: Not reported |3454 and 3487 intervention and | | |**, *** Notes: See next | |
| |control group patients, | | |column. | |
|Location: United States |respectively. | | | | |
|(Indiana) | | | | | |
|Solberg et al. 2000 (298) |Number of patients: 7997 |Continuous quality improvement |Influenza |Influenza |Pneumococcal vaccination rates |
| |(6830 available for analysis, |facilitation vs usual care |Proportion of eligible |Baseline |improved more in CQI than in control |
|Design: |enumerated below.) | |patients receiving |Group 1: 62.1% |clinics. However, the intervention was|
|Cluster RCT | |Intervention aim: Improve preventive care|vaccination |Control: 62.5% |generally considered a failure, since |
| |Group 1 |QI agent: HMO | | |improvements were not different |
|Group allocation: |Number of patients: 3379 | | |Follow-up |between groups for the other |
|Experimental study with |Female/male: 2311/1068 |Group 1 | |Results not reported. |preventive health services targeted. |
|medical clinics randomly |Age (mean(sd)): 48.4 (1.3) | | | | |
|allocated to treatment and | |Continuous Quality Improvement (or |Pneumococcal |Pneumococcal |This may have been due to ceiling |
|control groups. |Control group |similar): Each clinic’s team |Proportion of eligible |Baseline |effects or a-typicality of clinics. |
| |Number of patients: 3451 |leader/facilitator was provided with an |patients receiving |Group 1: 30.3% |More likely, the CQI approach may have|
|Follow-up period: 20 months|Female/male: 2371/1080 |initial 6 hour conference overview of CQI|vaccination |Control: 28.6% |been ineffective. Process evaluations |
| |Age (mean(sd)): 48.6 (2.3) |methods and systems, followed by six | | |showed that teams did not complete or |
|Number of sites: 2 large | |workshops over six months. Clinic leaders| |Follow-up |repeat the improvement cycle, were |
|HMOs |Eligibility criteria: |were taught a seven-step cycle – identify| |Group 1: 48% |slow to implement changes, and usually|
| |Clinics were required to be |the problem, collect data, analyze the | |Control: 29% |implemented incomplete changes. |
|Site affiliation: Private |part of a medical group |data to understand root problems, develop| | | |
|MCOs, private practices |contracting with one of the |solutions, generate recommendations, |Change in proportion of|Follow-up* | |
| |study HMOs. |implement recommendations, and evaluate |eligible patients |Group 1: +17.2% | |
|Number of practices or |Patients were randomly selected|the process. Additionally, teams were |receiving vaccination |Control: +0.3% | |
|physicians: 44 clinics* |from all those visiting |provided with evidence for a systems | |P = 0.003 | |
| |participating clinics during |approach to improving preventive | | | |
|Location: United States |the baseline and follow-up data|services. Systems that teams could chose | | | |
|(Minnesota) |collection periods. Patients > |from included clinician reminders and | | | |
| |64 years of age were targeted |team change – however the particular QI | |* Adjusted for clustering. | |
|* Clinics were randomly |for influenza/pneumococcal |tactics deployed were not reported. | | | |
|allocated to treatment (22 |vaccine. | | | | |
|clinics, 6.7 +/- 4.2 adult | |Control group | | | |
|primary care physicians | | | | | |
|each (mean +/- sd)) and | |Usual care. | | | |
|control (22 clinics, 8.7 | | | | | |
|+/- 6.1 adult primary care | | | | | |
|physicians each) groups. | | | | | |
|Spaulding et al. 1991 (299)|Number of patients: 1068 |Patient postcard reminders vs usual care |Influenza |Influenza |The use of a reminder postcard was |
| | | |Proportion of eligible |Follow-up |associated with higher influenza |
|Design: |Group 1 |Intervention aim: Improve vaccination |patients receiving |Group 1: 131/519 (25%) |immunization rates. |
|RCT |Number of patients: 519 |rates |vaccination |Control: 50/549 (9.1%) | |
| |Female/male: 257/262 |QI agent: Department of Family Practice | | |Vaccination rates were generally low. |
|Group allocation: |Age (>64): 116 (22%) | |Odds ratio of receiving|Follow-up |Enlisted (vs officer) rank and an age |
|Experimental study with | |Group 1 |vaccination between |OR = 3.37 |of 40 years or less were risk factors |
|patients allocated randomly|Control group | |treatment and control |P < 0.001 |for not getting vaccinated. |
|to treatment or control |Number of patients: 549 |Patient education / reminders: Patients |groups | | |
|groups. |Female/male: 238/311 |were mailed a reminder postcard advising | | | |
| |Age (>64): 108 (20%) |them that their physician had determined |Pneumococcal |Pneumococcal | |
|Follow-up period: 6 months | |that they were at high risk of |Proportion of eligible |Not targeted. | |
| |Eligibility criteria: |complications should they catch the |patients receiving | | |
|Number of sites: 1 | |“flu”. |vaccination | | |
|department of family |Patients aged 65 or older, or | | | | |
|practice, at an army |patients with chronic disease, |Control group | | | |
|medical center |army personnel. | | | | |
| | |Usual care. | | | |
|Site affiliation: Military | | | | | |
| | | | | | |
|Number of practices or | | | | | |
|physicians: Not reported | | | | | |
| | | | | | |
|Location: United States | | | | | |
|(Washington) | | | | | |
|Tang et al. 1999 (300) |Number of patients: 347 to 629 |Clinician reminders and EMR vs usual care|Influenza |Influenza |Both the introduction of an EMR and |
| |from year to year. Age and |with paper based records |Proportion of eligible |1995 |the subsequent introduction of an |
|Design: |gender distribution not | |visits resolved by |Group 1: 40% |EMR-based clinician reminder system |
|PCS |reported. |Intervention aim: Improve vaccination |guideline-concordant |Control: 28% |were associated with increases in |
| | |rates |physician action | |physician compliance with influenza |
|Group allocation: |Group 1 |QI agent: General medicine clinic | |1996 |vaccination recommendations. |
|Observational study with |Number of patients: | | |Group 1: 39% | |
|physicians allocated to |182 – 314 from year to year. |Group 1 | |Control: 29% |Immunization rates in a group of |
|treatment or control groups| | | | |physicians using paper based patient |
|by personal choice. |Control group |Other: EMR implemented between the | |1997 |records with no reminder system |
| |Number of patients: 165 – 315 |1996-1997 reporting periods | |Group 1: 61%* |fluctuated, but ultimately was not |
|Follow-up period: 1 year |from year to year. | | |Control: 37%* |changed at study’s end. |
| | |Clinician reminders: A pop-up window | | | |
|Number of sites: 1 large |Eligibility criteria: |reminding physicians to provide influenza| |1998 | |
|university internal |Patients aged 65 years of over |vaccinations appears when each eligible | |Group 1: 68%** |* Significant increase compared to |
|medicine clinic |with a non-acute visit to the |patient’s EMR is opened. Reminders were | |Control: 31%*** |1996 results, p=0.001 for the |
| |study clinic during influenza |implemented between the 1997-1998 | | |intervention group, p = 0.02 for the |
|Site affiliation: |season. Patients vaccinated in |reporting period. |Pneumococcal |Pneumococcal |control group. |
|University |September, before influenza | |Not targeted. |Not targeted. |** Significant increase compared to |
| |season began, were excluded. |Control group | | |1997 results, p=0.02 for the |
|Number of practices or | | | |* , **, and *** notes: See |intervention group. |
|physicians: 23 physicians* | |Usual care with paper based records | |next column. All findings |*** Non-significant compared with 1995|
| | | | |unadjusted for potential unit|control group outcome, p=0.18 |
|Location: United States | | | |of analysis effects. | |
|(Illinois) | | | | | |
|Tape et al. 1993 (301) |Number of patients: 384 |Computer-generated clinician reminders vs|Influenza |Influenza |Physicians using an EMR including |
| | |generic reminder sheets |Proportion of eligible |Follow-up |preventive care reminders were more |
|Design: |Group 1 | |patients receiving |Group 1: 62/212 (29%) |likely to recommend preventive care |
|Cluster CBA |Number of patients: 212 |Intervention aim: Improve preventive care|vaccination |Control: 37/172 (22%) |measures. However, compliance with |
| | |QI agent: Physician practices | | |preventive recommendations was |
|Group allocation: |Control group | |Odds ratio of receiving|Follow-up |generally low. |
|Experimental study with |Number of patients: 172 |Group 1 |vaccination between |OR = 1.51 | |
|block-alternating | | |treatment and control |P = 0.05 |The attending physician and level of |
|allocation of resident |Eligibility criteria: |Clinician reminders: Patient-specific |groups | |training of the resident physician |
|physicians to treatment or |Practice patients eligible for |clinician reminder page automatically | | |affected preventive care. |
|control groups. |influenza or pneumococcal |generated from the EMR provided to |Pneumococcal |Pneumococcal | |
| |vaccination – aged 65 years and|physicians at each visit. |Proportion of eligible |Follow-up | |
|Follow-up period: 1 year |older or history of diabetes, | |patients receiving |Group 1: 35/310 (11%) | |
| |chronic respiratory, or heart |Control group |vaccination at 1 year |Control: 13/274 (5%) | |
|Number of sites: 1 academic|disease. Patients were also | | | | |
|internal medicine |eligible for pneumococcal |Clinician reminders: A generic reminder |Odds ratio of receiving|Follow-up | |
|outpatient clinic |vaccination if they were |sheet was placed in each patient chart. |vaccination between |OR = 2.56 | |
| |immuno-compromised, and were |No EMR was available. |treatment and control |P = 0.003 | |
|Site affiliation: |not eligible if there was a | |groups | | |
|University |record of previous vaccination.| | | | |
| | | | | | |
|Number of practices or | | | | | |
|physicians: 4 attending | | | | | |
|physicians-practices | | | | | |
|supervising numerous | | | | | |
|resident physicians | | | | | |
| | | | | | |
|Location: United States | | | | | |
|(Nebraska) | | | | | |
|Terrell-Perica et al. 2001 |Number of patients: 6528 |Influenza vaccination reminder letters vs|Influenza |Influenza |Mailing reminder letters for influenza|
|(302) |Female/male: 2872/3656 |reminder letters for pneumococcal as |Proportion of eligible |Follow-up |or influenza and pneumococcal |
| |Age (median):65 |well as influenza vaccinations vs usual |patients receiving |Group 1: 438/2213 (20%) |vaccination to new no-managed-care |
|Design: |Group-specific age and gender |care |vaccination |Group 2: 454/2171 (21%) |Medicare beneficiaries residing in |
|CCT |distributions not reported. | | |Control: 367/2144 (17%) |Hawaii had a modest, but significant |
| | |Intervention aim: Improve vaccination | | |impact on improving influenza and |
|Group allocation: |Group 1 |rates | |Overall test of significance |pneumococcal vaccination levels. |
|Experimental study with |Number of patients: 2213 |QI agent: State Health Department | |P = 0.03 | |
|patients randomly allocated| | | | |The addition of the pneumococcal |
|to treatment and control |Group 2 |Group 1 – Influenza reminder |Risk difference between|Follow-up |reminder did not appear to detract |
|groups. |Number of patients: 2171 | |treatment and control |Group 1 |from the influenza message in the |
| | |Patient education / reminders: One-page |groups |Diff: 2.7% |combined reminder letter. |
|Follow-up period: 3 months |Control group |influenza vaccination reminder letters | |P = 0.023 | |
| |Number of patients: 2144 |were written on State of Hawaii | | | |
|Number of sites: State-wide| |Department of Health letterhead and | |Group 2 | |
|intervention delivered by |Eligibility criteria: |signed by the state epidemiologist. | |Diff: 3.8% | |
|the state health |Medicare beneficiaries newly |Content consisted of simple bullets | |P = 0.017 | |
|department. |enrolled during an 11 month |emphasizing that “Medicare covers FLU | | | |
| |period of time. |shots!” All patients were additionally |Odds ratio of receiving|Follow-up | |
|Site affiliation: | |exposed to routine State of Hawaii |vaccination between |Group 1 | |
|Government / Medicare |Exclusions: Receipt of |Department of Health promotional |treatment and control |OR = 1.19 | |
| |influenza and/or pneumococcal |activities for influenza vaccination, |groups |P = 0.02 | |
|Number of practices or |vaccination the year before the|including a mass media campaign. | | | |
|physicians: Not reported |intervention. | | |Group 2 | |
| | |Delivery site change: Immunization | |OR = 1.28 | |
|Location: United States | |clinics were held at pharmacies and | |P = 0.002 | |
|(Hawaii) | |retail stores. | | | |
| | | |Pneumococcal |Pneumococcal | |
| | |Clinician education: Pneumococcal |Proportion of eligible |Follow-up | |
| | |education kits produced by the National |patients receiving |Group 1: 60/2213 (3%) | |
| | |Institute on Aging were mailed to |vaccination |Group 2: 146/2171 (7%) | |
| | |physicians. | |Control: 68/2144 (3.2%) | |
| | | | | | |
| | |Group 2 – Influenza and pneumococcal | |Overall test of significance | |
| | |reminder | |P < 0.001 | |
| | | | | | |
| | |Delivery site change, clinician |Risk difference between|Follow-up | |
| | |education, and patient education / |study groups |Group 2 vs control | |
| | |reminders, as above, except reminder | |Diff: 3.5% | |
| | |letters also covered pneumococcal | |P < 0.001 | |
| | |vaccinations. | | | |
| | | | |Group 2 vs group 1 | |
| | |Control group | |Diff: 4.0% | |
| | | | |P < 0.001 | |
| | |Delivery site change, clinician |Odds ratio of receiving| | |
| | |education, and patient education / |vaccination between |Follow-up | |
| | |reminders, as above, except without |treatment and control |Group 1 | |
| | |reminder letters. |groups |OR = 0.85 | |
| | | | |P > 0.05 | |
| | | | | | |
| | | | |Group 2 | |
| | | | |OR = 2.20 | |
| | | | |P < 0.001 | |
|Thomas et al. 2003 (303) |Number of patients: 558 |Culturally tailored video modeling |Influenza |Influenza |Exposure to patient education tools |
| | |patient-physician communication about |Not targeted. |Not targeted. |represents an effective mechanism for |
|Design: |Group 1 |vaccination and vaccination educational | | |increasing pneumococcal vaccination |
|CCT |Number of patients: 189 |brochure vs culturally tailored video |Pneumococcal |Pneumococcal |rates. A brief (64): 65 |Intervention aim: Improve preventive care| | |fecal occult blood tests, and Pap |
|Group allocation: |Female/male: 112/65 |QI agent: Academic internal medicine |Odds ratio of receiving|Follow-up |smears; but not mammography or |
|Experimental study with | |clinic |vaccination between |OR = 2.00 |pneumococcal vaccinations. |
|randomized allocation of |Control group | |treatment and control |P = 0.002 | |
|medical residents to |Number of patients: 246 |Group 1 |groups | | |
|treatment and control |Age (>64): 76 | | | | |
|groups. |Female/male: 170/76 |Patient education/reminders: Wallet sized|Pneumococcal |Pneumococcal | |
| | |preventive care cards were given to |Proportion of eligible |Follow-up | |
|Foll0w-up period: 9 months |Eligibility criteria: |patients. Patients were told to present |patients receiving |Group 1: 19/86 (22%) | |
| |Adult patients aged over 65, or|the card to their physicians at each |vaccination |Control: 29/118 (24%) | |
|Number of sites: 1 general |younger patients with chronic |visit. | | | |
|medicine clinic at an |disease. Patients with previous| |Odds ratio of receiving|Follow-up | |
|academic department of |pneumococcal vaccination were |Clinician reminders: Computer generated |vaccination between |OR = 0.870 | |
|medicine |excluded from pneumococcal |patient-specific preventive care reminder|treatment and control |P = 0.34 | |
| |vaccination rates. |sheets were generated and attached to |groups | | |
|Site affiliation: | |each patient’s visit chart. | | | |
|University | | | | | |
| | |Control group | | | |
|Number of practices or | | | | | |
|physicians: 24* | |Clinician reminders, as above. | | | |
| | | | | | |
|Location: United States | | | | | |
|(North Carolina) | | | | | |
| | | | | | |
|* Physicians randomly | | | | | |
|allocated to treatment (12 | | | | | |
|medical residents) and | | | | | |
|control (12 medical | | | | | |
|residents) groups. | | | | | |
|Turner et al. 1994 (308) |Number of patients: |Generic clinician reminders sheet VS |Influenza |Influenza |The results of the intervention were |
| |44 practices enrolled* |patient–held reminder card |Proportion of eligible |Baseline |mixed, and in most cases small. |
|Design: | | |patients receiving |Group 1: 17% |Computer prompts increased performance|
|Cluster RCT |Group 1 |Intervention aim: Improve preventive care|vaccination |Control: 20% |of all preventive measures over time. |
| |Number of practices: 15 ** |QI agent: Physician practices | | |The card group increased performance |
|Group allocation: | | | |1 year |of influenza vaccination and |
|Experimental study with |Control group |Group 1 | |Group 1: 24% |mammography, but not other targeted |
|randomized allocation of |Number of practices: 22 ** | | |Control: 26% |measures. |
|physicians to treatment and| |Clinician reminder: A computer was used | | | |
|control groups. |Eligibility criteria: |to generate generic preventive care |Odds ratio of receiving|1 year | |
| |All adult patients in each |prompt sheets which were fixed to patient|vaccination between |OR = 1.11 | |
|Follow-up period: |practice. Influenza |charts. |treatment and control |p = 0.51 | |
|8 months |vaccinations were provided for | |groups | | |
| |patients >65 years or younger |Control group | | | |
|Number of sites: 44 private|if suffering from a chronic | |Pneumococcal |Pneumococcal | |
|medical practices |disease. |Patient education / reminder: Patients |Not targeted. |Not targeted. | |
| | |received a wallet-sized card with | | | |
|Site affiliation: Private |*Outcomes measured for cross |preventive health service prompts. | | | |
|practices |sections of ten patients per |Patients were instructed to carry the | | | |
| |practice before and after |cards with them and show them to their | | | |
|Number of practices or |intervention. |physician at each visit. | | | |
|physicians: 44 |** Number of practices | | | | |
| |remaining at follow-up | | | | |
|Location: United States |reported. | | | | |
|(North Carolina) | | | | | |
|Walter et al., 2008 (309) |Number of patients: 8912 |Postcard reminder with a safety statement|Influenza – Postcard |Influenza – Comparison of |Influenza vaccine coverage rates among|
| |Female/male: 5649/3236 |and practice-level QI initiative vs |with asthma-specific |patient reminder postcards |asthmatic patients were not |
|Design: RCT / Cluster-CBA |Age (>65): 1071 (12%)* |regular postcard reminder and |safety message vs | |significantly affected by either |
| | |practice-level QI initiative vs post care|regular postcard (RCT) | |adding a safety message to the regular|
|Patients in 15 primary care|Group 1, 2, 3, and 4 |reminder with a safety statement and no | | |postcard reminder or by practice |
|practices were randomly |Number of patients: Not |other QI initiative vs regular postcard |Proportion of eligible | |improvement interventions evaluated in|
|allocated to postcard |reported. |reminder and no other QI initiative. |patients receiving |Follow-up season 1 – Patient |the study. |
|groups. | | |vaccination |survey findings* | |
| |Eligibility criteria: |QI agent: Primary care clinics | |Groups 1 and 3: 78% |This study demonstrated that results |
|Within randomized postcard |Asthmatic patients. |Intervention aim: Improve vaccination | |Groups 2 and 4: 77% |are sensitive to the method of |
|groups, practices were | |rates | | |measuring receipt of vaccination. |
|allocated by researchers to| | | |Follow-up season 1 – |Analyses of primary care charts or |
|“practice QI” or “no QI“ | |Group 1 | |Administrative database |clinical databases may underestimate |
|groups. |* This study included children.| | |findings |results, since over 40% of those who |
| |3% of patients were aged 2 or |Patient education / reminders: A postcard| |Groups 1 and 3: 22% |received vaccine reported receiving |
|Follow-up period: 2 years |younger, and 85% of patients |reminder about influenza vaccination was | |Groups 2 and 4: 23% |vaccination at a place other than the |
| |were aged 3 to 65. |mailed to patients. The postcard | | |primary care provider’s office when |
|Number of practices or | |contained a safety statement, saying that| |Follow-up season 2 – Patient |surveyed by mail or by a computer |
|physicians: 15 academic | |a recent national study by the American | |survey findings* |survey of asthmatic patients attending|
|primary care practices | |Lung Association demonstrated that | |Groups 1 and 3: 76% |the office. |
| | |influenza vaccination did not worsen | |Groups 2 and 4: 78% | |
|Site affiliation: | |asthma symptoms. | | | |
|University | | | |Follow-up season 2 – | |
| | |Continuous quality improvement (or | |Administrative database | |
|Number of sites: 1 | |similar): Practice staff attended small | |findings | |
|university health system | |group meeting examining previous | |Groups 1 and 3: 27% | |
| | |influenza vaccination performance and | |Groups 2 and 4: 26% | |
|Location: United States | |potential quality improvement strategies.|Odds ratio of receiving| | |
|(North Carolina) | |Practices selected one or more strategies|vaccination between |Follow-up season 2 | |
| | |from a list of eight options. Practices |treatment and control |OR = 1.08 ** | |
|Description: Primary care | |implemented patient education (6/8 |groups |p = 0.17 | |
|practices, including | |practices), mail or phone reminders (3 | |95% CI = [0.97, 1.19] | |
|internal medicine, family | |practices), expanded access (1 practice),|Influenza – QI | | |
|medicine, and pediatric | |and chart reminders (1 practice). |practices vs practices |Influenza – QI intervention | |
|clinics, belonging to a | | |without QI initiatives |analysis | |
|university health system. | |Group 2 |other than patient | | |
| | | |reminder postcards | | |
| | |Patient education / reminders: A postcard|(CBA) | | |
| | |reminder without a special safety message| | | |
| | |was mailed to patients. |Change in practice | | |
| | | |vaccination proportions|Follow-up season 2 | |
| | |Continuous quality improvement (or |taken as continuous |Groups 1 and 2: +4.5% (3.8%) | |
| | |similar): As above, for Group 1. |performance scores, |Groups 3 and 4: +4.0% (4.6%) | |
| | | |influenza season 1 to |P = 0.55 | |
| | |Group 3 |influenza season 2 | | |
| | | |(mean change (sd)) | | |
| | |Patient education / reminders: A postcard| | | |
| | |reminder about influenza vaccination was |Pneumococcal |Pneumococcal | |
| | |mailed to patients. The postcard |Not targeted. |Not targeted. | |
| | |contained a safety statement for | | | |
| | |asthmatic patients. | |* Survey response rate was | |
| | | | |26%. | |
| | |Group 4 | | | |
| | | | |** Estimate adjusted for age,| |
| | |Patient education / reminders: A postcard| |health insurance, ethnicity, | |
| | |reminder without a special safety message| |and gender by logistic | |
| | |was mailed to patients. | |regression. | |
|Warner et al. 2004 (310) |Number of patients: 191* |Clinician vaccination prompts affixed to |Influenza |Influenza |The simple and inexpensive method of |
| |Age and gender distributions |patient charts vs usual care |Not targeted. |Not targeted. |placing selective reminders in charts |
|Design: |not reported. | | | |for elderly patients was highly |
|Cluster-CBA | |Intervention aim: Improve vaccination |Pneumococcal |Pneumococcal |effective in increasing the |
| |Group 1 |rates |Proportion of eligible |Baseline |pneumococcal vaccination rate. |
|Group allocation: |Number of patients: 93* |QI agent: Medical clinics |patients receiving |Group 1: 56% | |
|Experimental study with | | |vaccination |Control: 46% | |
|medical sites allocated to |Control group |Group 1 | | | |
|treatment and control sites|Number of patients: 98* | | |Follow-up – 6 months | |
|by unreported means. | |Clinician education: An educational | |Group 1: 95/112 (85%) | |
| |Eligibility criteria: |session covering the variety of illnesses| |Control: 75/115 (65%) | |
|Follow-up period: 1 year |Patients aged 65 years or older|associated with pneumococcal infection, | | | |
| |who presented for a scheduled |the use of pneumococcal vaccination, and | |Follow-up – 12 months | |
|Number of sites: 2 |medical visit. Vaccinations |current recommendations for care was | |Group 1: 71/93 (76%) | |
|hospital-based ambulatory |were provided to consenting |provided to staff. | |Control: 57/98 (58%) | |
|family medical clinics |patients who had never been | | | | |
| |previously vaccinated. |Clinician reminders: Reminders stickers |Odds ratio of receiving|Follow-up– 6 months | |
|Site affiliation: | |were affixed to the chart of eligible |vaccination between |OR = 2.98 | |
|University | |patient-visits. A blue dot was placed on |treatment and control |P < 0.005 | |
| |* variable between baseline, 6 |charts of patients for whom vaccination |groups | | |
|Number of practices or |month, and 1 year measurements.|was given, had already been obtained, or | |Follow-up – 12 months | |
|physicians: Not reported |1 year chart review numbers |declined. Reminder stickers were affixed | |OR = 2.32 | |
| |reported. |by medical records staff. | |P = 0.05 | |
|Location: United States | | | | | |
|(Florida) | |Control group | | | |
| | | | | | |
| | |Clinician education: An educational | | | |
|* Care sites were allocated| |session covering the variety of illnesses| | | |
|to treatment (1 site) and | |associated with pneumococcal infection, | | | |
|control (1 site). | |the use of pneumococcal vaccination, and | | | |
| | |current recommendations for care was | | | |
| | |provided to staff. | | | |
| | | | | | |
|Weaver et al. 2003 (311) |Number of patients: 2284 |Patient education mailings, provider |Influenza |Influenza |This pilot study demonstrated |
| | |education, and clinical champions vs |Proportion of eligible |Baseline |significantly higher vaccination rates|
|Design: Cluster CBA |Group 1 |usual care |patients receiving |Group 1: 6.3% to 20.7% from |for patients receiving care at the |
| |Number of patients: 962 | |vaccination |site to site. |intervention site. |
|Group allocation: Study |Female/male: 32/930 |Intervention aim: Improve vaccination | |Control: 5.3% to 25.3% from | |
|investigators allocated |Age (mean(sd)): 57.1 (sd not |rates | |site to site | |
|medical centers to |reported) |QI agent: Medical center | | | |
|treatment and control | | | |Follow-up* | |
|groups so that |Control group |Intervention group | |Group 1: 396/654 (61%) | |
|between-group differences |Number of patients: 1322 | | |Control: 538/992 (54%) | |
|in site characteristics |Female/male: 30/1292 |Patient education / reminders: Reminder | | | |
|would be minimized |Age (mean(sd)): 54.6 (sd not |letters and education fliers were mailed |Odds ratio of receiving|Follow-up | |
| |reported) |to veterans. The fliers emphasized the |vaccination between |OR = 1.30 | |
|Follow-up period: 5 months | |high risk of respiratory complications |treatment and control |P = 0.01 | |
| |Eligibility criteria: Veterans |among individuals with spinal cord |groups | | |
|Number of sites: 8 VA |with spinal cord injury (i.e.: |injury, and common misconceptions. The | | | |
|spinal cord injury centers*|those who received care at the |letter encouraged veterans to be |Pneumococcal |Pneumococcal | |
| |study sites within 2 years |vaccinated at any location,. Bright |Not targeted. |Not targeted. | |
|Site affiliation: Veteran’s|prior to the study.) |reminder posters were posted in clinic | | | |
|Affairs | |spaces. | | | |
| | | | | | |
|Number of practices or | |Clinician education: Posters were posted | | | |
|physicians: Not reported | |in clinic spaces. Letters of endorsement | | | |
| | |from the Paralyzed Veterans of America | |* Numerators and denominators| |
|Location: United States | |and the VA Spinal Cord Injury and Disease| |estimated by present | |
|(Multiple states) | |Strategic Healthcare Group were sent, | |reviewers from other study | |
| | |along with literature on vaccination | |data. Additionally, | |
| | |effectiveness and importance, to | |intervention patients were | |
|* Sites were allocated to | |intervention providers. | |older, and had a higher | |
|treatment (4 SCI centers) | | | |prevalence of chronic | |
|and control (4 SCI centers)| |CQI (or similar): Clinical champions were| |illness. | |
|groups. | |selected among interested health care | | | |
| | |personnel. These champions included | | | |
| | |spinal cord injury chiefs, nurse | | | |
| | |managers, and spinal cord injury | | | |
| | |physicians with an interest in | | | |
| | |vaccination. Investigators worked with | | | |
| | |champions, via regular conference calls, | | | |
| | |to resolve problems as vaccination | | | |
| | |barriers were identified. | | | |
| | | | | | |
| | |Control characteristics: | | | |
| | | | | | |
| | |Usual care. One intervention site and two| | | |
| | |comparison sites report also having nurse| | | |
| | |standing orders for vaccination during | | | |
| | |the study period. | | | |
|Wilkinson et al. 2002 (312)|Number of patients: 277 |Patient pre-activation with an |Influenza |Influenza |The primary hypothesis that patients |
| |Female/male: 19/258 |pre-appointment guidebook vs usual care |Proportion of eligible |Follow-up* |pre-activated by an appointment |
| |Group-specific gender and age | |patients receiving |Group 1: 48/141 (34%) |guidebook would perceive primary care |
|Design: |distributions not reported. |Intervention aim: Improve preventive care|vaccination |Control: 25/106 (24%) |visits as more effective than patients|
|CCT | |QI agent: Medical clinics | | |not receiving a guidebook was |
| |Group 1 | |Odds ratio of receiving|Follow-up |supported. |
|Group allocation: |Number of patients: 141 |Group 1 |vaccination between |OR = 1.67 | |
|Experimental study with | | |treatment and control |P = 0.10 |However, authors applied a liberal p ................
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