‘Active choice’ intervention may boost flu vaccine rates

Researchers at the University of Pennsylvania have shown that an online reminder program may increase the rate of adults receiving the flu vaccine in the United States. Photo by Arianne Starnes/UPI | License Photo

March 28 (UPI) — A study at the University of Pennsylvania suggests a behavioral economics technique may increase the number of people getting flu vaccines.

In the United States, only 44 percent of adults get an annual flu vaccination despite recommendations and public awareness campaigns.

Now, researchers at Penn’s Perelman School of Medicine used a simple behavioral economics technique known as active choice and programmed electronic health records to alert healthcare providers when a patient is eligible to receive a flu vaccine and then prompts them to choose “accept” or “decline” a flu vaccination order.

Results showed a 6 percent increase in flu vaccinations in the 2012 to 2013 flu season when the program was introduced compared to clinics that did not use the online alert system. This represents a 37 percent relative increase in flu vaccinations from the previous year.

“Our results indicate that this simple intervention could be an effective and scalable approach to use the design of electronic health records to increase the rate of flu vaccinations, which are estimated to prevent millions of flu cases and tens of thousands of related hospitalizations every year,” Dr. Mitesh Patel, an assistant professor of Medicine and Health Care Management at Perelman and The Wharton School and director of the Penn Medicine Nudge Unit, said in a press release. “Nudges are changes to the way choices are framed or presented and can be very effective for changing physician and patient behavior. These findings build on our previous research demonstrating that active choice increased orders for high value screening tests including colonoscopies and mammographies.”

In the study, the intervention was programmed as a “best practices alert” in EPIC software widely used to access and change electronic health records.

Researchers studied vaccination rates from three clinics — one that used the program and two control clinics. In the clinic using the intervention program, doctors and healthcare providers with patients eligible to receive a flu shot would be alerted in electronic health records to accept or cancel an order for the vaccine — and when the doctor accepted an order, the vaccine was administered immediately at the clinic.

Before that, providers had to manually check through records to see if a patient was due for a vaccine and then order it.

“Much of the decisions that physicians and patients make has shifted from pen and paper to digital environments such as the electronic health record and patient portals,” Patel said. “This presents a significant opportunity to test ways to design choice architecture within these environments to improve health care value and outcomes.”

The study was published in the Journal of General Internal Medicine.


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