Measured Performance and Vaccine Administration After Decision Support and Office Workflow Changes for Influenza Vaccination

Stephen D. Persell*, Nora Lewin, Banu Yagci, Ji Young Lee, Sonali K. Oberoi, Erik Orelind, Phillip Roemer, Michael A. Schachter, Kathryn Thomas

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Influenza vaccination is underused. We examined changes in vaccination following decision support and workflow changes in a cross-sectional analysis of three vaccination seasons among adult primary care patients from 21 practices. Interventions included clinical decision support changes to facilitate documentation; changes to rooming workflow for medical assistants and licensed practical nurses to promote vaccination, prepare orders, document care done elsewhere; and record patient refusals. We measured rates for a national vaccination performance measure and receipt of onsite vaccination. Approximately 120,000 patients were eligible each season. Performance on the quality measure increased each year (40.6% to 62.5% to 76.4%). Corresponding rates of onsite vaccination were 27.7%, 28.8%, and 31.5%. The adjusted odds ratio for onsite vaccination in the second season compared with the first was 0.94 (95% confidence interval [CI] 0.92, 0.96). Onsite vaccination was more likely in the third season compared with either previous season - adjusted odds ratio for third versus second 1.14 (95% CI, 1.12, 1.16) or adjusted odds ratio for third versus first 1.07 (95% CI 1.05-1.09). Sequential changes in decision support and patient rooming process workflows were associated with large improvements in measured performance and with a significant increase in clinic-administered influenza vaccination by the third season.

Original languageEnglish (US)
Pages (from-to)333-340
Number of pages8
JournalJournal for Healthcare Quality
Issue number6
StatePublished - Nov 1 2020


  • electronic health records
  • influenza vaccination
  • primary care
  • quality improvement
  • quality measures

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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