High-risk Influenza Vaccine Alert

Study Overview
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Brief Summary
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The purpose of this study is to assess, prospectively, the effect on flu vaccination rates of salient alerts in the electronic health record that indicate a patient's high risk for flu and its complications. The investigators hypothesize that the salient alerts will lead to increased flu vaccination compared with a standard flu alert.

Detailed Description
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The CDC (Centers for Disease Control) recommends a flu vaccination to everyone aged 6+ months, with rare exception; almost anyone can benefit from the vaccine, which can reduce illnesses, missed work, hospitalizations, and death. One barrier to vaccination is a lack of cues to action, and, in particular, the lack of direct recommendation from medical personnel; this barrier is arguably the most effectively overcome by a simple nudge of clinicians, compared with barriers such as negative attitudes toward vaccination, low perceived utility of vaccination, and less experience with having received the vaccine. Geisinger partnered with Medial EarlySign (Medial) to develop a machine learning (ML) algorithm to help identify people at risk for serious flu-associated complications based on existing electronic health record data. Eligible at-risk patients will be randomized to an active control group (clinician will be shown a standard flu alert) or one of two experimental groups (clinician will be shown an alert indicating patient's high risk, with or without describing the patient's factors contributing to that risk).

Official Title
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Alerts With Risk Information to Increase Influenza Vaccinations

Conditions
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Influenza

Intervention / Treatment
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* Behavioral: Alert
* Behavioral: Salient alert features
* Behavioral: High-risk Text
* Behavioral: Risk factors


Participation Criteria
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Eligibility Criteria
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Patient Inclusion Criteria: Age 18+ Have been determined to be in the top 20% of risk through Medial's ML algorithm Attend an appointment where the flu alert fires (Geisinger sets when flu alerts start and end--between  9/1/2022 and  4/30/2023, as well as the trigger conditions for the alert, which includes valid departments and visits and excludes contraindications like Guillain-Barre syndrome) Clinician Inclusion Criteria: Any Geisinger clinician who sees patient-participants in our study for an appointment where their flu shot alert fires

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard Alert<br>Standard flu alert | Behavioral: Alert<br>* Non-interruptive best practice alert in the electronic health record<br>|
| Experimental: High-risk Alert<br>Flu alert that indicates patient is at high risk for flu and its complications | Behavioral: Alert<br>* Non-interruptive best practice alert in the electronic health record<br>Behavioral: Salient alert features<br>* Larger alert header and body font size, use of different font colors and boldface<br>Behavioral: High-risk Text<br>* Alert header indicates patient is at high risk for flu and its complications; alert body indicates the percentage of risk (e.g., in the top 3% of risk)<br>|
| Experimental: High-risk Alert with Risk Factors<br>Flu alert that indicates patient is at high risk for flu and its complications and presents the factors contributing to this high risk | Behavioral: Alert<br>* Non-interruptive best practice alert in the electronic health record<br>Behavioral: Salient alert features<br>* Larger alert header and body font size, use of different font colors and boldface<br>Behavioral: High-risk Text<br>* Alert header indicates patient is at high risk for flu and its complications; alert body indicates the percentage of risk (e.g., in the top 3% of risk)<br>Behavioral: Risk factors<br>* Alert body indicates the top 3 factors contributing to the high risk<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Flu vaccination | Patient received a flu vaccine (yes/no) | At the 1 day visit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Vaccination, Health Promotion, Health Behavior, Reminder Systems, Economics, Behavioral, Risk Assessment