Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Provider/Patient Communication Portal, Patient Reminder/Invitation,

Intervention Description: The intervention was a reminder system that sent portal reminders to patients according to randomization arm at the beginning of October (all intervention groups), November (those receiving 2-3 reminders), and December (those receiving 3 reminders).

Intervention Results: The study found that the reminder system significantly increased influenza vaccination rates among patients in the intervention groups compared to the control group.

Conclusion: The study concluded that a reminder system can be an effective tool for increasing influenza vaccination rates among patients.

Study Design: The study design was a 4-arm, pragmatic, intention-to-treat randomized clinical trial.

Setting: The study was conducted within all 52 UCLA Health System primary care practices.

Population of Focus: Patients within UCLA Health System practices who were 6 months or older at intervention launch and were defined as influenza vaccination eligible.

Sample Size: A total of 164,205 patients were randomly allocated to 1 of the 4 study arms

Age Range: Patients who were 6 months or older at intervention launch were included in the study.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation, Provider/Patient Communication Portal, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Secondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed. For each cancer screening, inclusion criteria were based on the age of screening recommendations and prior history of cancer diagnosis (n=35,912 for breast, n=48,512 for cervical, and n=45,884 for colon). The independent variable was whether adults used email PPC in the past 12 months (yes or no). The dependent variables were whether (1) women (aged ≥40 years) received a mammogram in the past 12 months; (2) women (aged 21-65 years) received a Pap test in the past 12 months; and (3) individuals (aged ≥50 years) received a colon cancer screening in the past 12 months. Bivariate and multivariable logistic regression analyses were conducted.

Intervention Results: Adults who reported receiving all three cancer screenings in the past 12 months were more likely to be non-Hispanic White; be married or living with a partner; have a bachelor’s degree or higher education level; have health insurance coverage; and perceive their health as excellent, very good, or good (all P<.001). Men were more likely to receive colon cancer screenings than women (P<.001). Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast (odds ratio [OR] 1.32, 95% CI 1.20-1.44) and cervical (OR 1.11, 95% CI 1.02-1.20) cancer screenings than women who did not use email PPC. Adults who used email to communicate with their health care providers had 1.55 times greater odds (95% CI 1.42-1.69) of receiving a colon cancer screening than those who did not use email PPC.

Conclusion: Our results demonstrate that email PPC is a marker of increased likelihood of adults completing age-appropriate cancer screenings, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of email PPC between patients and health care providers and determine avenues for health education and intervention to further explore this association.

Setting: Primary care setting

Population of Focus: Women ages 21-64 who received primary care within the past 12 months

Intervention Components (click on component to see a list of all articles that use that intervention): Provider/Patient Communication Portal,

Intervention Description: The intervention involves the evaluation of the effectiveness of electronic health record patient portal reminders in increasing pediatric influenza vaccination rates

Intervention Results: First-dose influenza vaccination rates were 56.9% in the control group, 58.0% in the loss-frame reminders group (P = .07), and 58.0% in the gain-frame group (P = .47). Rates were 58.3% in the precommitment group versus 57.0% in the control group (P = .11). Adjusted risk ratios for first vaccination were 1.02 (95% confidence interval [CI]: 1.00-1.04) for loss-frame reminders, 1.01 (95% CI: 0.98-1.05) for gain-frame reminders, and 1.02 (95% CI: 1.00-1.04) for precommitment messages versus controls. Second-dose vaccination rates were 44.1% in the control group and 55.0% in the reminder group, with an adjusted risk ratio of 1.25 (95% CI: 1.07-1.45).

Conclusion: Patient portal reminders for influenza vaccines in children, whether framed as gains or losses, did not increase first-dose influenza vaccination rates but were highly effective for the second dose of the vaccine.

Study Design: The study design is a randomized clinical trial

Setting: The setting of the study is a large health system

Population of Focus: The target audience of the study is pediatric patients within the health system

Sample Size: The sample size of the study is 22,046 children from 6 months to <18 years of age in 53 primary care practices

Age Range: The age range of the study participants is 6 months to <18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation (Parent/Family), Family-Based Interventions, Provider/Patient Communication Portal,

Intervention Description: N/A

Intervention Results: In multivariate analyses, there were no significant differences in access to care according to parental citizenship status. Children with 2 noncitizen parents had fewer doctor visits and were less likely to go to the emergency department in the past year than those with 2 citizen parents. Among children with 1 or 2 noncitizen parents, their parents reported worse experiences in care than those with 2 citizen parents. Similar results were observed for language use. Parents of children in bilingual and Spanish-only households were less likely to report that their children's doctors explained things clearly, and parents in Spanish-only households were less likely to communicate via telephone or e-mail than those in English-only households.

Conclusion: Health policy should focus on provider-parent communication to ensure health care equity for Latino children whose parents are not citizens or do not speak English.

Study Design: Analyses were conducted to determine the associations between access (usual of source of care, delay in receiving needed care, health insurance), utilization (physician visits in past year, emergency department visits), and experiences (doctor listens, doctor explains instructions clearly, communication via telephone or e-mail) according to parental citizenship status and household language use after adjusting for confounders.

Setting: 2011 and 2012 California Health Interview Survey; California

Population of Focus: Latinx children

Sample Size: 2841

Age Range: <12

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider/Patient Communication Portal, Educational Material (Provider),

Intervention Description: Although patient-provider continuity improves care delivery and satisfaction, poor continuity with primary care providers (PCP) often exists in academic centers. We aimed to increase patient empanelment from 0% to 90% and then increase the percent of well-child care (WCC) visits scheduled with the PCP from 25.6% to 50%, without decreasing timely access that might result if patients waited for PCP availability. Nationwide Children's Hospital Primary Care Network cares for >120,000 mostly Medicaid-enrolled patients across 13 offices. Before 2017, patients were empaneled to an office, not individual PCPs. We empaneled patients to PCPs, reduced provider floating, implemented continuity-promoting scheduling guidelines, scheduled future WCC visits for patients ≤15 months during check-in for their current one, and encouraged online scheduling. We tracked the percentage of all WCC visits that were scheduled with the patient's PCP and the percentage of subsequent WCC visits for patients ≤15 months that were scheduled during the current visit, and provided feedback to schedulers. We followed emergency department (ED) utilization and visit show rates. WCC visit completion rates were tracked using HEDIS metrics.

Intervention Results: Patient empanelment increased from 0% to >90% (P < .001). Patient-provider WCC continuity increased from 25.6% to 54.7% (P < .001). A 20.5% decrease in ED utilization rate was associated with continuity project initiation. Empaneled patients demonstrated higher show rates (76.9%) versus unempaneled patients (71.4%; P < .001). WCC completion rates increased from 52.6% to 60.7%.

Conclusion: WCC continuity more than doubled after interventions and was associated with decreased ED utilization, higher show rates, and increased timely WCC completion.

Study Design: Program evaluation

Setting: Nationwide Children's Hospital (NCH) Primary Care Network (PCN) with a group of 13 urban offices in Columbus, Ohio

Population of Focus: Patients of the Nationwide Children's Hospital (NCH) Primary Care Network (PCN) in Columbus, Ohio serving a diverse population of over 120,000 patients, most of whom are Medicaid-enrolled.

Sample Size: 13 primary care offices

Age Range: Pediatric practices serving children 0-17 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, Provider/Patient Communication Portal,

Intervention Description: The intervention included portal messages promoting influenza vaccination, listing upcoming clinics, and offering online scheduling of vaccination appointments, as well as interactive voice response calls.

Intervention Results: The interventions led to a significant increase in early influenza vaccination rates among eligible adults in the outpatient population.

Conclusion: The study demonstrated that outreach interventions can effectively improve influenza vaccination rates among eligible adults in an outpatient population.

Study Design: The study was a nonblinded randomized controlled intervention.

Setting: The study was conducted at a large multispecialty medical group in central Massachusetts.

Population of Focus: The target audience was eligible adults in an outpatient population.

Sample Size: The study included 97,007 participants.

Age Range: The age range of the participants was not specified in the article.