Using computer decision support to increase maternal postpartum tetanus, diphtheria, and acellular pertussis...

Area of Science:

• Public Health
• Infectious Disease Prevention
• Health Informatics

Background:

• Postpartum women are a critical group for Tdap vaccination to protect against pertussis.
• Rates of Tdap vaccination in postpartum women have historically been suboptimal.
• Electronic health record (EHR) systems offer opportunities to improve vaccination delivery.

Purpose of the Study:

• To assess the impact of a computer-based clinical decision-support algorithm on Tdap vaccine administration to postpartum women.
• To determine if automating vaccine recommendations within the EHR increases uptake.

Main Methods:

• A before-and-after cohort study was conducted at an urban public teaching hospital.
• The intervention involved an automated clinical decision-support algorithm presenting preselected Tdap vaccine orders to physicians.
• Vaccination rates were compared between preintervention and postintervention periods.

Main Results:

• Tdap vaccination increased significantly from 0% preintervention to 59% postintervention.
• Women meeting automated criteria for the decision support rule were more likely to be vaccinated (63% vs. 6%).
• Older women showed a trend towards lower vaccination rates.

Conclusions:

• A computer-based clinical decision-support algorithm effectively increased Tdap vaccination rates in postpartum women.
• Implementing such algorithms in hospitals with EHRs can enhance postpartum preventive interventions.
• Automated decision support is a viable strategy for improving vaccination coverage.