{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:50:16Z","timestamp":1793836216116,"version":"4.6.1"},"reference-count":50,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2009,10,29]],"date-time":"2009-10-29T00:00:00Z","timestamp":1256774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis &amp; Rheumatism"],"published-print":{"date-parts":[[2009,11,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine whether an electronic health record (EHR) best practice alert (BPA), a clinical reminder to help guideline adherence, improved vaccination rates in rheumatology patients receiving immunosuppressants. Guidelines recommend yearly influenza and pneumococcal vaccination with revaccination for patients age &gt;65 years who are taking immunosuppressive medications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A vaccination BPA was developed based on immunosuppressant treatment, age, and prior vaccinations. At site 1, a hospital\u2010based academic practice, physicians ordered vaccinations. At site 2, a community\u2010based practice, physicians signed orders placed by nurses. Demographics, vaccination rates, and documentation (vaccination or no administration) were obtained. Chi\u2010square and Fisher's exact test analysis compared vaccination and documentation rates for October 1 through December 31, 2006 (preBPA), and October 1 through December 31, 2007 (postBPA). Breslow\u2010Day statistics tested the odds ratio of improvement across the years between the sites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>PostBPA influenza vaccination rates significantly increased (47% to 65%;<jats:italic>P<\/jats:italic>&lt; 0.001), with significant improvement at both sites. PostBPA pneumococcal vaccination rates likewise significantly increased (19% to 41%;<jats:italic>P<\/jats:italic>&lt; 0.001). PostBPA documentation rates for influenza and pneumococcal vaccinations also increased significantly. Site 2 (nurse\u2010driven) had significantly higher preBPA vaccination rates for influenza (69% versus 43%;<jats:italic>P<\/jats:italic>&lt; 0.001) than pneumococcal (47% versus 15%;<jats:italic>P<\/jats:italic>&lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The use of a BPA significantly increased influenza and pneumococcal vaccination and documentation rates in rheumatology patients taking immunosuppressants. A nurse\u2010driven process offered higher efficacy. An EHR programmed to alert providers is an effective tool for improving quality of care for patients receiving immunosuppressants.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.24873","type":"journal-article","created":{"date-parts":[[2009,10,29]],"date-time":"2009-10-29T21:18:03Z","timestamp":1256851083000},"page":"1505-1510","source":"Crossref","is-referenced-by-count":80,"title":["Improved influenza and pneumococcal vaccination in rheumatology patients taking immunosuppressants using an electronic health record best practice alert"],"prefix":"10.1002","volume":"61","author":[{"given":"Lindsay J.","family":"Ledwich","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Harrington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Ayoub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Sartorius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Newman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,10,29]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780140119"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.4933.228"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.10524"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780370408"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.21568"},{"key":"e_1_2_6_7_2","first-page":"1473","article-title":"Immune status and risk of infection in patients receiving chronic immunosuppressive therapy","volume":"32","author":"Gluck T","year":"2005","journal-title":"J Rheumatol"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1053\/berh.2001.0226"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-0172(95)80009-3"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.53.4.224"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.19.2275"},{"key":"e_1_2_6_12_2","unstructured":"Centers for Disease Control and Prevention. 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