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

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.

Correlates of vitamin D insufficiency in an affluent adult population.

OBJECTIVES: Vitamin D is necessary for bone health and calcium metabolism. Vitamin D deficiency may play a role in coronary artery disease, some cancers, autoimmune disease, and glucose tolerance. Vitamin D deficiency may be prevalent even among affluent US adults. METHODS: We conducted a retrospective chart review study of 287 adult patients who underwent executive physical examinations between April 2009 and May 2010 in Chicago, Illinois. Data collected included age, sex, body mass index, vitamin D levels, supplement use, fish consumption, milk consumption, hours spent outdoors, and sunscreen use. Vitamin D insufficiency was defined as <30 ng/mL. RESULTS: The mean vitamin D level was 40.0 ng/mL (standard deviation 16.6), which varied by month. The mean vitamin D level ranged from 32.9 ng/mL in January to 55.4 ng/mL in September. Insufficient levels of vitamin D were observed in 30.3% of patients. Younger age (younger than 40 years); no milk or fish consumption; no use of multivitamins, vitamin D supplements, or calcium supplements; no sun exposure; and routine use of sunscreens were positively associated with vitamin D insufficiency. CONCLUSION: Vitamin D insufficiency in almost one-third of patients presenting for executive physicals may be indicative of a widespread nutritional deficiency in the US population.