Influenza vaccination rates among Medicaid recipients seeing primary care providers participating in a city-sponsored EHR subsidy program

The Primary Care Information Project (PCIP) is a quality improvement initiative targeting medical offices with high levels of Medicaid and uninsured patient populations and focusing on the delivery of preventive services by facilitating the implementation of an electronic health record that promotes preventive care and improvement of population health. Compare influenza vaccination rates among patients whose primary care providers are participating in PCIP to patients whose primary care providers are not. Using Medicaid claims data for Medicaid Managed Care (MMC) beneficiaries in New York City, influenza vaccination rates were compared between PCIP and non-PCIP primary care providers (i.e., family medicine, internal medicine, pediatrics, geriatrics, or preventive medicine), stratified by influenza season and patient demographics such as age, and the presence of medical conditions that can increase the risk of developing influenza-related complications. On average, ~2,000 PCIP providers treated ~940,000 and ~5,800 non-PCIP providers treated ~850,000 MMC patients per year. Mean vaccination rates were compared for groups of patients by clinician across three influenza seasons, at baseline (9/1/2008 – 4/30/2009) and end-of-study (9/1/2010 – 4/30/2011). From baseline, significantly larger increases (p-value <0.001) in influenza vaccination rates were observed among PCIP patients, particularly among those ≤ 18 years, i.e., ≤ 5 years [PCIP/baseline= 28.7% (percent increase= +6.2%); non-PCIP/ 23.1% (+3.9%)]; 6-12 years [PCIP/ 25.5% (+9.9%); non-PCIP/ 23.0% (+7.2%)]; 19-64 years [PCIP/ 13.5% (+3.7%); non-PCIP/ 11.6% (+1.7%)]; ≥ 65 years [PCIP/ 27.2% (+2.6%); non-PCIP/ 21.3 (+1.8%)]. Larger increases were also observed among those ≤ 18 with asthma [PCIP/ 12.8% (+1.5%); non-PCIP/ 8.0% (+0.3%)], and those ≥ 18 with diabetes [PCIP/ 14.8% (+1.3%); non-PCIP/ 12.3% (+0.2%)]. Results of this study suggest that a prevention-oriented focus to health care; namely, quality improvement initiatives utilizing health information technology can have a positive impact on preventive services utilization and potentially improve patient quality-of-care in medically under-served communities.