Is Adopting Electronic Medical Records Associated with Increased Influenza Vaccination Rates in Nursing Homes?

Objective:Immunization rates among nursing home (NH) residents are far below the goal of 90% that was suggested by Healthy People 2020. Whether adopting Health Information Technology (HIT) improves influenza vaccination in NHs has not been well explored. This study aimed to address this question.

Study Design:Employing merged MDS, CASPER, NHC and HIMSS datasets 2005-2011, a propensity score matching model with state-and-year fixed effects was developed. Five implications of HITs were assessed separately: a clinical data repository (CDR), clinical decision support systems (CDSS), order entry (OE), computerized provider order entry (CPOE), and physician documentation (PD). To cover the whole flu season, the MDS records from October through the following May were selected. Facility-level flu vaccination rates for long-stay and for short-stay residents were examined separately.

Principal Findings:From 2005-2011, the influenza vaccination rate for short-stay residents was 74.14% (SD = 19.24), and 86.57% (18.88) for long-stay. For short-stayers, flu shot rates were 3% higher (CI = [-0.73, 0.54]) for NHs adopting CDR, 1.20% higher (1.03, 2.01) for CDSS, 2.56% higher (1.87, 4.01) for OE, 7.73% higher (6.81, 8.01) for CPOE, and 10.11% (9.4, 10.41) for PD. For long-stayers, these rates were 0.5% higher (-1.27,1.01) for CDR, 0.51% higher (-0.76, 0.77) for CDSS, 1.77% higher (1.57, 2.01) for OE, 5.71% higher (4.88, 6.01) for CPOE, and 6.91% (5.99, 7.41) for PD.

Conclusions/Policy Implication: Adoption of CPOE and PD were associated with improved flu vaccination rates in NH residents. Hence, adopting HIT may be an effective way to improve NH care.