Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.7133 Dr. Shivan J. Mehta et al.
Points
- Researchers found that patients were twenty eight percent more likely to receive a flu shot when they received text reminders and their clinicians had pre-populated orders waiting in the system.
- The study randomly assigned over fifty two thousand individuals to either a multicomponent nudge intervention group or a standard care control group across two large university based health care systems.
- Automated nudges included text messages for patients and pre-populated vaccine orders for clinicians as well as monthly feedback comparing individual provider performance to the vaccination rates of their peers.
- This randomized trial resulted in nearly three thousand more vaccinations than expected under standard care which traditionally relies on clinicians manually identifying vaccination needs within the electronic health records.
- Utilizing existing electronic health record tools to nudge both patients and providers offers a cost effective and scalable method for health systems to improve preventive health outcomes and vaccine compliance.
Summary
This randomized clinical trial evaluated a multicomponent nudge intervention designed to increase influenza vaccination rates during primary care visits. Given that influenza causes up to 710,000 hospitalizations and 52,000 deaths annually in the United States, addressing recent downward trends in vaccine uptake is critical. The study sought to determine if synchronizing patient-facing reminders with clinician-facing electronic health record (EHR) modifications could significantly improve completion rates compared to standard care.
The study enrolled more than 52,000 participants across the University of Pennsylvania and University of Washington health systems. The intervention group received automated text or voice reminders, while clinicians were presented with pre-populated vaccine orders requiring only final approval. Additionally, providers received monthly feedback comparing their vaccination performance to peer benchmarks. The control group followed standard clinical pathways, where vaccination relied on the provider’s manual identification of the need within the EHR during the encounter.
Results demonstrated that patients in the nudge cohort were 28% more likely to receive a vaccination than those in the standard care group. This intervention resulted in nearly 3,000 additional vaccinations beyond the control baseline. While multicomponent nudges significantly increased completion rates, bi-directional text messaging did not provide incremental benefit in high-risk populations. These findings suggest that leveraging existing EHR automation and behavioral nudges can effectively enhance preventive health outcomes without necessitating additional clinical staffing.
Link to the article: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2843384
References
Mehta, S. J., Waddell, K. J., Linn, K. A., Brophy, C., Liang, J., Park, S.-H., Reitz, C., Williams, K., Couzens, C., Staloff, J., White, A. A., Rhodes, C., Liao, J. M., & Navathe, A. S. (2026). Nudges to clinicians and patients for influenza vaccines during visits: The be immune randomized clinical trial. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.7133
