Using active choice to increase influenza vaccination


Each year, more than 50% of adults in the United States do not receive the flu vaccine. These levels have not changed significantly in nearly a decade.  The electronic health record (EHR) has grown in adoption and could be leveraged to change clinician and patient behavior.


We evaluated an active choice intervention in the EHR that prompted physicians and their medical assistants to decide whether or not to order the flu vaccination for patients visiting their physician at an internal medicine clinic.    


Compared to similar control practices, this intervention led to a 37% relative increase in flu vaccinations. 


Based on these findings, the health system decided to expand the approach to other primary care clinics in the Penn Medicine network.  Upon expansion, the active choice intervention was refined from previously being delivered to physicians and their medical assistants to being delivered only to medical assistants who template orders for physicians to review and sign. 

After the intervention was scaled, we conducted a retrospective quality improvement study of 11 primary care practices at Penn Medicine. The data showed that influenza vaccination rates significantly declined as the clinic day progressed. These findings indicate that time of day and choice architecture play an important role in influencing clinician behaviors and patient outcomes. To our knowledge, this is one of the first studies of its kind to evaluate variations in influenza vaccination rates by clinic appointment time.


Leonard Davis Institute of Health Economics (LDI)

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