Using the 4 Pillars Practice Transformation Program to Increase Pneumococcal Immunizations for Older Adults: A Cluster-Randomized Trial.
Using the 4 Pillars Practice Transformation Program to Increase Pneumococcal Immunizations for Older Adults: A Cluster-Randomized Trial.
复制标题
使用4个支柱实践转化计划来增加老年人的肺炎球菌免疫接种：一项聚类随机试验。
DOI：
10.1111/jgs.14451
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发表时间：
2017-01
影响因子：
6.3
通讯作者：
Nowalk MP
中科院分区：
文献类型：
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作者：
Zimmerman RK;Brown AE;Pavlik VN;Moehling KK;Raviotta JM;Lin CJ;Zhang S;Hawk M;Kyle S;Patel S;Ahmed F;Nowalk MP
初级保健质量的提高重点是改善成人免疫接种。测试分步循证指南“4 Pillars™ 免疫工具包”的有效性，以增加成人肺炎球菌疫苗接种。第一年（2013年6月1日至2014年5月31日）进行随机对照整群试验（RCCT），第二年（2014年6月1日至2015年1月31日）进行事前研究，数据于2016年进行分析。基线年为2012年6月1日至2013年5月31日。人口统计和疫苗接种数据来自去识别化的 EMR 提取。 25 个初级保健机构按城市（休斯顿、匹兹堡）、地点（农村、城市、郊区）和类型（家庭医学、内科）分层，随机在第 1 年 (n=13) 或第 2 年 (n=12) 接受干预。由 18,107 名基线年龄≥65 岁的患者组成的队列，平均年龄为 74.2 岁； 60.7% 是女性，16.5% 是非白人，15.7% 是西班牙裔。工具包、提供者教育以及基于实践的免疫冠军的一对一辅导。结果指标为 23 价肺炎球菌多糖疫苗 (PPSV) 和肺炎球菌结合疫苗 (PCV) 率和百分比 (PP) 变化。在 RCCT 中，所有干预组和对照组的 PPSV 疫苗接种率均显着较高，平均增幅为 6.5–8.7 PP（P<0.01）。干预措施与 PPSV 疫苗接种可能性较高无关。在第 2 年的前后研究中，匹兹堡的主动干预地点接种 PPSV 和 PCV 疫苗的可能性显着高于维持地点，但休斯顿则不然。在一项随机对照整群试验中，干预组和对照组均增加了 65 岁以上成年人的 PPSV。在一项前后研究中，与研究维持阶段的实践相比，使用 4 Pillars™ 免疫工具包的私人初级保健实践显着提高了 PPSV 和 PCV 的吸收率。
Quality improvement in primary care has focused on improving adult immunization. Test the effectiveness of a step-by step, evidence-based guide, the 4 Pillars™ Immunization Toolkit, to increase adult pneumococcal vaccination. Randomized controlled cluster trial (RCCT) in Year 1 (6/1/2013–5/31/2014) and a pre-post study in Year 2 (6/1/2014–1/31/2015) with data analyzed in 2016. Baseline year was 6/1/2012–5/31/2013. Demographic and vaccination data were derived from de-identified EMR extractions. 25 primary care practices stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), randomized to receive the intervention in Year 1 (n=13) or Year 2 (n=12). A cohort of 18,107 patients ≥65 years at baseline with a mean age of 74.2 years; 60.7% were women, 16.5% were non-white and 15.7% were Hispanic. The Toolkit, provider education, and one-on-one coaching of practice-based immunization champions. Outcome measures were 23-valent pneumococcal polysaccharide vaccine (PPSV) and pneumococcal conjugate vaccine (PCV) rates and percentage point (PP) changes. In the RCCT, all intervention and control groups had significantly higher PPSV vaccination rates with average increases ranging from 6.5–8.7 PP (P<0.01). The intervention was not related to higher likelihood of PPSV vaccination. In the Year 2 pre-post study, the likelihood of PPSV and PCV vaccination was significantly higher in the active intervention sites than the maintenance sites in Pittsburgh, but not in Houston. In a randomized controlled cluster trial, both intervention and control groups increased PPSV among adults ≥65 years. In a pre-post study, private primary care practices using the 4 Pillars™ Immunization Toolkit significantly improved PPSV and PCV uptake compared with practices that were in the maintenance phase of the study.