Improving Immunization Rates in Transplant Candidates Through the Use of a Health Information Technology Tool

项目摘要 疫苗可预防的感染（VPIs）是儿科实体器官移植后的严重并发症 导致移植受者的显著发病率、死亡率和成本。免疫是最低限度的 降低VPI侵入性和成本效益的方法。尽管有证据表明移植前 免疫接种，大多数儿科实体器官移植受者在接种疫苗时没有更新。 移植时间该项目的目的是确定移植特异性免疫障碍。的 中心假设是，可以创建一个卫生信息技术工具来协调疫苗的提供 解决移植特异性免疫障碍，从而提高移植前免疫率， 减少移植后VPI，改善移植受者的预后。这种职业发展 该奖项旨在支持艾米费尔德曼，医学博士，MSCS，儿科助理教授的过渡 在科罗拉多大学，成为一名独立的临床科学家，并实现她的长期职业目标 成为儿科移植结果研究的国家领导者。具体目标是：（1）开展 对儿科实体器官移植的主要利益相关者进行半结构化访谈，以确定 移植候选人免疫接种;（2）调整现有的免疫保健信息工具， 儿童进入免疫PT，移植特异性免疫工具;（3）使用修改后的RE-AIM框架 开展ImmunizePT的可接受性、可行性和有效性试点，提高实体器官免疫接种率 全国三个中心的移植候选人。这个项目，加上指导，从一个著名的 导师团队（Allison Kempe博士-健康服务研究，罗纳德Sokol博士-移植肝脏学， 梅根莫里斯-定性研究和博士Sheana公牛-健康信息技术）和高级培训 在定性方法，健康信息学，务实的试验设计和实施将提供博士。 费尔德曼的基础需要成功地开发和实施大规模的多中心务实 改善移植结果的试验。科罗拉多大学提供了一个独特的环境进行 利用卫生信息技术进行成果研究， 成人和儿童健康结果研究和交付科学联盟， 科罗拉多移动的健康影响实验室和儿童医院科罗拉多移植中心。 该提案针对的是AHRQ的优先群体，即儿童和需要特殊保健的个人， 慢性护理需求;以及AHRQ的目标，设计工具，传播基于证据的协议， 学习型卫生系统，让患者和提供者参与共同决策，加强沟通 在团队成员中，通过减少错失的机会， 推荐护理该工具有可能广泛适用于所有患有慢性疾病的儿童。 需要专科医生和初级保健提供者共同管理的疾病。

PROJECT SUMMARY Vaccine preventable infections (VPIs) are a serious complication following pediatric solid organ transplantation that lead to significant morbidity, mortality, and costs in transplant recipients. Immunizations are a minimally invasive and cost-effective approach to reducing VPIs. Despite evidence of the importance of pre-transplant immunization, the majority of pediatric solid organ transplant recipients are not up-to-date on vaccines at the time of transplant. The purpose of this project is to identify transplant specific immunization barriers. The central hypothesis is that a health information technology tool can be created to coordinate vaccine delivery and address transplant specific immunization barriers, thus increasing immunization rates before transplant, decreasing VPIs post-transplant, and improving outcomes for transplant recipients. This career development award is designed to support the transition of Amy Feldman, MD, MSCS, an Assistant Professor of Pediatrics at the University of Colorado, into an independent clinician-scientist and to achieve her long-term career goal of becoming a national leader in pediatric transplant outcomes research. The specific aims are to: (1) conduct semi-structured interviews of key stakeholders in pediatric solid organ transplant to identify barriers to immunization of transplant candidates; (2) adapt an existing immunization health information tool for healthy children into ImmunizePT, a transplant-specific immunization tool; and (3) use a modified RE-AIM framework to pilot acceptability, feasibility and effectiveness of ImmunizePT to improve immunization rates in solid organ transplant candidates at three centers nationally. This project, coupled with guidance from a renowned mentorship team (Dr. Allison Kempe-health services research, Dr. Ronald Sokol-transplant hepatology, Dr. Megan Morris-qualitative research and Dr. Sheana Bull-health information technology) and advanced training in qualitative methods, health informatics, and pragmatic trial design and implementation will provide Dr. Feldman with the foundation needed to successfully develop and implement large-scale multi-center pragmatic trials to improve transplant outcomes. The University of Colorado provides a unique environment to conduct outcomes research utilizing health information technology, supported by collaborative partnerships between The Adult and Child Consortium for Health Outcomes Research and Delivery Science, The University of Colorado Mobile Health Impact Lab, and the Children’s Hospital Colorado Transplant Center. This proposal addresses AHRQ’s priority populations of children and individuals with special health care and chronic care needs; as well as AHRQ’s goals to design tools that disseminate evidence-based protocols within the learning health system, engage patients and providers in shared decision-making, enhance communication amongst team members, and improve safety and quality outcomes by reducing missed opportunities to provide recommended care. This tool has the potential to have widespread applicability to all children with chronic diseases who require co-management by subspecialists and primary care providers.