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

项目总结 疫苗可预防感染(VPIS)是儿童实体器官移植后的严重并发症。 这会导致移植受者显著的发病率、死亡率和成本。免疫接种是最低限度的 减少VPIS的侵入性和成本效益方法。尽管有证据表明移植前的重要性 在疫苗接种方面，大多数儿童实体器官移植接受者没有及时接种疫苗。 移植的时间。该项目的目的是确定移植特异性免疫障碍。这个 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交付 并解决移植特异性免疫障碍，从而提高移植前的免疫率； 减少移植后的VPIS，改善移植受者的预后。这份职业发展 该奖项旨在支持儿科学助理教授艾米·费尔德曼(Amy Feldman)的转型 在科罗拉多大学，成为一名独立的临床医生兼科学家，并实现她的长期职业目标 成为全国儿科移植成果研究的领先者。具体目标是：(1)进行 对儿童实体器官移植关键利益相关者的半结构化访谈，以确定障碍 移植候选者的免疫接种；(2)使现有的免疫健康信息工具适用于健康 儿童进入免疫PT，这是一种移植特异性免疫工具；以及(3)使用改进的RE-AIM框架 试行免疫PT提高实体器官免疫接种率的可接受性、可行性和有效性 全国三个中心的移植候选人。这个项目，再加上一位著名的 导师团队(Allison Kempe博士-健康服务研究，Ronald Sokol博士-移植肝病，Dr. Megan Morris--定性研究和Sheana Bull博士--健康信息技术)和高级培训 在定性方法方面，卫生信息学和务实的试验设计和实施将为Dr。 费尔德曼具备成功开发和实施大型多中心务实项目所需的基础 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 利用卫生信息技术的成果研究，得到以下合作伙伴关系的支持 成人和儿童健康结果研究和交付科学联合会，加州大学 科罗拉多州流动健康影响实验室和科罗拉多州儿童医院移植中心。 这项建议涉及AHRQ的优先儿童和个人群体，他们有特殊的医疗保健和 慢性护理需求；以及AHRQ的目标是设计工具，在 学习卫生系统，让患者和提供者参与共享决策，加强沟通 并通过减少错过的机会来提高安全和质量结果 推荐的护理。该工具有可能广泛适用于所有患有慢性病的儿童 需要由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.