Implementation research to improve the uptake of influenza vaccination in CKD

摘要/项目摘要 石上纯一博士，医学博士，公共卫生硕士，寻求导师研究科学家发展奖，以获得 基本技能和指导研究经验，以成为一名独立的研究人员在该领域 提高慢性肾脏病患者接种流感疫苗接种率的实施研究 疾病(CKD)。研究提案详细说明了一项五年计划，该计划包括实施研究，以 改善慢性肾脏病患者接种流感疫苗的情况，并在 约翰霍普金斯大学彭博公共卫生学院在松下幸弘博士的共同指导下， 医学博士和David Dowdy博士。在美国，每年有1000-3500万人感染流感， 导致多达71万人住院，5.6万人死亡。接种流感疫苗尤其重要 对于患有CKD的人来说很重要，因为他们患流感并发症的风险很高(例如肺炎， 心血管疾病)。然而，我们最近报告称，在65岁的≥成年人中，约40%的人没有透析 美国依赖CKD的人没有接种流感疫苗，疫苗接种率在 2005年和2015年。这表明迫切需要更多的努力来改善流感的传播。 疫苗接种，特别是在这一高危人群中。然而，没有循证的执行战略。 存在着改善流感疫苗接种的情况，特别是在慢性肾脏病患者中。建议数 该项目将解决这一公共卫生问题。本研究方案的具体目的是：1)确定 患者和提供者对肾脏疾病护理中流感疫苗接种的认知，2)设计一种基于理论的 疫苗接种计划并测试其在肾脏疾病护理中的可行性，以及3)评估 肾内科护理中的以理论为基础的疫苗接种计划。为了解决这些问题，我们将利用长期的 肾功能不全队列(CRIC)，一个由NIDDK资助的、种族多样、有充分记录、当代、 基线时5,499名年龄在21-74岁的不同CKD分期的纵向队列患者。这个项目 将提供实施战略，以加强CKD有效的流感疫苗交付，提供证据 在肾脏内科护理推广流感疫苗接种的概念，并提供有关成本的资料- 基于理论的疫苗接种计划在资源利用决策中的有效性。总而言之，这 该项目将为制定具有成本效益和可行的疫苗接种计划奠定理论基础 CKD的个人，可以在其他资助机制下进一步延长，如R01。这 该项目将使候选人完全具备成为独立调查员的能力，并将提供 改善慢性肾脏病流感疫苗接种率的证据基础，这是一项研究不足的重要临床优先事项 肾内科护理。

ABSTRACT/ PROJECT SUMMARY Dr. Junichi Ishigami, MD, MPH seeks a Mentored Research Scientist Development Award in order to obtain essential skills and mentored research experience to become an independent investigator in the field of implementation research to improve the uptake of influenza vaccination among individuals with chronic kidney disease (CKD). The research proposal details a five-year plan consisting of implementation research to improve the uptake of influenza vaccination among individuals with CKD, and advanced coursework at the Johns Hopkins Bloomberg School of Public Health under the combined mentorship of Dr. Kunihiro Matsushita, MD, PhD, and Dr. David Dowdy, MD, PhD. Influenza affects 10-35 million individuals annually in the US, resulting in up to 710,000 hospitalizations and 56,000 deaths. Vaccination against influenza is especially important for individuals with CKD due to their high risk of influenza complications (e.g., pneumonia, cardiovascular disease). Yet, we have recently reported that ~40% of adults aged ≥65 years with non-dialysis dependent CKD in the US did not get an influenza vaccine and the vaccination rate has not improved between 2005 and 2015. This indicates that additional efforts are urgently needed to improve the uptake of influenza vaccination particularly in this high risk population. However, no evidence-based implementation strategies exist to improve the uptake of influenza vaccination specifically among individuals with CKD. The proposed project will address this public health concern. The specific aims of this research proposal are 1) To determine patient and provider perceptions about influenza vaccination in nephrology care, 2) To design a theory-based vaccination program and test its feasibility in nephrology care, and 3) To evaluate the cost-effectiveness of a theory-based vaccination program in nephrology care. To address these issues, we will leverage the Chronic Renal Insufficiency Cohort (CRIC), an NIDDK-funded, ethnically-diverse, well-documented, contemporary, longitudinal cohort of 5,499 persons aged 21-74 years at baseline with a variety of CKD stages. This project will inform implementation strategies to enhance an effective influenza vaccine delivery in CKD, provide proof of concept of promoting influenza vaccination in nephrology care, and provide information on the cost- effectiveness of a theory-based vaccination program for decision-making on resource utilization. Together, this project will pave a theoretical foundation for developing cost-effective and feasible vaccination programs for individuals with CKD, which can be further extended under other funding mechanisms such as an R01. This project will make the candidate fully equipped to be an independent investigator and also will provide an evidence base for improving influenza vaccine uptake in CKD, an understudied and important clinical priority in nephrology care.