Provider Reminders: Improving Vaccine Delivery in Office Practice

提供者提醒：改善办公室实践中的疫苗输送

• 批准号: 7413924
• 负责人: PAUL M DARDEN
• 金额: $ 20万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7413924
• 关键词: Provider; Reminders; Improving; Vaccine; Delivery

DESCRIPTION (provided by applicant): Immunizations are among the most effective and cost effective medical interventions affecting the health of children. In order to reach Healthy People 2010 goals for the immunization of preschool children there must be increased emphasis on the effective delivery of vaccines. The US Task Force on Immunization Delivery strongly recommends that pediatric providers implement some type of provider based reminder/recall system to improve immunization delivery. Yet barriers exist that prevent some practices from achieving adequate immunization delivery. Our primary hypothesis is that provider reminders focused on a particular age group (18 month olds) can be efficiently added to office based systems and increase the rate of delivery of immunizations to those children. The aims of this project are as follows: 1) Within a diverse set of private offices, determine the effectiveness of a provider prompt for needed vaccines at 19 months of age, 2) Assess the challenges and test solutions for a practice to institute a provider prompt for needed vaccines on the medical record of 18 month children within a diverse set of practices 3) Identify the challenges and test solutions to completing the immunization of 18 month old patients (becoming up to date) within a diverse set of practices, and 4) Determine predictors of successful immunization by practice and patient factors including: A. patient factor- including insurance, race, ethnicity, previous vaccine history and B. Practice factors-including practice type, location (rural, suburban, urban), patient assignment (one physician, common assignment), medical record type (electronic medical record). This project will take place in a regional practice-based research network, the South Carolina Pediatric Practice Research Network (SCPPRN), with 8 pediatric practices and approximately 133,000 visits per year. Four practices use an electronic medical record (EMR), and four use paper medical records. SCPPRN also has a diverse population of rural, suburban, and urban populations. The participating practices current procedures and practices around the delivery of immunizations will be measured and optimized for the provider reminder. Practice implementation of the provider reminder interventions are expected to be diverse, and could range from a flag system in the (EMR) to post-it notes on a paper medical chart. The implementation of the intervention will utilize practice-based quality improvement, including a face to face group training, onsite assessments and monthly conference calls. Process measures such as number of prompts, visits and vaccines delivered will be measured monthly and problems addressed. It will be critical to identify interventions that will be efficient, effective, and sustainable in the practice. Immunization rates will be measured at the beginning and the end of the study, and change in these rates within practice will be the primary outcome measure. The outcome is vaccination series complete at 19 months, as well as a measure of time it takes until up to date status is achieved. We will also compare results between practices, particularly differences between practices and patients by practice and patient characteristics. This project is designed to test whether implementation of a provider reminder/recall or prompting system will be effective in increasing the rate of immunization delivery to 18 month old children. Utilizing diverse patient populations, including poor and minority patients, the implementation of the reminder/prompting and recall system will occur in suburban, urban, and rural practice settings.

描述（由申请人提供）：免疫接种是影响儿童健康的最有效和最具成本效益的医疗干预措施之一。为了实现《2010年健康人口》关于学龄前儿童免疫接种的目标，必须更加强调有效提供疫苗。美国免疫接种工作小组强烈建议儿科服务提供者实施某种基于提供者的提醒/召回系统，以改善免疫接种服务。然而，存在一些障碍，使某些做法无法实现充分的免疫接种。我们的主要假设是，针对特定年龄组（18个月大）的提供者提醒可以有效地添加到基于办公室的系统中，并提高对这些儿童的免疫接种率。本项目的目的如下：1)在一个多样化的私人办公室,确定供应商提示所需疫苗的有效性在19个月的年龄,2)评估实践研究所的挑战和测试解决方案提供者提示所需疫苗在18个月的儿童的医疗记录在一个多样化的实践3)识别的挑战和测试解决方案完成18月大的患者的免疫(成为最新的)在一个多样化的实践,4)通过实践和患者因素确定免疫成功的预测因素，包括：A.患者因素——包括保险、种族、民族、既往疫苗史；B.实践因素——包括实践类型、地点（农村、郊区、城市）、患者分配（一名医生、普通分配）、病历类型（电子病历）。该项目将在一个以实践为基础的区域研究网络中进行，即南卡罗来纳州儿科实践研究网络（SCPPRN），该网络有8个儿科实践，每年约有133,000人次就诊。四家诊所使用电子病历（EMR），四家使用纸质病历。SCPPRN还拥有农村、郊区和城市人口的多样化人口。将衡量有关提供免疫接种的参与做法、现行程序和做法，并针对提供者提醒进行优化。提供者提醒干预措施的实践实施预计将是多种多样的，可以从电子病历中的标志系统到纸质医疗图表上的便利贴。干预措施的实施将利用基于实践的质量改进，包括面对面的小组培训、现场评估和每月的电话会议。流程措施，如提示次数、访问次数和提供的疫苗，将按月进行衡量，并解决问题。确定在实践中高效、有效和可持续的干预措施至关重要。免疫接种率将在研究开始和结束时测量，这些接种率在实践中的变化将是主要的结果测量。结果是在19个月时完成疫苗接种系列，以及在达到最新状态之前所需的一定时间。我们还将比较实践之间的结果，特别是实践和患者之间的差异，通过实践和患者特征。该项目旨在测试提供者提醒/召回或提示系统的实施是否能有效提高18个月大儿童的免疫接种率。利用不同的患者群体，包括贫困和少数民族患者，提醒/提示和召回系统将在郊区、城市和农村实践环境中实施。