Adolescent Vaccination in the Medical Home

描述(由申请人提供)：该项目的总体目标是提高国家在初级保健实践(医疗机构)中为青少年接种疫苗的能力。大多数青少年都有医疗院，先前的研究表明，需要加强医疗院的设施，以有效地为青少年接种疫苗。该项目将确定并严格评估一项可行和可持续的战略，以改进医疗院内的青少年疫苗接种。我们将与两个以初级保健实践为基础的研究网络(PBRN)合作--一个区域网络(85个实践)和一个以学术为基础的医疗之家国家网络(110个实践)，以评估多组成部分青少年疫苗接种战略。这一战略将在一系列不同的医疗机构中进行评估，这些机构根据不同的专业(儿科、家庭医学)、患者群体(高收入和低收入)、执业类型(私立、诊所、健康中心)和教学角色(有或没有住院医生)进行评估。其目的是：1.对网络中所有实践的从业者进行形成性定量调查，并对从业者和父母进行定性访谈，以确定可行和可持续的青少年疫苗接种战略。我们将使用改进的Delphi技术来选择最优的策略进行评估；2.设计和实施随机对照试验，每个PBRN内有6个干预措施和6个护理标准对照措施(n=24个措施)。我们将使用标准化图表审查(n=3840名青少年，每个诊所160名)来衡量免疫接种、错失机会、预防性就诊和其他就诊的基线比率。我们将实施多组成部分战略；并在18个月的后续行动中评估同样的措施。我们将使用双变量和多变量分析来评估该战略对关键措施的影响，对整个人群、患者亚群和实践类型；3.通过评估1800万干预前后《青少年预防服务指南》中的预防性就诊和服务，评估该战略对接受预防服务的影响；4.评估成本和成本效益，以及该战略的可行性，使用标准化的人员/非人员资源评估和医生调查来衡量看法；5.与顾问和国家组织(AAP、AAFP、APA、SAM、CDC)合作传播研究结果；为医疗机构开发工具包，以实施青少年疫苗接种的最佳战略。我们的团队一直站在儿童、成人和现在青少年免疫接种研究的前沿。我们在涉及医疗之家的干预以及资源和成本分析方面拥有长期经验。通过在广泛的患者和实践中严格评估以实践为基础的可行策略的有效性，这项研究将为免疫和公共卫生领域的实践者和领导者提供关键信息，以实施加强青少年免疫接种和预防护理的战略。 公共卫生相关性：由于最近推荐了三种新的青少年疫苗(脑膜炎球菌、百日咳和HPV疫苗)和两种针对青少年的新疫苗建议(流感和水痘)，青少年疫苗接种已成为公共卫生的一个主要新的优先领域。目前，青少年的疫苗接种率很低。初级保健实践或疗养院是美国大多数青少年的主要医疗保健来源，但需要证据来制定可行和可持续的战略，在医疗院内优化青少年疫苗接种服务。这项研究将为儿科、青少年医学和公共卫生提供有关为青少年接种疫苗的实用战略、这些战略的成本以及通过加强医疗院青少年疫苗接种来改善其他预防服务的潜在溢出效益的关键信息。

DESCRIPTION (provided by applicant): The overall goal of this project is to enhance the nation's ability to vaccinate adolescents in primary care practices (medical homes). Most adolescents have a medical home, and prior studies demonstrate that enhancements are needed in medical homes to efficiently vaccinate adolescents. The project will identify and rigorously evaluate a feasible and sustainable strategy for improving adolescent vaccinations within medical homes. We will work with two primary care practice-based research networks (PBRNs)-a regional network (85 practices) and a national network of academic-based medical homes (110 practices), to evaluate a multi-component adolescent vaccination strategy. This strategy will be evaluated in a diverse spectrum of medical homes that vary by specialty (pediatrics, family medicine), patient population (high and lower income), practice type (private, clinic, health center), and teaching role (practices with and without residents). The aims are to: 1. Perform formative quantitative surveys of practitioners from all practices in the networks and qualitative interviews of practitioners and parents to identify feasible and sustainable adolescent vaccination strategies. We will use a modified Delphi technique to select the most optimal strategy to evaluate; 2. Design and implement a randomized controlled trial, with 6 intervention practices and 6 standard-of-care control practices within each PBRN (n=24 practices). We will use standardized chart reviews (n=3,840 adolescents, 160 per practice) to measure baseline rates of immunizations, missed opportunities, preventive visits, and other visits. We will implement a multi-component strategy; and asses the same measures at 18-month follow-up. We will use bivariate and multivariate analyses to assess the impact of the strategy on the key measures, for the entire population and for subgroups of patients and practice types; 3. Evaluate the impact of the strategy on receipt of preventive services by assessing preventive visits and services from the Guidelines for Adolescent Preventive Services, before and after the 18m intervention; 4. Evaluate costs and cost-effectiveness, as well as the feasibility of the strategy, using standardized assessments of personnel/non-personnel resources and surveys of physicians to gauge perceptions; 5. Work with consultants and national organizations (AAP, AAFP, APA, SAM, CDC) to disseminate findings; develop a toolkit for medical homes to implement best strategies for adolescent vaccinations. Our team has been at the forefront of research in childhood, adult, and now adolescent immunization delivery. We have longstanding experience in interventions involving medical homes, and analyses of resources and costs. By rigorously evaluating the effectiveness of a feasible practice-based strategy across a wide spectrum of patients and practices, this study will provide critical information for practitioners and leaders in immunization and public health to implement strategies to enhance adolescent immunizations and preventive care. PUBLIC HEALTH RELEVANCE: Due to the recent recommendation of three new adolescent vaccines (meningococcus, pertussis, and HPV vaccines) and two new vaccine recommendations for adolescents (influenza and varicella), adolescent vaccinations have become a major new priority area for public health. Currently, adolescent vaccination rates are low. Primary care practices or medical homes are the major sources of healthcare for the majority of adolescents across the US, yet evidence is needed for feasible and sustainable strategies, within medical homes, to optimize adolescent vaccination delivery. This study will provide critical information for pediatrics, adolescent medicine, and public health regarding practical strategies for vaccinating adolescents, the cost of these strategies, and the potential spillover benefits for improving other preventive services by enhancing vaccination of adolescents in medical homes.