From Innovation to Solutions: Autodialers, Use of Early Autumn Physicals and Vac

描述(申请人提供)：2008年，疾控中心将流感疫苗接种的适应症扩大到6个月至18岁的儿童，极大地增加了符合条件的儿童数量。由于工作量增加，而且青少年很少去看卫生监督员，因此需要采取创新战略来提高疫苗接种率。在第一年，我们将利用创新扩散理论，在实践环境中确定和制定增加儿童流感疫苗接种的策略。将通过文献回顾以及阿勒格尼县免疫联盟成员和父母的焦点小组进行鉴定。然后，我们将利用我们教学发展中心和当地媒体的图形专业知识，开发和形式化地评估针对家长和青少年的新的电子大众媒体信息。接下来，我们将制定一系列提高疫苗接种率的策略，包括工具包、常规命令、快速疫苗接种诊所、重新设计工作流程以评估生命体征期间的疫苗接种情况、在8月提前开始使用减毒活流感疫苗的疫苗接种季节，以及自动拨号提醒。我们还将与初级保健实践合作，通过审查文件和与宾夕法尼亚州全州免疫信息系统(PA-SIIS)合作，教育临床医生，增强电子记录保存。我们将对一些拟议的干预措施进行试点测试。为了达到目标2，在第二年，我们将对20种不同的做法进行分层、随机的整群试验，以比较干预地点和对照地点的疫苗接种率。干预地点将使用一套新开发的基于证据的技术，这些技术将根据其实践结构和文化而量身定做。通常的护理实践不会得到这样的帮助。两个不同的以实践为基础的研究网络将是研究的重点。我们将使用混合方法评估干预的成功，包括定性(例如，焦点小组)、过程和定量措施。由于患者聚集在诊所，将进行分层线性建模，并将包括实施与疫苗接种相关的干预和实践因素的保真度。我们的多学科团队在疫苗接种障碍和促进者的实践研究以及进行试验方面拥有经验。我们建议在网上传播工具包和干预材料。 公共卫生相关性：免疫做法咨询委员会提出的为所有6个月至18岁的儿童接种流感疫苗的新建议，将需要采取创新战略，以提高以前疫苗接种率较低的群体的疫苗接种率。该项目将使用各种方法来确定和制定一揽子干预措施，以提高儿童的流感疫苗接种率。这些策略将在初级保健实践的分层随机整群试验中进行测试。

DESCRIPTION (provided by applicant): In 2008, the CDC expanded the indications for influenza vaccination to encompass children ages 6 months through 18 years, dramatically increasing the number of eligible children. Innovative strategies to increase vaccination rates are needed due to the increased workload and to the fact that adolescents make fewer health supervision visits. During the first year, we will identify and develop strategies to increase influenza vaccination of children in practice settings, using the Diffusion of Innovation Theory. Identification will occur by a literature review and by focus groups of Allegheny County Immunization Coalition members and parents. Then, we will develop and formatively evaluate new, electronic, mass media messages targeting parents and teens, using graphic expertise in our Center for Instructional Development and local media. Next, we will develop a package of strategies to increase rates including a toolkit, standing orders, express vaccination clinics, workflow redesign to assess vaccination status during vital signs, early start to the vaccination season in August using live attenuated influenza vaccine, and autodialed reminders. We will also work with primary care practices to educate clinicians, to enhance electronic record keeping by reviewing documentation and by collaborating with Pennsylvania's Statewide Immunization Information System (PA-SIIS). We will conduct a pilot test of some of the proposed interventions. To address Aim 2, in the second year, we will conduct a stratified, randomized cluster trial of 20 diverse practices to compare vaccination rates in intervention and control sites. Intervention sites will use a package of newly developed and evidence-based techniques that will be tailored to their practice structure and culture. Usual care practices will not receive such assistance. Two diverse practice-based research networks will be the focus of the study. We will evaluate the success of the intervention using a mixed methods approach, including qualitative (e.g., focus groups), process, and quantitative measures. As the patients are clustered in clinics, hierarchical linear modeling will be conducted and will include the fidelity of implementation of the intervention and practice factors associated with vaccination. Our multidisciplinary team has experience in practice-based research on barriers and facilitators to vaccination and in conducting trials. We propose to disseminate the toolkit and intervention materials on the web. PUBLIC HEALTH RELEVANCE: New recommendations by the Advisory Committee for Immunization Practices to vaccinate all children ages 6 months through 18 years against influenza will require innovative strategies to increase vaccination rates among groups with previously low vaccine uptake. This project will use a variety of methods to identify and develop a package of interventions to increase influenza vaccination rates among children. These strategies will be tested in a stratified random cluster trial of primary care practices.