The VAX-MOM study: Increasing Influenza and Tdap Vaccinations of Pregnant Women

6个月以下的婴儿患流感和百日咳的风险增加， 妇女患流感有可能导致严重疾病和早产。免疫实践咨询委员会 建议妇女在流感季节接种流感疫苗，破伤风类毒素，减少白喉类毒素， 在每次怀孕期间（理想情况下在27-36周之间）接种无细胞百日咳（Tdap）疫苗，以降低 流感和百日咳疾病。然而，美国只有一半的孕妇 分别接种流感和Tdap疫苗;只有33%的妇女同时接种这两种疫苗。缺乏疫苗接种 源于患者（缺乏知识、疫苗犹豫）、提供者（次优 沟通技巧、错失机会）和系统（例如，缺乏长期医嘱和患者提醒） 因素需要采取有效的干预措施来提高孕妇的流感和Tdap疫苗接种率。我们 将调整我们非常成功的基于质量指数的干预措施（沟通培训，提供者提示，提供者 反馈和长期订单）以及用于VAX-EFL的其他疫苗的提醒/召回干预措施 项目该项目的目标1是测量基线流感/Tdap疫苗接种覆盖率和提供者知识， 在纽约州和加利福尼亚州的4个卫生系统的32个OB/GYN实践中对流感/Tdap疫苗接种的态度和行为。 目的2是使用聚类RCT（实践随机化）来测量多组分QI的效果 干预（VAX-ESTA：沟通培训，提供者提示，长期订单+费率反馈） 疫苗接种率和提供者的态度，并衡量干预措施的成本。目标3是测量 基于患者的提醒/教育干预对孕妇疫苗接种率的影响， 在第3年向对照实践（患者随机化）提供RCT。目标4：翻译 妇产科医生做法和孕产妇疫苗接种卫生系统计划/工具包。如果VAX-100干预 并且患者提醒/教育研究是成功的，我们将在两个方面都有一套可扩展的干预措施， 在实践层面和卫生系统层面，提高孕产妇疫苗接种率。

Infants under 6 months of age are at increased risk of both influenza (flu) and pertussis disease, and pregnant women risk serious illness and premature labor from flu. The Advisory Committee on Immunization Practices recommends that women receive a flu vaccine in flu season, and tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap) vaccine during each pregnancy (ideally between 27-36 weeks) to lower the risk for flu and pertussis disease for themselves and their infants. However, only half of pregnant women in the US receive a flu and Tdap vaccine, respectively; only 33% of women receive both vaccines. Lack of vaccination stems from a combination of patient (lack of knowledge, vaccine hesitancy), provider (suboptimal communication skills, missed opportunities), and system (e.g. lack of standing orders and patient reminders) factors. An effective intervention is needed to improve flu and Tdap vaccination rates for pregnant women. We will adapt our highly successful QI-based interventions (communication training, provider prompts, provider feedback, and standing orders) and reminder/recall interventions used for other vaccines to the VAX-MOM project. Aim 1 of this project is to measure baseline flu/Tdap vaccination coverage and provider knowledge, attitudes and behaviors for flu/Tdap vaccination in 32 OB/GYN practices in 4 health systems in NY and CA. Aim 2 is to use a clustered RCT (practice randomization) to measure the effect of a multi-component QI intervention (VAX-MOM: training in communication, provider prompts, standing orders + feedback on rates) on vaccination rates and provider attitudes, and to measure costs of the intervention. Aim 3 is to measure the effect of a patient-based reminder/education intervention on vaccination rates of pregnant mothers, using a RCT provided to control practices (with patient randomization) in Year 3. Aim 4 is to develop a translation plan/toolkit for OB/GYN practices and health systems for maternal vaccination. If the VAX-MOM intervention and the patient reminder/education studies are successful, we will have a scalable set of interventions at both the practice level and the health system level to raise maternal vaccination rates.