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

6个月以下婴儿患流感(流感)和百日咳的风险增加，怀孕 女性有患严重疾病和因流感早产的风险。免疫接种做法咨询委员会 建议妇女在流感季节接种流感疫苗，破伤风类毒素，减量白喉类毒素， 在每次怀孕期间(最好是在27-36周之间)接种无细胞百日咳疫苗，以降低患上 流感和百日咳给他们自己和他们的婴儿带来的疾病。然而，在美国只有一半的孕妇 分别接种流感疫苗和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，疫苗犹豫不决)、提供者(次优)的组合 沟通技巧、错失的机会)和系统(例如，缺乏常规命令和患者提醒) 各种因素。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 将采用我们非常成功的基于QI的干预措施(沟通培训、提供商提示、提供商 反馈和常规命令)和提醒/召回用于其他疫苗的干预措施 项目。该项目的目标1是衡量基线流感/TDAP疫苗接种覆盖率和提供者的知识， 纽约州和加利福尼亚州4个卫生系统32个妇产科诊所接种流感/TDAP疫苗的态度和行为 目标2是使用集群RCT(练习随机化)来衡量多组分QI的效果 干预(VAX-MOM：沟通培训、供应商提示、常备订单+费率反馈) 疫苗接种率和提供者的态度，并衡量干预的成本。目标3是测量 以病人为基础的提醒/教育干预对孕妇疫苗接种率的影响 在第三年提供随机对照试验(患者随机)。目标4是制定翻译 妇产科实践和孕产妇疫苗接种保健系统的计划/工具包。如果VAX妈妈的干预 而且患者提醒/教育研究是成功的，我们将在这两个方面都有一套可扩展的干预措施 实践水平和卫生系统水平，以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.