AFIX-OB: A Customizable Quality Improvement Intervention to Increase Maternal Vaccine Uptake

项目摘要 孕妇特别容易受到流感的负面影响，她们的婴儿面临的风险最大。 百日咳感染的严重后果。为此，季节性流感和破伤风、白喉 建议妇女在每次怀孕期间接种百日咳疫苗。然而，覆盖率 这两种疫苗的接种率都很低，很少超过50%，远远低于2020年健康人群80%的目标。 覆盖 孕妇接种疫苗的障碍已经得到了很好的描述， 疫苗的安全性，缺乏提供者的建议和获得疫苗/财政障碍， 储备疫苗是主要的障碍之一虽然有各种各样的干预措施， 临床环境中的这些障碍，既有侧重于特定障碍（即患者教育）的障碍，也有 多模式一揽子干预措施，这些干预措施对孕产妇接种疫苗的有效性是 各种各样。 有一个明确的需要，可用于确定和应用的框架'最佳做法'的质量 改善措施。AFIX（Assessment，Feedback，Incentive，eXchange，评估、反馈、激励、交换）模型由 国家免疫计划在儿科护理环境中为儿童免疫接种做这件事。 该模型评估了一个实践的基线免疫接种率和免疫接种提供实践， 比较同行做法之间的这一信息，促进竞争，以提高免疫接种率。 然后，实践选择那些直接解决免疫接种障碍的质量改进干预措施 在实践中遇到的困难。 在拟议的项目中，我们将评估AFIX-OB的有效性，我们对传统AFIX的适应 这一模式旨在改善产科护理环境中的孕产妇免疫接种服务。我们将首先深入利用 与患者和提供者进行访谈，以完善基于证据的质量改进的选择 将提供给实践的干预措施。然后，我们将使用一个群集随机试验来评估影响 在一组社会人口统计学上多样化的产科中， 耶鲁纽黑文卫生系统内的护理诊所。 如果有效的话，AHIX-OB框架有可能在各种产科护理中广泛实施 通过支持产科护理提供者，在产科护理提供者解决 实践、提供者和患者水平。

PROJECT SUMMARY Pregnant women are at particular risk of negative outcomes from influenza and their infants face the most serious outcomes from pertussis infections. For this reason, the seasonal influenza and the Tetanus, diphtheria and pertussis (Tdap) vaccines are recommended for women during every pregnancy. However, coverage rates remain low with rates rarely exceeding 50% for either vaccine, far from the Healthy People 2020 goal of 80% coverage. The barriers to vaccine receipt among pregnant women have been well characterized, with concerns about the safety of the vaccine, lack of a provider recommendation and access to the vaccine/financial barriers to stocking the vaccine being some of the primary barriers. While there exist a variety of interventions to address these barriers in the clinical setting, both ones that focus on specific barriers (i.e. patient education) as well as multi-modal packages of interventions, the effectiveness of these interventions on maternal vaccine uptake are varied. There is a clear need for a framework that can be used to determine and apply the ‘best practice’ quality improvement interventions. The AFIX (Assessment, Feedback, Incentive, eXchange) model was developed by the National Immunization Program to do just that in the pediatric care setting for childhood immunizations. The model evaluates a practice’s baseline immunization rates and immunization delivery practices and compares this information between peer practices, promoting competition to improve immunization rates. Practices then select those quality improvement interventions that directly address the barriers to immunization delivery faced in their practice. In the proposed project, we will evaluate the effectiveness of AFIX-OB, our adaptation of the traditional AFIX model, for improving maternal immunization delivery in the obstetric care setting. We will first utilize in-depth interviews with patients and providers to refine the selection of evidence-based quality improvement interventions that will be offered to practices. Then we will use a cluster-randomized trial to evaluate the impact of the AFIX-OB model on maternal immunization uptake in a socio-demographically diverse set of obstetric care clinics within the Yale New Haven Health System. If efficacious the AFIX-OB framework has the potential to be widely implemented in a variety of obstetric care settings to improve vaccine uptake by supporting obstetric care providers as they address barriers at the practice, provider and patient levels.