BE IMMUNE: Behavioral Economics to Improve and Motivate vaccination Using Nudges through the EHR

项目总结/摘要 疫苗可预防的疾病，如流感、肺炎球菌病和带状疱疹，导致患病率很高， 住院和老年人死亡。在美国，疫苗接种率在2010年几乎没有变化。 少数种族和族裔群体的死亡率较低。需要新的和可扩展的方法来解决这个问题 重要的公共卫生问题。 助推是改变提供选择或信息的方式，可以对行为产生巨大影响。 例如，默认选项是阻力最小的路径，以及在未选择备选方案时发生的操作。 主动选择是一种立即做出决策的方法，而不是等待利益相关者认识到需要 自己做决定我们在宾夕法尼亚大学（宾夕法尼亚医学院）和宾夕法尼亚大学的团队 华盛顿（华盛顿大学医学）已经形成了行为设计团队嵌入在我们的卫生系统的运作 并证明了这些类型的推动如何提高医疗保健价值和患者结果。由于电子 在美国，超过90%的临床医生采用了健康记录（EHR），这种可扩展的技术平台 一个最佳的环境来实施和部署这些类型的推动。 在这项研究中，我们建议设计，测试和实施个性化的轻推，以临床医生和患者的目标障碍 在高危亚群中，提高疫苗接种率。我们将在两个卫生系统进行试点， 在VA卫生系统的这些卫生系统和站点进行实用性试验。在R61阶段，我们将重点关注 以下是宾夕法尼亚大学医学和华盛顿大学医学的目标。目标1：使用EHR数据和分析方法识别高风险 流感、肺炎球菌病和带状疱疹疫苗接种率不理想的老年人群体。目标二： 为了评估对临床医生和患者实施不同类型的个性化轻推的可行性， 确定群体，以提高老年人的疫苗接种率。目标3：试点测试个性化的方法， 推动临床医生和患者改善老年人的疫苗接种。 在R33阶段，我们将专注于宾夕法尼亚大学医学，华盛顿大学医学和VA卫生系统的以下目标。目的 1：进行一项为期12个月、多中心、随机分组、务实的试验，以评估个性化治疗的有效性。 推动临床医生和患者相对于对照组提高老年人的疫苗接种率。目标2：评价 干预措施在减少与种族/族裔有关的疫苗接种率差异方面的有效性， 社会经济因素。目的3：评价临床医生、患者和实践中治疗效果的异质性 在未来的干预设计中进一步调整方法。

PROJECT SUMMARY/ABSTRACT Vaccine-preventable diseases such as influenza, pneumococcal disease, and shingles lead to significant rates of illness, hospitalization, and death among older adults. In the United States, vaccination rates have been mostly unchanged for a decade with lower rates among racial and ethnic minority groups. New and scalable approaches are needed to address this important public health issue. Nudges are changes to the way choices are offered or information is framed that can have outsized effects on behavior. For example, default options are the path of least resistance and the action that takes place if no alternatives are selected. Active choice is a method that prompts a decision-making now, rather than waiting for stakeholders to recognize the need to make the decision on their own. Our groups at the University of Pennsylvania (Penn Medicine) and the University of Washington (UW Medicine) have formed behavioral design teams embedded within the operations of our health systems and have demonstrated how these types of nudges can improve health care value and patient outcomes. Since electronic health records (EHRs) have been adopted by more than 90% of clinicians in the US, this scalable technology platform is an optimal environment to implement and deploy these types of nudges. In this study, we propose to design, test, and implemented personalized nudges to clinicians and patients to target barriers among high-risk subgroups to improve vaccination rates. We will pilot this at two health systems and then implement a pragmatic trial at those health systems and sites in the VA Health System. In the R61 phase, we will focus on the following aims at Penn Medicine and UW Medicine. Aim 1: To use EHR data and analytical methods to identify high-risk groups of older adults with suboptimal vaccination rates for influenza, pneumococcal disease, and herpes zoster. Aim 2: To assess the feasibility of implementing different types of personalized nudges to clinicians and patients to target the identified groups to improve vaccination rates among older adults. Aim 3: To pilot test ways to personalize promising nudges to clinicians and patients for improving vaccination among older adults. In the R33 phase, we will focus on the following aims at Penn Medicine, UW Medicine, and the VA Health System. Aim 1: To conduct a 12-month, multisite, cluster randomized, pragmatic trial to evaluate the effectiveness of personalized nudges to clinicians and patients relative to control to improve vaccination rates among older adults. Aim 2: To evaluate the effectiveness of the intervention on reducing disparities in vaccination rates related to race/ethnicity and socioeconomic factors. Aim 3: To evaluate heterogeneity in treatment effect across clinician, patient, and practice characteristics to further tailor approaches in future intervention design.