Improving Immunization Rates in Transplant Candidates Through the Use of a Health Information Technology Tool

通过使用健康信息技术工具提高移植候选者的免疫率

• 批准号: 10671486
• 负责人: Amy Feldman
• 金额: $ 14.85万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10671486
• 关键词: Improving; Immunization; Rates; Transplant; Candidates

PROJECT SUMMARY Vaccine preventable infections (VPIs) are a serious complication following pediatric solid organ transplantation that lead to significant morbidity, mortality, and costs in transplant recipients. Immunizations are a minimally invasive and cost-effective approach to reducing VPIs. Despite evidence of the importance of pre-transplant immunization, the majority of pediatric solid organ transplant recipients are not up-to-date on vaccines at the time of transplant. The purpose of this project is to identify transplant specific immunization barriers. The central hypothesis is that a health information technology tool can be created to coordinate vaccine delivery and address transplant specific immunization barriers, thus increasing immunization rates before transplant, decreasing VPIs post-transplant, and improving outcomes for transplant recipients. This career development award is designed to support the transition of Amy Feldman, MD, MSCS, an Assistant Professor of Pediatrics at the University of Colorado, into an independent clinician-scientist and to achieve her long-term career goal of becoming a national leader in pediatric transplant outcomes research. The specific aims are to: (1) conduct semi-structured interviews of key stakeholders in pediatric solid organ transplant to identify barriers to immunization of transplant candidates; (2) adapt an existing immunization health information tool for healthy children into ImmunizePT, a transplant-specific immunization tool; and (3) use a modified RE-AIM framework to pilot acceptability, feasibility and effectiveness of ImmunizePT to improve immunization rates in solid organ transplant candidates at three centers nationally. This project, coupled with guidance from a renowned mentorship team (Dr. Allison Kempe-health services research, Dr. Ronald Sokol-transplant hepatology, Dr. Megan Morris-qualitative research and Dr. Sheana Bull-health information technology) and advanced training in qualitative methods, health informatics, and pragmatic trial design and implementation will provide Dr. Feldman with the foundation needed to successfully develop and implement large-scale multi-center pragmatic trials to improve transplant outcomes. The University of Colorado provides a unique environment to conduct outcomes research utilizing health information technology, supported by collaborative partnerships between The Adult and Child Consortium for Health Outcomes Research and Delivery Science, The University of Colorado Mobile Health Impact Lab, and the Children’s Hospital Colorado Transplant Center. This proposal addresses AHRQ’s priority populations of children and individuals with special health care and chronic care needs; as well as AHRQ’s goals to design tools that disseminate evidence-based protocols within the learning health system, engage patients and providers in shared decision-making, enhance communication amongst team members, and improve safety and quality outcomes by reducing missed opportunities to provide recommended care. This tool has the potential to have widespread applicability to all children with chronic diseases who require co-management by subspecialists and primary care providers.

项目概要 疫苗可预防感染（VPI）是儿科实体器官移植后的严重并发症 这导致移植受者的显着发病率、死亡率和费用。免疫接种是最低限度的 减少 VPI 的侵入性且具有成本效益的方法。尽管有证据表明移植前的重要性 免疫接种方面，大多数儿科实体器官移植受者并未接种最新疫苗 移植的时间。该项目的目的是确定移植特异性免疫障碍。这 中心假设是可以创建一种健康信息技术工具来协调疫苗的交付 并解决移植特异性免疫障碍，从而提高移植前的免疫率， 减少移植后的 VPI，并改善移植受者的结果。这个职业发展 该奖项旨在支持儿科助理教授 Amy Feldman（医学博士、理学硕士）的过渡 在科罗拉多大学，成为一名独立的临床医生科学家并实现她的长期职业目标 成为儿科移植结果研究的全国领导者。具体目标是：（1） 对儿科实体器官移植的主要利益相关者进行半结构化访谈，以确定阻碍移植的障碍 移植候选者的免疫接种； (2) 采用现有的免疫健康信息工具，以促进健康 儿童使用 ImmunizePT，一种针对移植的免疫工具； (3) 使用修改后的 RE-AIM 框架 试点ImmunizePT的可接受性、可行性和有效性，以提高实体器官的免疫率 全国三个中心的移植候选者。该项目在知名人士的指导下 指导团队（Allison Kempe 博士 - 健康服务研究、Ronald Sokol 博士 - 移植肝病学、Dr. Megan Morris-定性研究和 Sheana Bull 博士-健康信息技术）和高级培训 定性方法、健康信息学和务实的试验设计和实施将为 Dr. Feldman 具备成功开发和实施大规模多中心务实所需的基础 改善移植结果的试验。科罗拉多大学提供了独特的环境来开展 利用卫生信息技术进行成果研究，并得到以下机构之间合作伙伴关系的支持 成人和儿童健康结果研究和交付科学联盟，大学 科罗拉多州移动健康影响实验室和科罗拉多州儿童医院移植中心。 该提案针对 AHRQ 的优先人群：儿童和需要特殊医疗保健的个人， 慢性护理需求；以及 AHRQ 设计工具来传播基于证据的协议的目标 学习型医疗系统，让患者和提供者参与共同决策，加强沟通 团队成员之间，通过减少错失的机会来提高安全和质量成果 建议护理。该工具有可能广泛适用于所有患有慢性病的儿童 需要亚专科医生和初级保健提供者共同管理的疾病。

项目成果

North American Biliary Stricture Management Strategies in Children After Liver Transplantation: A Multicenter Analysis From the Society of Pediatric Liver Transplantation (SPLIT) Registry.

北美儿童肝移植后胆道狭窄的处理策略：来自儿科肝移植协会 (SPLIT) 登记处的多中心分析。

• DOI: 10.1002/lt.26379
• 发表时间: 2022
• 期刊: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
• 作者: Valentino,PamelaL;Wang,Tianhao;Shabanova,Veronika;Ng,VickyLee;Bucuvalas,JohnC;Feldman,AmyG;Gonzalez-Peralta,ReginoP;Gupta,NitikaArora;Miloh,TamirA;Mohammad,Saeed;Pace,Erika;Sundaram,ShikhaS;Yazigi,NadaA;Soltys,Kyle;Soc
• 通讯作者: Soc

The impact of COVID-19 on the pediatric solid organ transplant population.

• DOI: 10.1016/j.sempedsurg.2022.151178
• 发表时间: 2022-06
• 期刊: SEMINARS IN PEDIATRIC SURGERY
• 影响因子: 1.7
• 作者: Feldman, Amy G.;Danziger-Isakov, Lara A.
• 通讯作者: Danziger-Isakov, Lara A.

Barriers to Pretransplant Immunization: A Qualitative Interview Study of Pediatric Solid Organ Transplant Stakeholders.

• DOI: 10.1016/j.jpeds.2020.07.038
• 发表时间: 2020-12
• 期刊: The Journal of pediatrics
• 作者: Feldman AG;Marsh R;Kempe A;Morris MA
• 通讯作者: Morris MA

Acute Liver Failure in a Child With Adenovirus Detected by PCR in the Explanted Liver.

通过 PCR 在外植肝脏中检测到腺病毒导致儿童急性肝功能衰竭。

• DOI: 10.1542/peds.2022-059237
• 发表时间: 2023
• 期刊: Pediatrics
• 影响因子: 8
• 作者: Boster,JuliaM;Dominguez,SamuelR;Messacar,Kevin;Adams,Megan;Weinberg,Adriana;Black,JenniferO;Feldman,AmyG
• 通讯作者: Feldman,AmyG

Live Vaccines in Pediatric Liver Transplant Recipients: "To Give or Not to Give".

儿童肝移植受者的活疫苗：“给予或不给予”。

• DOI: 10.1002/cld.1123
• 发表时间: 2021
• 期刊: Clinical liver disease
• 作者: Kemme,Sarah;Kohut,TaisaJ;Boster,JuliaM;Diamond,Tamir;Rand,ElizabethB;Feldman,AmyG
• 通讯作者: Feldman,AmyG