Population versus Practice-Based Interventions to Increase Immunization Rates

描述（由申请人提供）：本申请涉及广泛的挑战领域（05）比较有效性研究（CER）和特定的挑战主题，05- lm -103：改善学童对免疫计划的依从性。尽管该国的免疫规划取得了巨大成功，但在2007年，约有25%的儿童在上幼儿园之前没有接种所有推荐的疫苗。疫苗接种率较低在贫困儿童和少数民族儿童中尤其普遍，他们可能没有通常的初级保健地点。除了接种所有推荐的疫苗外，鉴于幼儿特别容易感染许多疫苗可预防的疾病，及时接种疫苗也很重要。由于这些原因，正如《2010年健康人》所概述的那样，国家的主要卫生优先事项之一是增加接种所有普遍推荐疫苗的19至35个月儿童的比例。社区预防服务工作队建议了几项以证据为基础的干预措施，以提高免疫接种覆盖率，包括家长教育和患者提醒/召回免疫接种。虽然这些努力已被证明在实践层面上是有效的，但由于初级保健实践中的负担和相互竞争的需求，大多数提供者仍未充分利用这些努力。目前的建议将在实践层面提高免疫接种的标准方法的有效性与召回免疫接种滞后的19-35个月儿童的创新方法以及不依赖基于实践的努力而是侧重于社区层面的教育家庭的方法进行比较。据推测，以人群为基础的方法可能减轻初级保健提供者的负担，并提高接触到没有通常初级保健来源的儿童并为其接种疫苗的能力。该研究建立在研究小组在实践、公共卫生和社区环境中开展免疫接种研究的丰富经验的基础上，并将与科罗拉多州免疫信息系统和整个州的当地县公共卫生部门合作进行。拟议的研究将是一项在县一级进行的组随机试验，比较两种提高城市和农村地区幼儿免疫接种率的方法。第一种方法将涉及在个人初级保健实践层面实施标准的循证方法，另一种方法将使用创新技术，包括在科罗拉多州免疫信息系统中使用出生证明数据和集中召回县一级的患者。这项研究将在六个以城市为主的县和八个以农村为主的县进行。将比较每种干预措施在提高免疫接种率方面的有效性，以及每种方法的可行性和成本。最后，定性部分将评估两种方法对提供者和患者的可接受性，并将评估每种方法成功的障碍。这项研究的结果将有助于指导未来国家努力提高入学前幼儿的更新率。正如《2010年健康人》所概述的那样，该国的主要卫生优先事项之一是增加接种所有普遍推荐疫苗的19至35个月儿童的比例。本研究将比较两种提高该年龄组免疫接种率的干预措施，一种使用经过充分研究的基于初级保健实践的方法，另一种使用创新技术提高人口一级的免疫接种率。这项研究的结果将提供与国家相关的数据，指导未来的资源投资，以提高入学前幼儿的更新率。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05) Comparative Effectiveness Research (CER) and specific Challenge Topic, 05-LM-103: Improving Compliance of School Children with Immunization Schedules. Despite the immense success of the immunization program in this country, in 2007 approximately 25% of children had not received all recommended vaccines before kindergarten. Lower vaccination rates are especially prevalent among poor and minority children who may not have a usual site of primary care. In addition to receiving all recommended vaccines, the need to receive vaccines in a timely manner is also important, given the particular vulnerability of young children to a host of vaccine-preventable diseases. For these reasons, one of the nation's major health priorities, as outlined in Healthy People 2010, is to increase the proportion of children aged 19 to 35 months who have received all universally recommended vaccines. The Task Force on Community Preventive Services has recommended several evidence-based interventions to increase immunization coverage, including parent education and patient reminder/recall for immunizations. Although such efforts have been shown to be effective when used at the practice level, they remain underutilized by most providers because of the burdens and competing demands in primary care practice. The current proposal compares the effectiveness of standard approaches to raising immunizations at the practice level to an innovative approach to recalling children age 19-35 months who are behind on immunizations and to educating families that do not rely on practice-based efforts, but rather focused efforts at the level of the community. It is hypothesized that a population-based approach may reduce the burdens on primary care providers and increase the capacity to reach and immunize children who do not have a usual source of primary care. The study builds upon the extensive experience of the study team in conducting immunization delivery research within practice, public health and community settings and will be conducted in conjunction with the Colorado Immunization Information System and local county public health departments throughout the state. The proposed study will be a group-randomized trial at the level of the county comparing two approaches to improving immunization rates in young children in both urban and rural areas. The first approach will involve the implementation of standard evidence-based methods at the level of individual primary care practices and the other will use innovative technologies, including the ongoing population of the Colorado Immunization Information System with birth certificate data and centralized recall of patients at the level of the county. The study will be conducted in six primarily urban counties and eight primarily rural counties. The effectiveness of each type of intervention at increasing immunization rates will be compared as well as the feasibility and cost of each approach. Finally, a qualitative component will assess the acceptability of the two approaches to providers and patients and will assess barriers to the success of each. Results of this study will help direct future national efforts to increase up-to-date rates in young children prior to school entry. One of the nation's major health priorities, as outlined in Healthy People 2010, is to increase the proportion of children aged 19 to 35 months who have received all universally recommended vaccines. This study will compare two interventions for increasing immunization rates in this age group, one using well-studied primary care practice-based methods and the other using innovative technologies to increase immunization rates at the population-level. Results of this study will provide data that will be relevant nationally in guiding future investment of resources to increase up-to-date rates in young children prior to school entry.