The INFLUENTIAL Trial- Inpatient FLU Vaccination Program Effectiveness: National Trial Implementing Best Practices And Learning Collaboratives

项目总结/摘要 在美国，流感感染每年都会导致高发病率和死亡率。流感疫苗接种 儿童是减少个人疾病负担的最有效战略之一， 社区，但覆盖率仍然不理想。医院是一个很有希望的环境， 高危儿童的数量。然而，最近的研究表明，许多符合流感疫苗接种条件的儿童， 在住院期间未能接种所需疫苗。当地数据表明，多模式方法 利用卫生信息技术可增加住院儿童的流感疫苗接种。 该项目将建立在现有证据的基础上，建立一个标准化的儿科住院流感 疫苗接种计划，可以很容易地传播，并成功地在不同的健康 系统.在本提案的目标1中，研究小组将邀请父母、护士、供应商和其他关键人员参与， 来自西雅图儿童医院、科罗拉多儿童医院和 芝加哥为住院患者流感疫苗接种计划创建最佳实践实施指南。核心 组成部分将包括建立一个多学科领导团队，保持最终用户的参与， 利用新的电子健康记录和数据分析工具，加强循证教育， 父母、护士和供应商的沟通。该计划将在3个牵头地点进行试点，并进行完善， 需要基于评估指标。在目标2中，研究小组将使用 在全国12个卫生系统进行的序贯多重分配随机试验适应性设计， 流感疫苗接种计划对提高住院患者流感疫苗接种率的效果 孩子在第一个干预季节，将对研究中心进行随机化，以实施标准化流感 使用上述实施指南或常规护理的疫苗接种计划。在第二次干预中， 季节，通常的护理部位和表现较低的干预部位将重新随机分配至标准化 或者是强化版的程序后者将包括一个学习协作机构，每月举行会议， 现场负责人以及与研究小组的一对一会议，以促进成功实施。在 在第三个干预季节，所有地点将继续其流感疫苗接种计划，以评估可持续性。在 目标3，研究小组将使用混合方法，并将覆盖范围、有效性、采用、实施和 维护（RE-AIM）框架，以评估该计划，包括识别关键障碍，促进者， 以及对今后传播的考虑。这些信息将用于优化和扩展程序。 这个以证据为基础的计划，利用新的临床决策支持工具，在一个最常用的 电子健康记录系统和优化医院基础设施，有可能显着增加 为高危儿童接种流感疫苗。它也有广泛的公共卫生影响，因为该计划可能是 易于适应和扩展，以包括其他所需的疫苗，患者群体和医疗保健设置。

PROJECT SUMMARY/ABSTRACT Influenza infection causes high morbidity and mortality each year in the United States. Influenza vaccination of children is one of the most effective strategies for reducing the burden of disease among individuals and communities, yet coverage levels remain suboptimal. Hospitals are a promising setting for reaching a large number of high-risk children. Recent studies, however, indicate that many influenza vaccine-eligible children fail to receive this needed vaccine during hospitalization. Local data suggest that multimodal approaches leveraging health information technology may increase influenza vaccine uptake among hospitalized children. This project will build upon this existing evidence to establish a standardized pediatric inpatient influenza vaccination program that can be readily disseminated and successfully implemented across diverse health systems. In Aim 1 of this proposal, the study team will engage parents, nurses, providers and other key stakeholders from Seattle Children’s Hospital, Children’s Hospital Colorado, and Lurie Children’s Hospital of Chicago to create a best practice implementation guide for the inpatient influenza vaccination program. Core components will include creating a multidisciplinary leadership team, maintaining end-user engagement, utilizing novel electronic health record and data analytic tools, and enhancing evidence-based education and communication of parents, nurses, and providers. The program will be piloted at the 3 lead sites and refined as needed based upon evaluation metrics. In Aim 2, the study team will conduct a cluster randomized trial using a Sequential Multiple Assignment Randomized Trial adaptive design at 12 health systems nationally to test the effectiveness of the influenza vaccination program in improving influenza vaccination rates of hospitalized children. In the first intervention season, sites will be randomized to implement the standardized influenza vaccination program using the aforementioned implementation guide or usual care. In the second intervention season, the usual care sites and lower-performing intervention sites will be re-randomized to the standardized or intensified version of the program. The latter will include a learning collaborative, with monthly meetings of site leaders as well as one-on-one meetings with the study team to facilitate successful implementation. In the third intervention season, all sites will continue their influenza vaccination program to assess sustainability. In Aim 3, the study team will use mixed methods and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate the program, including identification of key barriers, facilitators, and considerations for future dissemination. This information will be used to optimize and expand the program. This evidence-based program, which leverages novel clinical decision support tools in one of the most utilized electronic health record systems and optimizes hospital infrastructure, has the potential to markedly increase influenza vaccination of high-risk children. It also has broad public health implications, as the program could be readily adapted and expanded to include other needed vaccines, patient populations, and healthcare settings.