Office Barries & Facilitators to Overcoming Disparities in Elderly Vaccinations

描述（由申请方提供）：肺炎球菌多糖疫苗（PPV）和流感疫苗接种率存在种族差异，导致未受保护的人群患上可预防的疾病和死亡。最近的研究表明，黑人和白人在很大程度上由不同的提供者治疗，这些提供者在培训和资源方面也不同。为了调查实践水平差异对种族差异的影响程度，我们计划：（1）确定医疗实践用于促进免疫接种的策略;（2）描述实践的特征，以了解当前的组织和患者护理模式以及潜在变化的关键途径;（3）计算不同实践的PPV和流感疫苗接种率，并使用分层回归分析，计算这些比率的决定因素。为了在高答复率的情况下切实可行，将对14个习俗进行有意抽样，其中7个习俗黑人比例高，7个习俗白人比例高。实践将来自医疗中心的多样化网络和联邦合格的健康中心（CIMCs）。将对临床医生和办公室管理人员进行关于免疫策略、实践组织、文化和免疫接种的调查，调查基于对依从性的认识模型。医疗记录审查将在每个实践中随机抽取165名患者（共2310名）进行，以确定免疫接种、错过的机会、护理的连续性和图表组织。将使用SUDAAN进行分析，以解释聚类数据;分层线性模型将解释多水平（实践，临床医生和患者）数据;以及重复流感疫苗接种的多项式回归。一个人类学家小组将访问这些办事处，评估组织、文化和变革途径，并收集有关访问时间长短的时间数据。该提案的重要特征如下：1）多种族，多学科团队与大学的少数民族健康中心和项目出口联系在一起;该提案在提交之前已提交给该中心的社区咨询委员会; 2）该团队已发表了关于实践水平和医生水平因素如何影响患者免疫率的研究; 3）人类学家的参与导致了一种多模式的方法，从多个角度对问题进行三角测量; 4）医疗中心的多样化网络和老年人健康中心提供了一个可行的环境，有大量的老年黑人和老年白人。

DESCRIPTION (provided by applicant): Racial disparities exist in rates of pneumococcal polysaccharide vaccine (PPV) and influenza vaccine resulting in unprotected persons who suffer from preventable diseases and deaths. Recent research indicates that blacks and whites are largely treated by different providers and that these providers differ in (training and in resources. In order to investigate the extent to which practice-level differences contribute to racial disparities, we plan to: (1) identify strategies used by the medical practices to facilitate immunizations; (2) characterize the practices in order to understand current organization and patterns of patient care as well as critical pathways for potential change; and (3) calculate PPV and influenza vaccination rates for the various practices and, using hierarchical regression analyses, calculate the determinants of these rates. To be feasible with a high response rate, an intentional sampling of 14 practices, 7 with a high proportion of blacks and 7 with a high proportion of whites will be conducted. Practices will come from the Medical Center's diverse network and from federally qualified health centers (FQHCs). Surveys will be conducted of both clinicians and office managers about immunization strategies, practice organization, culture, and immunization, based on the Awareness-to-Adherence model. Medical record reviews will be conducted on a random sample of 165 patients per practice (2310 total) to determine immunizations, missed opportunities, continuity of care and chart organization. Analyses will be conducted using SUDAAN to account for clustered data; hierarchical linear modeling will account for multilevel (practice, clinician, & patient) data; and multinomial regression for repeat influenza vaccinations. A team of anthropologists will visit the offices to assess organization, culture, and pathways for change and to collect timing data on the length of visits. Important features of this proposal follow: 1) the multiracial, multidisciplinary team is tied to the University's Center for Minority Health and Project EXPORT; this proposal was presented to the Center's Community Advisory Board before submission; 2) the team has published studies of how practice-level and physician- level factors influence patient immunization rates; 3) inclusion of anthropologists leads to a multimodal approach to triangulate the problem from multiple perspectives; and 4) the Medical Centers' diverse network and FQHCs provide a feasible setting with high numbers of elderly blacks and elderly whites.