Provider Reminders: Improving Vaccine Delivery in Office Practice

说明(申请人提供)：免疫接种是影响儿童健康的最有效和最具成本效益的医疗干预措施之一。为了实现2010年为学龄前儿童接种疫苗的健康人目标，必须更加重视有效地提供疫苗。美国免疫接种提供特别工作组强烈建议儿科提供者实施某种类型的基于提供者的提醒/召回系统，以改进免疫提供。然而，存在一些障碍，阻碍了某些做法实现适当的免疫接种。我们的主要假设是，针对特定年龄段(18个月大)的提供者提醒可以有效地添加到基于办公室的系统中，并提高向这些儿童提供疫苗的比率。该项目的目标如下：1)在不同的私人办公室中，确定提供者在19个月大时提示提供所需疫苗的有效性，2)评估建立提供者在不同做法中提示18个月大儿童提供所需疫苗的做法的挑战和测试解决方案3)在不同的做法中确定完成18个月大患者(成为最新的)免疫接种的挑战和测试解决方案，以及4)通过实践和患者因素确定成功免疫的预测因素，包括：a.患者因素--包括保险、种族、民族、既往疫苗接种史和B.实践因素--包括实践类型、地点(农村、郊区、城市)、患者分配(一名医生，普通分配)、病历类型(电子病历)。该项目将在一个以实践为基础的区域研究网络--南卡罗来纳州儿科实践研究网络(SCPPRN)--进行，每年有8个儿科实践和约13.3万人次就诊。有四家诊所使用电子病历(EMR)，四家诊所使用纸质病历。SCPPRN还拥有不同的农村、郊区和城市人口。将对参与的做法、目前的程序和围绕提供疫苗的做法进行衡量和优化，以供提供者提醒。预计提供者提醒干预措施的实施将是多种多样的，范围可能从电子病历中的旗帜系统到纸质病历上的便利贴。干预措施的实施将利用以实践为基础的质量改进，包括面对面的小组培训、现场评估和每月电话会议。将每月衡量提示、访问和提供疫苗的数量等流程措施，并解决问题。确定在实践中有效、有效和可持续的干预措施将是至关重要的。将在研究开始和结束时测量免疫接种率，实践中这些接种率的变化将是主要结果衡量标准。结果是疫苗接种系列在19个月内完成，并衡量达到最新状态所需的时间。我们还将比较不同做法的结果，特别是不同做法和患者之间的差异。该项目旨在测试实施提供者提醒/召回或提示系统是否将有效地提高18个月大儿童的免疫接种率。利用不同的患者群体，包括贫困患者和少数民族患者，将在郊区、城市和农村实践环境中实施提醒/提示和召回系统。

DESCRIPTION (provided by applicant): Immunizations are among the most effective and cost effective medical interventions affecting the health of children. In order to reach Healthy People 2010 goals for the immunization of preschool children there must be increased emphasis on the effective delivery of vaccines. The US Task Force on Immunization Delivery strongly recommends that pediatric providers implement some type of provider based reminder/recall system to improve immunization delivery. Yet barriers exist that prevent some practices from achieving adequate immunization delivery. Our primary hypothesis is that provider reminders focused on a particular age group (18 month olds) can be efficiently added to office based systems and increase the rate of delivery of immunizations to those children. The aims of this project are as follows: 1) Within a diverse set of private offices, determine the effectiveness of a provider prompt for needed vaccines at 19 months of age, 2) Assess the challenges and test solutions for a practice to institute a provider prompt for needed vaccines on the medical record of 18 month children within a diverse set of practices 3) Identify the challenges and test solutions to completing the immunization of 18 month old patients (becoming up to date) within a diverse set of practices, and 4) Determine predictors of successful immunization by practice and patient factors including: A. patient factor- including insurance, race, ethnicity, previous vaccine history and B. Practice factors-including practice type, location (rural, suburban, urban), patient assignment (one physician, common assignment), medical record type (electronic medical record). This project will take place in a regional practice-based research network, the South Carolina Pediatric Practice Research Network (SCPPRN), with 8 pediatric practices and approximately 133,000 visits per year. Four practices use an electronic medical record (EMR), and four use paper medical records. SCPPRN also has a diverse population of rural, suburban, and urban populations. The participating practices current procedures and practices around the delivery of immunizations will be measured and optimized for the provider reminder. Practice implementation of the provider reminder interventions are expected to be diverse, and could range from a flag system in the (EMR) to post-it notes on a paper medical chart. The implementation of the intervention will utilize practice-based quality improvement, including a face to face group training, onsite assessments and monthly conference calls. Process measures such as number of prompts, visits and vaccines delivered will be measured monthly and problems addressed. It will be critical to identify interventions that will be efficient, effective, and sustainable in the practice. Immunization rates will be measured at the beginning and the end of the study, and change in these rates within practice will be the primary outcome measure. The outcome is vaccination series complete at 19 months, as well as a measure of time it takes until up to date status is achieved. We will also compare results between practices, particularly differences between practices and patients by practice and patient characteristics. This project is designed to test whether implementation of a provider reminder/recall or prompting system will be effective in increasing the rate of immunization delivery to 18 month old children. Utilizing diverse patient populations, including poor and minority patients, the implementation of the reminder/prompting and recall system will occur in suburban, urban, and rural practice settings.