Evaluation of Vaccination Reminder/Recall Systems for Adolescent Patients

描述（由申请人提供）：该项目的总体目标是提高国家在初级保健实践中为青少年接种疫苗的能力。大多数11岁以上的青少年现在有资格接受新许可的青少年疫苗接种，包括人乳头瘤病毒、脑膜炎球菌疫苗和破伤风-百日咳疫苗。这一青少年疫苗接种的新时代将需要对许多青少年的初级保健做法进行更多的访问。需要系统来跟踪，提醒和召回青少年进行所需的免疫接种，特别是在低收入青少年中，他们的疫苗接种率较低，预防性医疗保健访问较少。一个潜在的有效的策略，提醒/召回的青少年是基于这些系统的管理式护理，因为大多数青少年参加了健康保险组织。因此，本研究的目的是：1。在罗切斯特纽约地区的低收入人群中，设计一个以邮件或电话信息为基础的青少年免疫提醒/召回系统。2.使用随机临床试验（RCT）评估这种基于管理式护理的青少年免疫提醒/召回系统的有效性，以测试邮寄与电话（基于自动拨号器）提醒/召回与对照。在不同的实践（儿科/家庭医生和不同的实践类型）和青少年人群（11- 18岁，城市/郊区/农村地区）中实施RCT。3.评估和比较邮寄/电话系统的成本、成本效益和可行性。4.与公共卫生和专业组织合作传播调查结果。对于目标1，我们将使用定性方法对提醒/回忆系统和信息进行试点测试，并听取家长、青少年和管理式护理专家的意见。对于目标2，我们将在12个月内评估邮寄提醒、电话提醒和标准护理控制在提高（a）青少年疫苗接种率和（B）预防性就诊和其他预防性服务方面的有效性。我们将在纽约州北部的40个初级保健实践中随机抽取5,000名青少年。我们将使用双变量和多变量分析来测试提醒/回忆的影响，针对整个人群和以下亚组：（a）青少年（按年龄、性别、城市/郊区/农村居住地）;（B）实践（儿科或家庭MD，以及私人办公室/诊所/健康中心）;和（c）保险（医疗补助或州儿童健康保险计划）。对于目标3，我们将衡量和比较两种提醒系统的成本及其成本效益，并将评估不同环境的可行性和普遍性。对于目标4，我们将与专家合作传播研究结果。通过严格评估免疫提醒/召回对青少年的有效性，这项研究将为从业人员和免疫接种和公共卫生领导人提供关键信息，以实施加强青少年免疫接种和预防保健的战略。 公共卫生声明：免疫接种是最伟大的公共卫生成就之一。青少年免疫接种的新时代将需要新的战略来保护数百万青少年免受疫苗可预防的疾病，包括人乳头瘤病毒（HPV），脑膜炎球菌疫苗和破伤风-百日咳疫苗（TdaP）。本研究评估了患者提醒/召回在改善青少年免疫接种服务和其他关键的青少年预防服务方面的有效性。

DESCRIPTION (provided by applicant): The overall goal of this project is to enhance the nation's ability to vaccinate adolescents in primary care practices. Most adolescents >11 years are now eligible to receive newly licensed adolescent vaccinations including human papilloma virus (HPV), meningococcal vaccine and tetanus-pertussis vaccine (TdaP). This new era of adolescent vaccinations will require additional visits to primary care practices for many adolescents. Systems are needed to track, remind, and recall adolescents for needed immunizations, particularly among low-income adolescents who have lower vaccination rates and fewer preventive healthcare visits. A potentially efficient strategy for reminder/recall for adolescents is to base these systems in managed care, since most adolescents are enrolled in health insurance organizations. Therefore, the aims of this study are to: 1. Design an adolescent immunization reminder/recall system with mailed or telephone messages, and based in managed care settings for low-income populations in the Rochester New York, region. 2. Evaluate the effectiveness of this managed care-based adolescent immunization reminder/recall system using a randomized clinical trial (RCT) to test mailed versus telephone (autodialer-based) reminder/recall versus control. Implement the RCT across diverse practices (pediatric/family physician, and different practice types) and adolescent populations (11-18yrs, and urban/suburban/rural regions). 3. Evaluate and compare the costs, cost-effectiveness and feasibility of the mailed / telephone systems. 4. Disseminate findings in collaboration with public health and professional organizations. For Aim 1, we will pilot test the reminder/recall systems and messages using qualitative methods, with input from parents, adolescents, and managed care experts. For Aim 2 we will evaluate, over 12 months, the effectiveness of mailed reminders vs telephone reminders vs standard of care control in improving (a) adolescent vaccination rates and (b) preventive visits and other preventive services. We will randomize 5,000 adolescents across 40 primary care practices in upstate NY. We will test the impact of reminder/recall using bivariate and multivariate analyses, for the entire population, and for subgroups of (a) adolescents (by age, gender, urban/suburban/rural residence); (b) practices (pediatric or family MD, and private office/clinic/health center); and (c) insurance (Medicaid or the State Children's Health Insurance Program). For Aim 3 we will measure and compare costs of the two reminder systems, and their cost-effectiveness, and will assess feasibility and generalizability to different settings. For Aim 4 we will work with experts to disseminate findings. By rigorously evaluating the effectiveness of immunization reminder/recall for adolescents across a wide spectrum of patients and practices, this study will provide critical information for practitioners and immunization and public health leaders to implement strategies to enhance adolescent immunizations and preventive care. Public Health Statement: Immunizations are one of the greatest public health achievements. The new era of adolescent immunizations will require new strategies to protect millions of adolescents from vaccine-preventable diseases including human papilloma virus (HPV), meningococcal vaccine, and tetanus-pertussis vaccine (TdaP). This study evaluates the effectiveness of patient reminder/recall in improving both adolescent immunization delivery and the delivery of other critical adolescent preventive services.