Strategies to Vaccinate all Children for Influenza in a Practice Setting

说明(由申请人提供)：2008年，免疫实践咨询委员会(ACIP)扩大了每年接种流感疫苗的建议，将所有6个月至18岁的儿童包括在内。要实现所有儿童的高流感覆盖率，将需要大幅增加初级保健就诊，并可能在实践和卫生保健系统一级改变接生做法。在目前的提案中，一个在免疫接种研究方面拥有丰富经验的研究小组将调查创新的办公室和公私合作战略的可行性和有效性，以便在不同的实践环境中向儿童提供流感疫苗。这项研究将包括四种类型的临床环境，包括城市儿科和城市家庭医学实践，城市管理保健组织(MCO)地点和农村家庭医学实践。将招募每一种做法类型和临床环境中类似做法的小组，并将其随机分配到干预组或对照组。在拨款的第一年，将在干预地点的家长中开展重点小组，以评估各种促进流感疫苗接种的策略的可行性和可接受性。干预做法将与研究小组合作，并了解患者的态度和偏好，制定以办公室为基础的干预措施，包括在实践中识别高危患者的方法，以及在实践中最大限度地为这些儿童接种疫苗的方法，使用患者提醒、下班后流感诊所、提供流感疫苗，以及更加重视关于免疫接种必要性的教育。这些诊所还将与其县公共卫生部门和来访的护理协会合作，开发公私合作干预措施，其中可能包括为学龄儿童提供多种诊所的大型诊所，以及在供应延迟或不足时跟踪流感供应和在诊所之间重新分发流感疫苗。在第二年，我们将进行一项团体随机试验，以确定免疫接种计划的有效性。研究小组将跟踪在执行以办事处为基础的干预措施和公私干预措施期间的重要进程措施，以确定执行成功的程度，并查明成功的障碍。我们还将在干预实践和参与的公共卫生部门中进行有组织的访谈，以评估提供者和工作人员对其设置的公私合作提供障碍和改进流程的方法的看法。最后，在两个干预实践中，我们将检查父母对实施的基于办公室的干预和公私合作干预的态度。第二年年底获得的定性数据将用于修改第三年的干预措施，第三年获得的数据将评估干预措施的可持续性。 公共卫生相关性：2008年，免疫实践咨询委员会S建议将流感疫苗接种范围扩大到所有6个月至18岁的儿童，这极大地增加了初级保健提供者每年需要接种疫苗的儿童数量。该项目将帮助招募的实践发展创新的基于实践的和公私合作的干预措施，旨在实现实践中儿童流感的高覆盖率。然后将使用整群随机设计在四种类型的实践环境中测试这些干预措施的有效性、可行性和可持续性。这四种实践环境分别是城市儿科、城市家庭医学、城市管理的保健组织和农村家庭医学实践。

DESCRIPTION (provided by applicant): In 2008, the Advisory Committee on Immunization Practices (ACIP) expanded recommendations for yearly influenza vaccination to include all children 6 months to 18 years. Achieving high influenza coverage rates for all children will require a substantial increase in primary care visits and, potentially, changes in delivery practices both at the level of the practice and the health care system. In the current proposal, a study team with extensive experience in immunization delivery research will investigate the feasibility and effectiveness of innovative office-based and private-public collaborative strategies for the delivery of influenza vaccine to children in different practice settings. The study will include four types of clinical settings including urban pediatric and urban family medicine practices, urban managed care organization (MCO) sites and rural family medicine practices. Groups of similar practices within each of these practice types and clinical settings will be recruited and randomized to either intervention or control arms. During the first year of the grant, focus groups will be conducted among parents at intervention sites to assess the feasibility and acceptability of various strategies to promote influenza vaccination. In collaboration with the study team, and informed by patient attitudes and preferences, intervention practices will develop office-based interventions including methods to identify high-risk patients within their practices and methods of maximizing the immunization of these children within the practice, use of patient reminders, after-hours influenza clinics, walk-in provision of influenza vaccine and increased focus on education regarding the need for immunization. The practices will also collaborate with their county public health departments and visiting nursing associations to develop private-public collaborative interventions that may include large clinics for school-aged children for multiple practices and tracking of influenza supplies and redistribution of influenza vaccine between practices when supplies are delayed or inadequate. During the second year, we will conduct a group-randomized trial to determine the effectiveness of the immunization delivery program. The study team will track important process measures during implementation of both the office-based and private-public interventions in order to determine the degree to which implementation was successful and to identify impediments to success. We will also conduct structured interviews in the intervention practices and the participating public health departments to assess provider and staff perceptions regarding barriers to private-public collaborative delivery in their settings and means of improving the process. Finally, in two intervention practices we will examine parental attitudes about the office-based and private-public collaborative interventions that were implemented. Qualitative data obtained at the end of year 2 will be used to modify the intervention in year 3 and data obtained in year 3 will assess the sustainability of the interventions. PUBLIC HEALTH RELEVANCE: Expansions in the Advisory Committee on Immunization Practices (ACIP)'s 2008 recommendations for influenza vaccination to include all children 6 months to 18 years has dramatically increased the volume of children primary care providers need to vaccinate on a yearly basis. This project will assist recruited practices in the development of innovative practice-based and private-public collaborative interventions aimed at achieving high rates of influenza coverage among children in the practices. The effectiveness, feasibility, and sustainability of these interventions will then be tested using a cluster-randomized design in four types of practice settings, urban pediatric, urban family medicine, urban managed care organization and rural family medicine practices.