Adolescent Vaccination in the Medical Home: Established and Innovative Strategies

描述（由申请人提供）：三种新疫苗已获得许可并推荐用于青少年。鉴于青少年在接种疫苗方面面临许多障碍，包括缺乏健康保险、一般医疗保健利用不足，特别是预防保健利用不足，以及在就诊期间错过接种疫苗的机会，确保较高比例的青少年实际接种这些疫苗可能是困难的。已提出若干战略，以加强青少年免疫接种提供系统，包括改进初级保健医疗所的青少年免疫接种程序。此外，在青少年人群中试验的免疫干预措施很少。在目前的提案中，一个在免疫接种研究方面具有丰富经验的研究小组将调查多方面青少年免疫接种计划的可行性、有效性、可持续性和成本，以促进在医疗家中接种疫苗。该研究将在不同类型的初级保健实践中进行（包括公立、私立和管理护理环境中的家庭医学和儿科实践），为不同社会经济和种族/民族背景的青少年患者提供服务。将在提供者、工作人员和家长中进行定性研究，包括关键信息提供者访谈和焦点小组，以评估促进青少年疫苗接种的各种基于实践的战略的可行性和可接受性。这些定性数据将用于制定多方面的青少年免疫规划。然后，我们将进行一项组随机试验，以确定该免疫计划在提高青少年免疫接种率方面的有效性，包括新推荐的疫苗和推荐多年的疫苗。来自组随机试验的行政和电子医疗记录数据也将用于确定免疫计划对接受推荐给青少年的其他临床预防服务的影响，如健康维护访问、身高、体重和身体质量指数测量以及血压筛查。这项调查还将包括成本分析，从实施成本和运营成本两方面衡量青少年免疫规划的成本，以及成本-结果分析，衡量每个儿童接种疫苗的成本。最后，我们将在实施阶段后对提供者和工作人员进行定性访谈，以确定可能促进或阻碍项目可持续性的因素。这项研究的结果将直接关系到2010年健康人的目标，即减少美国本土疫苗可预防疾病的数量

DESCRIPTION (provided by applicant): Three new vaccines have been licensed and recommended for use in adolescents. Ensuring that a high proportion of adolescents actually receive these vaccines may prove difficult, given that adolescents face many barriers to vaccination, including lack of health insurance, under-utilization of health care in general, and preventive care in particular, and missed opportunities for vaccination during health care visits. A number of strategies have been proposed to strengthen the adolescent immunization delivery system, including improving adolescent vaccination processes in primary care medical homes. Additionally, few immunization interventions have been tested in adolescent populations. In the current proposal, a study team with extensive experience in immunization delivery research will investigate the feasibility, effectiveness, sustainability, and cost of a multi-faceted adolescent immunization program to promote vaccination within the medical home. The study will be conducted in different types of primary care practices (including family medicine and pediatric practices in public, private, and managed care settings) serving adolescent patients of diverse socioeconomic and racial/ethnic backgrounds. Qualitative research, consisting of key informant interviews and focus groups, will be conducted among providers, staff, and parents to assess the feasibility and acceptability of various practice-based strategies to promote adolescent vaccination. These qualitative data will be utilized to develop a multi-faceted adolescent immunization program. We will then conduct a group-randomized trial to determine the effectiveness of this immunization program in improving adolescent immunization rates, both for newly recommended vaccines and those recommended for many years. Administrative and electronic medical record data from the group-randomized trial will also be used to determine the impact of the immunization program on the receipt of other clinical preventive services recommended for adolescents, such as health maintenance visits, height, weight, and body mass index measurement, and blood pressure screening. This investigation will also include a cost analysis, measuring the cost of the adolescent immunization program, both in terms of implementation costs and operating costs, as well as a cost-outcome analysis, measuring the cost per child vaccinated. Finally, we will conduct qualitative interviews with providers and staff after the implementation phase, to determine the factors which may facilitate or hamper sustainability of the program. Findings from this study will be directly relevant to Healthy People 2010 goals of reducing the number of indigenous vaccine-preventable diseases in the U.S. PUBLIC HEALTH RELEVANCE: While there are several important new vaccines recommended for adolescents, ensuring that adolescents actually receive these vaccines will be difficult, particularly because most adolescents are not regularly seen by their primary care provider. In this project, we will develop, implement, and evaluate an adolescent vaccination program, with the program designed to encourage adolescents to visit their usual primary care provider to receive vaccinations and other recommended preventive health services. This study will be conducted in different types of primary care settings, such as public, private, and managed care clinics serving adolescent patients of diverse backgrounds, and will provide important information to help guide future public health efforts to achieve high rates of immunization in adolescents.