Adolescent Vaccination in the Medical Home: Established and Innovative Strategies

说明(申请人提供)：已有三种新疫苗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，包括缺乏医疗保险、普遍的保健服务利用不足，特别是预防性护理，以及在保健访问期间错过接种疫苗的机会，确保高比例的青少年实际接种这些疫苗可能会被证明是困难的。已经提出了一些加强青少年免疫接种系统的战略，包括改进初级保健医疗机构的青少年疫苗接种程序。此外，在青少年人群中测试的免疫干预措施很少。在目前的提案中，一个在免疫提供研究方面拥有丰富经验的研究小组将调查一个多方面的青少年免疫计划的可行性、有效性、可持续性和成本，以促进医疗院内的疫苗接种。这项研究将在为不同社会经济和种族/民族背景的青少年患者提供服务的不同类型的初级保健实践(包括公共、私人和管理保健环境中的家庭医学和儿科实践)中进行。将在提供者、工作人员和家长中进行定性研究，包括关键线人访谈和焦点小组，以评估各种以实践为基础的战略促进青少年疫苗接种的可行性和可接受性。这些定性数据将被用于制定多方面的青少年免疫计划。然后，我们将进行一项分组随机试验，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，无论是新推荐的疫苗还是多年来推荐的疫苗。来自小组随机试验的行政和电子病历数据也将被用来确定免疫计划对接受其他推荐给青少年的临床预防服务的影响，如健康维护就诊、身高、体重和体重指数测量以及血压筛查。这项调查还将包括成本分析，从实施成本和运作成本两方面衡量青少年免疫方案的成本，以及成本-结果分析，衡量每名儿童接种疫苗的成本。最后，我们将在实施阶段后与提供者和工作人员进行定性访谈，以确定可能促进或阻碍计划可持续性的因素。这项研究的结果将与2010年健康人减少美国本土疫苗可预防疾病数量的目标直接相关。 与公共卫生相关：虽然有几种推荐给青少年的重要新疫苗，但确保青少年真正接种这些疫苗将是困难的，特别是因为大多数青少年没有定期得到他们的初级保健提供者的帮助。在这个项目中，我们将制定、实施和评估青少年疫苗接种计划，该计划旨在鼓励青少年去他们通常的初级保健提供者那里接受疫苗接种和其他推荐的预防性卫生服务。这项研究将在不同类型的初级保健环境中进行，例如为不同背景的青少年患者提供服务的公立、私立和管理性保健诊所，并将提供重要信息，以帮助指导未来的公共卫生努力，以实现青少年的高接种率。

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.