From Innovation to Solutions: Autodialers, Use of Early Autumn Physicals and Vac

描述（由申请人提供）：2008年，CDC扩大了流感疫苗接种的适应症，包括6个月至18岁的儿童，大大增加了合格儿童的数量。 由于工作量增加，而且青少年进行健康监督的次数减少，因此需要采取创新战略，提高疫苗接种率。 在第一年，我们将确定和制定战略，以增加流感疫苗接种的儿童在实践环境中，使用创新理论的扩散。 将通过文献综述和阿勒格尼县免疫联盟成员和家长的重点小组进行鉴定。 然后，我们将开发和形成性地评估新的，电子，大众媒体信息针对家长和青少年，使用我们的教学发展中心和当地媒体的图形专业知识。 接下来，我们将制定一套策略来提高接种率，包括工具包、长期订单、快速接种诊所、重新设计工作流程以评估生命体征期间的接种状况、提前开始8月份的接种季节，使用减毒活流感疫苗以及自动拨号提醒。我们还将与初级保健实践合作，教育临床医生，通过审查文件和与宾夕法尼亚州的全州免疫信息系统（PA-SIIS）合作，加强电子记录保存。 我们将对一些拟议的干预措施进行试点测试。 为了实现目标2，在第二年，我们将对20种不同做法进行分层、随机分组试验，以比较干预和对照地点的疫苗接种率。 干预地点将使用一套新开发的循证技术，这些技术将根据其实践结构和文化进行调整。家庭护理做法将得不到这种援助。 两个不同的基于实践的研究网络将是研究的重点。 我们将使用混合方法评估干预的成功，包括定性（例如，焦点小组）、过程和量化措施。 由于患者聚集在诊所，因此将进行分层线性建模，并将包括与疫苗接种相关的干预措施和实践因素的实施保真度。 我们的多学科团队在基于实践的疫苗接种障碍和促进因素研究以及开展试验方面具有丰富的经验。 我们建议在网上传播工具包和干预材料。 公共卫生相关性：免疫实践咨询委员会提出的为所有6个月至18岁儿童接种流感疫苗的新建议将需要创新战略，以提高以前疫苗接种率低的群体的疫苗接种率。该项目将使用各种方法来确定和制定一揽子干预措施，以提高儿童的流感疫苗接种率。 这些策略将在初级保健实践的分层随机群集试验中进行测试。

DESCRIPTION (provided by applicant): In 2008, the CDC expanded the indications for influenza vaccination to encompass children ages 6 months through 18 years, dramatically increasing the number of eligible children. Innovative strategies to increase vaccination rates are needed due to the increased workload and to the fact that adolescents make fewer health supervision visits. During the first year, we will identify and develop strategies to increase influenza vaccination of children in practice settings, using the Diffusion of Innovation Theory. Identification will occur by a literature review and by focus groups of Allegheny County Immunization Coalition members and parents. Then, we will develop and formatively evaluate new, electronic, mass media messages targeting parents and teens, using graphic expertise in our Center for Instructional Development and local media. Next, we will develop a package of strategies to increase rates including a toolkit, standing orders, express vaccination clinics, workflow redesign to assess vaccination status during vital signs, early start to the vaccination season in August using live attenuated influenza vaccine, and autodialed reminders. We will also work with primary care practices to educate clinicians, to enhance electronic record keeping by reviewing documentation and by collaborating with Pennsylvania's Statewide Immunization Information System (PA-SIIS). We will conduct a pilot test of some of the proposed interventions. To address Aim 2, in the second year, we will conduct a stratified, randomized cluster trial of 20 diverse practices to compare vaccination rates in intervention and control sites. Intervention sites will use a package of newly developed and evidence-based techniques that will be tailored to their practice structure and culture. Usual care practices will not receive such assistance. Two diverse practice-based research networks will be the focus of the study. We will evaluate the success of the intervention using a mixed methods approach, including qualitative (e.g., focus groups), process, and quantitative measures. As the patients are clustered in clinics, hierarchical linear modeling will be conducted and will include the fidelity of implementation of the intervention and practice factors associated with vaccination. Our multidisciplinary team has experience in practice-based research on barriers and facilitators to vaccination and in conducting trials. We propose to disseminate the toolkit and intervention materials on the web. PUBLIC HEALTH RELEVANCE: New recommendations by the Advisory Committee for Immunization Practices to vaccinate all children ages 6 months through 18 years against influenza will require innovative strategies to increase vaccination rates among groups with previously low vaccine uptake. This project will use a variety of methods to identify and develop a package of interventions to increase influenza vaccination rates among children. These strategies will be tested in a stratified random cluster trial of primary care practices.