AFIX-OB: A Customizable Quality Improvement Intervention to Increase Maternal Vaccine Uptake

项目总结 孕妇特别容易感染流感，而她们的婴儿面临的风险最大。 百日咳感染的严重后果。因此，季节性流感和破伤风、白喉 建议妇女在每次怀孕期间接种百日咳(Tdap)疫苗。然而，覆盖率 保持在较低的水平，两种疫苗的接种率都很少超过50%，距离2020年健康人群80%的目标相去甚远 覆盖范围。 孕妇获得疫苗的障碍已经得到了很好的描述，人们对 疫苗的安全性，缺乏提供者的推荐，以及获得疫苗/资金障碍 储存疫苗是一些主要障碍。虽然有各种干预措施需要解决 临床环境中的这些障碍，两者都集中在特定的障碍(即患者教育)以及 多模式干预措施包，这些干预措施对孕产妇接种疫苗的有效性为 多种多样。 显然需要一个框架来确定和应用“最佳实践”的质量 改善干预措施。AFIX(评估、反馈、激励、交流)模型由 国家免疫计划在儿童免疫接种的儿科保健环境中做到了这一点。 该模型评估实践的基线免疫接种率和免疫提供实践，并 将这些信息在同行做法之间进行比较，促进竞争以提高免疫率。 然后实践者选择那些直接解决免疫障碍的质量改进干预措施 在他们的实践中面临着交付。 在拟议的项目中，我们将评估AFIX-OB的有效性，这是我们对传统AFIX的改编 模式，以改善产科护理环境中的孕产妇免疫接种。我们首先要深入利用 与患者和提供者的访谈以完善循证质量改进的选择 将提供给实践的干预措施。然后我们将使用整群随机试验来评估影响 AFIX-OB模型在社会人口学不同的产科人群中的孕产妇免疫接种情况 耶鲁大学纽黑文卫生系统内的护理诊所。 如果有效，AFIX-OB框架有可能在各种产科护理中广泛实施 通过支持产科护理人员解决产科护理人员在 实践层、提供者层和患者层。

PROJECT SUMMARY Pregnant women are at particular risk of negative outcomes from influenza and their infants face the most serious outcomes from pertussis infections. For this reason, the seasonal influenza and the Tetanus, diphtheria and pertussis (Tdap) vaccines are recommended for women during every pregnancy. However, coverage rates remain low with rates rarely exceeding 50% for either vaccine, far from the Healthy People 2020 goal of 80% coverage. The barriers to vaccine receipt among pregnant women have been well characterized, with concerns about the safety of the vaccine, lack of a provider recommendation and access to the vaccine/financial barriers to stocking the vaccine being some of the primary barriers. While there exist a variety of interventions to address these barriers in the clinical setting, both ones that focus on specific barriers (i.e. patient education) as well as multi-modal packages of interventions, the effectiveness of these interventions on maternal vaccine uptake are varied. There is a clear need for a framework that can be used to determine and apply the ‘best practice’ quality improvement interventions. The AFIX (Assessment, Feedback, Incentive, eXchange) model was developed by the National Immunization Program to do just that in the pediatric care setting for childhood immunizations. The model evaluates a practice’s baseline immunization rates and immunization delivery practices and compares this information between peer practices, promoting competition to improve immunization rates. Practices then select those quality improvement interventions that directly address the barriers to immunization delivery faced in their practice. In the proposed project, we will evaluate the effectiveness of AFIX-OB, our adaptation of the traditional AFIX model, for improving maternal immunization delivery in the obstetric care setting. We will first utilize in-depth interviews with patients and providers to refine the selection of evidence-based quality improvement interventions that will be offered to practices. Then we will use a cluster-randomized trial to evaluate the impact of the AFIX-OB model on maternal immunization uptake in a socio-demographically diverse set of obstetric care clinics within the Yale New Haven Health System. If efficacious the AFIX-OB framework has the potential to be widely implemented in a variety of obstetric care settings to improve vaccine uptake by supporting obstetric care providers as they address barriers at the practice, provider and patient levels.