BE IMMUNE: Behavioral Economics to Improve and Motivate vaccination Using Nudges through the EHR

项目摘要/摘要 流感、肺炎球菌病和带状疱疹等疫苗可预防的疾病会导致显著的发病率， 住院和老年人死亡。在美国，疫苗接种率多年来基本保持不变 在种族和少数族裔群体中，这十年的比率较低。需要新的、可扩展的方法来解决这个问题 重要的公共卫生问题。 轻推是对提供选择的方式或信息框架的改变，可能会对行为产生过大的影响。 例如，默认选项是阻力最小的路径，以及未选择替代方案时发生的操作。 主动选择是一种现在就提示决策的方法，而不是等待利益相关者认识到需要 自己做决定。我们在宾夕法尼亚大学(宾夕法尼亚大学医学院)和宾夕法尼亚大学的团队 华盛顿(UW Medicine)已经组建了嵌入我们医疗系统运营的行为设计团队 并展示了这些类型的轻推如何提高医疗保健价值和患者结果。自电子以来 健康记录(EHR)已被美国90%以上的临床医生采用，这一可扩展的技术平台是 实现和部署这些类型的微调的最佳环境。 在这项研究中，我们建议设计、测试和实现针对临床医生和患者的个性化轻推，以达到目标障碍 在高危亚群中提高疫苗接种率。我们将在两个医疗系统进行试点，然后实施 在退伍军人健康系统中的这些医疗系统和站点进行务实的试验。在R61阶段，我们将重点关注 以下是针对宾夕法尼亚大学医学院和华盛顿大学医学院的。目标1：使用电子病历数据和分析方法识别高危人群 流感、肺炎球菌病和带状疱疹的接种率低于最佳接种率的老年人群体。目标2： 评估向临床医生和患者实施不同类型的个性化推送的可行性，以针对 确定了提高老年人疫苗接种率的群体。目标3：试行个性化有前途的方法 敦促临床医生和患者改善老年人的疫苗接种。 在R33阶段，我们将重点关注以下目标：宾夕法尼亚医学、威斯康星州医学和退伍军人健康系统。目标 1：进行为期12个月的多点、整群随机、务实的试验，以评估个性化治疗的效果 敦促临床医生和患者相对于对照提高老年人的疫苗接种率。目标2：评估 干预措施在减少与种族和族裔有关的疫苗接种率差距方面的有效性 社会经济因素。目的3：评估临床医生、患者和实践中治疗效果的异质性 在未来的干预设计中进一步调整方法的特点。

PROJECT SUMMARY/ABSTRACT Vaccine-preventable diseases such as influenza, pneumococcal disease, and shingles lead to significant rates of illness, hospitalization, and death among older adults. In the United States, vaccination rates have been mostly unchanged for a decade with lower rates among racial and ethnic minority groups. New and scalable approaches are needed to address this important public health issue. Nudges are changes to the way choices are offered or information is framed that can have outsized effects on behavior. For example, default options are the path of least resistance and the action that takes place if no alternatives are selected. Active choice is a method that prompts a decision-making now, rather than waiting for stakeholders to recognize the need to make the decision on their own. Our groups at the University of Pennsylvania (Penn Medicine) and the University of Washington (UW Medicine) have formed behavioral design teams embedded within the operations of our health systems and have demonstrated how these types of nudges can improve health care value and patient outcomes. Since electronic health records (EHRs) have been adopted by more than 90% of clinicians in the US, this scalable technology platform is an optimal environment to implement and deploy these types of nudges. In this study, we propose to design, test, and implemented personalized nudges to clinicians and patients to target barriers among high-risk subgroups to improve vaccination rates. We will pilot this at two health systems and then implement a pragmatic trial at those health systems and sites in the VA Health System. In the R61 phase, we will focus on the following aims at Penn Medicine and UW Medicine. Aim 1: To use EHR data and analytical methods to identify high-risk groups of older adults with suboptimal vaccination rates for influenza, pneumococcal disease, and herpes zoster. Aim 2: To assess the feasibility of implementing different types of personalized nudges to clinicians and patients to target the identified groups to improve vaccination rates among older adults. Aim 3: To pilot test ways to personalize promising nudges to clinicians and patients for improving vaccination among older adults. In the R33 phase, we will focus on the following aims at Penn Medicine, UW Medicine, and the VA Health System. Aim 1: To conduct a 12-month, multisite, cluster randomized, pragmatic trial to evaluate the effectiveness of personalized nudges to clinicians and patients relative to control to improve vaccination rates among older adults. Aim 2: To evaluate the effectiveness of the intervention on reducing disparities in vaccination rates related to race/ethnicity and socioeconomic factors. Aim 3: To evaluate heterogeneity in treatment effect across clinician, patient, and practice characteristics to further tailor approaches in future intervention design.