Adolescent Vaccination in the Medical Home

描述（由申请人提供）：该项目的总体目标是提高国家在初级保健实践（医疗之家）中为青少年接种疫苗的能力。 大多数青少年都有一个医疗之家，以前的研究表明，需要加强医疗之家，以有效地为青少年接种疫苗。 该项目将确定并严格评估一项可行和可持续的战略，以改善医疗之家内的青少年疫苗接种。 我们将与两个以初级保健实践为基础的研究网络（PBRN）-一个区域网络（85个实践）和一个以学术为基础的医疗之家（110个实践）的国家网络合作，以评估多组分青少年疫苗接种策略。 该策略将在不同的医疗家庭中进行评估，这些家庭因专业（儿科，家庭医学），患者人群（高收入和低收入），实践类型（私人，诊所，健康中心）和教学角色（有和没有居民的实践）而异。目的是：1.对网络中所有做法的从业人员进行形成性定量调查，并对从业人员和家长进行定性访谈，以确定可行和可持续的青少年疫苗接种战略。 我们将使用一种改进的德尔菲技术来选择最优的策略进行评估; 2.设计并实施一项随机对照试验，在每个PBRN内采用6种干预措施和6种标准治疗对照措施（n=24）。 我们将使用标准化图表审查（n= 3，840名青少年，每次实践160名）来衡量免疫接种的基线率，错过的机会，预防性访视和其他访视。 我们将实施多组件策略;并在18个月随访时评估相同的措施。我们将使用双变量和多变量分析来评估策略对整个人群以及患者和实践类型亚组的关键指标的影响; 3.在18个月干预前后，通过评估《青少年预防服务指南》中的预防性访问和服务，评估该战略对接受预防服务的影响; 4.评估成本和成本效益，以及战略的可行性，使用标准化的评估人员/非人员资源和医生的调查，以衡量的看法; 5.与顾问和国家组织（AAP、AAFP、阿帕、SAM、CDC）合作，传播研究结果;为医疗之家开发工具包，以实施青少年疫苗接种的最佳战略。 我们的团队一直处于儿童，成人和现在的青少年免疫接种研究的最前沿。我们在涉及医疗之家的干预措施以及资源和成本分析方面有着长期的经验。 通过严格评估一个可行的基于实践的战略在广泛的患者和实践的有效性，这项研究将提供关键信息的从业人员和领导人在免疫和公共卫生实施战略，以加强青少年免疫接种和预防保健。 公共卫生相关性：由于最近推荐了三种新的青少年疫苗（脑膜炎球菌、百日咳和HPV疫苗）和两种新的青少年疫苗（流感和水痘），青少年疫苗接种已成为公共卫生的一个新的主要优先领域。目前，青少年疫苗接种率很低。 初级保健实践或医疗之家是美国大多数青少年的主要医疗保健来源，但需要证据证明在医疗之家内采取可行和可持续的战略，以优化青少年疫苗接种。 这项研究将为儿科，青少年医学和公共卫生提供关键信息，关于青少年接种疫苗的实用策略，这些策略的成本，以及通过加强青少年在医疗之家的疫苗接种来改善其他预防服务的潜在溢出效益。

DESCRIPTION (provided by applicant): The overall goal of this project is to enhance the nation's ability to vaccinate adolescents in primary care practices (medical homes). Most adolescents have a medical home, and prior studies demonstrate that enhancements are needed in medical homes to efficiently vaccinate adolescents. The project will identify and rigorously evaluate a feasible and sustainable strategy for improving adolescent vaccinations within medical homes. We will work with two primary care practice-based research networks (PBRNs)-a regional network (85 practices) and a national network of academic-based medical homes (110 practices), to evaluate a multi-component adolescent vaccination strategy. This strategy will be evaluated in a diverse spectrum of medical homes that vary by specialty (pediatrics, family medicine), patient population (high and lower income), practice type (private, clinic, health center), and teaching role (practices with and without residents). The aims are to: 1. Perform formative quantitative surveys of practitioners from all practices in the networks and qualitative interviews of practitioners and parents to identify feasible and sustainable adolescent vaccination strategies. We will use a modified Delphi technique to select the most optimal strategy to evaluate; 2. Design and implement a randomized controlled trial, with 6 intervention practices and 6 standard-of-care control practices within each PBRN (n=24 practices). We will use standardized chart reviews (n=3,840 adolescents, 160 per practice) to measure baseline rates of immunizations, missed opportunities, preventive visits, and other visits. We will implement a multi-component strategy; and asses the same measures at 18-month follow-up. We will use bivariate and multivariate analyses to assess the impact of the strategy on the key measures, for the entire population and for subgroups of patients and practice types; 3. Evaluate the impact of the strategy on receipt of preventive services by assessing preventive visits and services from the Guidelines for Adolescent Preventive Services, before and after the 18m intervention; 4. Evaluate costs and cost-effectiveness, as well as the feasibility of the strategy, using standardized assessments of personnel/non-personnel resources and surveys of physicians to gauge perceptions; 5. Work with consultants and national organizations (AAP, AAFP, APA, SAM, CDC) to disseminate findings; develop a toolkit for medical homes to implement best strategies for adolescent vaccinations. Our team has been at the forefront of research in childhood, adult, and now adolescent immunization delivery. We have longstanding experience in interventions involving medical homes, and analyses of resources and costs. By rigorously evaluating the effectiveness of a feasible practice-based strategy across a wide spectrum of patients and practices, this study will provide critical information for practitioners and leaders in immunization and public health to implement strategies to enhance adolescent immunizations and preventive care. PUBLIC HEALTH RELEVANCE: Due to the recent recommendation of three new adolescent vaccines (meningococcus, pertussis, and HPV vaccines) and two new vaccine recommendations for adolescents (influenza and varicella), adolescent vaccinations have become a major new priority area for public health. Currently, adolescent vaccination rates are low. Primary care practices or medical homes are the major sources of healthcare for the majority of adolescents across the US, yet evidence is needed for feasible and sustainable strategies, within medical homes, to optimize adolescent vaccination delivery. This study will provide critical information for pediatrics, adolescent medicine, and public health regarding practical strategies for vaccinating adolescents, the cost of these strategies, and the potential spillover benefits for improving other preventive services by enhancing vaccination of adolescents in medical homes.