Strategies to Vaccinate all Children for Influenza in a Practice Setting

描述（由申请人提供）：2008年，免疫实践咨询委员会（ACIP）扩大了每年接种流感疫苗的建议，包括所有6个月至18岁的儿童。为所有儿童实现高流感覆盖率，将需要大幅增加初级保健就诊，并可能在实践和卫生保健系统层面改变提供做法。在目前的提议中，一个在免疫接种研究方面具有丰富经验的研究小组将调查在不同实践环境中向儿童提供流感疫苗的创新办公室和公私合作战略的可行性和有效性。该研究将包括四种类型的临床设置，包括城市儿科和城市家庭医学实践，城市管理医疗组织（MCO）网站和农村家庭医学实践。在这些实践类型和临床环境中，将招募相似实践的组，并随机分为干预组或对照组。在拨款的第一年，我们会在干预地点的家长中组织焦点小组，评估各种推广流感疫苗策略的可行性和可接受性。通过与研究小组合作，并根据患者的态度和偏好，干预实践将制定基于办公室的干预措施，包括在其实践中识别高风险患者的方法，以及在实践中最大限度地为这些儿童接种疫苗的方法，使用患者提醒，下班后流感诊所，提供流感疫苗，以及更加注重关于免疫需求的教育。这些诊所还将与其所在县的公共卫生部门和来访的护理协会合作，制定公私合作干预措施，其中可能包括为学龄儿童提供多种诊所，跟踪流感供应情况，并在供应延迟或不足时在诊所之间重新分配流感疫苗。在第二年，我们将进行一项分组随机试验，以确定免疫交付计划的有效性。研究小组将在办事处和公私干预措施的执行过程中跟踪重要的过程措施，以确定执行的成功程度，并查明成功的障碍。我们还将在干预做法和参与的公共卫生部门进行结构化访谈，以评估提供者和工作人员对在其环境中公私合作提供服务的障碍的看法，以及改进这一过程的方法。最后，在两个干预实践中，我们将检查家长对实施的办公室干预和公私合作干预的态度。第二年末获得的定性数据将用于修改第三年的干预措施，第三年获得的数据将用于评估干预措施的可持续性。

DESCRIPTION (provided by applicant): In 2008, the Advisory Committee on Immunization Practices (ACIP) expanded recommendations for yearly influenza vaccination to include all children 6 months to 18 years. Achieving high influenza coverage rates for all children will require a substantial increase in primary care visits and, potentially, changes in delivery practices both at the level of the practice and the health care system. In the current proposal, a study team with extensive experience in immunization delivery research will investigate the feasibility and effectiveness of innovative office-based and private-public collaborative strategies for the delivery of influenza vaccine to children in different practice settings. The study will include four types of clinical settings including urban pediatric and urban family medicine practices, urban managed care organization (MCO) sites and rural family medicine practices. Groups of similar practices within each of these practice types and clinical settings will be recruited and randomized to either intervention or control arms. During the first year of the grant, focus groups will be conducted among parents at intervention sites to assess the feasibility and acceptability of various strategies to promote influenza vaccination. In collaboration with the study team, and informed by patient attitudes and preferences, intervention practices will develop office-based interventions including methods to identify high-risk patients within their practices and methods of maximizing the immunization of these children within the practice, use of patient reminders, after-hours influenza clinics, walk-in provision of influenza vaccine and increased focus on education regarding the need for immunization. The practices will also collaborate with their county public health departments and visiting nursing associations to develop private-public collaborative interventions that may include large clinics for school-aged children for multiple practices and tracking of influenza supplies and redistribution of influenza vaccine between practices when supplies are delayed or inadequate. During the second year, we will conduct a group-randomized trial to determine the effectiveness of the immunization delivery program. The study team will track important process measures during implementation of both the office-based and private-public interventions in order to determine the degree to which implementation was successful and to identify impediments to success. We will also conduct structured interviews in the intervention practices and the participating public health departments to assess provider and staff perceptions regarding barriers to private-public collaborative delivery in their settings and means of improving the process. Finally, in two intervention practices we will examine parental attitudes about the office-based and private-public collaborative interventions that were implemented. Qualitative data obtained at the end of year 2 will be used to modify the intervention in year 3 and data obtained in year 3 will assess the sustainability of the interventions. PUBLIC HEALTH RELEVANCE: Expansions in the Advisory Committee on Immunization Practices (ACIP)'s 2008 recommendations for influenza vaccination to include all children 6 months to 18 years has dramatically increased the volume of children primary care providers need to vaccinate on a yearly basis. This project will assist recruited practices in the development of innovative practice-based and private-public collaborative interventions aimed at achieving high rates of influenza coverage among children in the practices. The effectiveness, feasibility, and sustainability of these interventions will then be tested using a cluster-randomized design in four types of practice settings, urban pediatric, urban family medicine, urban managed care organization and rural family medicine practices.