San Diego-Influenza Coverage Extension (SD-ICE)

描述（由申请人提供）： 尽管有有效的疫苗，但流感疫苗的覆盖率仍然远远低于2010年健康人目标。绝大多数年度流感疫苗接种是在12月至12月期间提供的。这是由于疫苗的可用性、提供者的做法和公众的期望。建议每年接种疫苗的群体的扩大意味着目前提供者的能力将受到挑战。如果建议和疫苗供应扩大到包括整个人口，供应商和公共卫生能力将受到严重考验。由于流感病例的季节性高峰在2月份最为常见，因此将季节性高峰期延长到2月份是一个可行的策略。我们建议与不同样本的医疗提供者合作，通过促进使用基于证据的干预措施来提高年度流感覆盖率，以提高免疫覆盖率的扩大（ICE）。预期的主要干预措施包括：患者和提供者提醒/召回系统（包括电子病历系统和该县基于网络的免疫登记处中的系统），长期订单以及对提供者的评估和反馈。许多干预措施建立在提供者和我们县免疫分支的现有能力之上。主要目标是将这些干预措施的使用延长到2月。为了实现这一扩展，我们将调查ICE的障碍，评估变革的准备和能力，并准备“工具包”以促进实践变革。为了更好地进行比较，在初步评估后，我们计划将分层或匹配的实践地点分为两个干预级别：强化和仅提供信息。为了评估覆盖范围的变化，干预措施的采用模式以及提供者做法的其他变化，我们将对所有做法进行后续评估。将采用定性和定量调查相结合的方法从实践中收集信息。主要结果包括流感疫苗覆盖率的变化和减少错过接种流感疫苗的机会。成本分析将评估延长疫苗接种季节所产生的增量成本。总结性评价将包括评估各种做法如何克服障碍、选择和实施干预措施以及延长季节的可持续性前景。

DESCRIPTION (provided by applicant): Despite the availability of an effective vaccine, influenza vaccine coverage levels remain far below Health People 2010 goals. The vast majority of annual influenza vaccinations are provided during the months of October-December. This is due to the availability of vaccine, provider practices and public expectations. The expansion of the groups recommended for annual vaccination means that current provider capabilities will be challenged. If recommendations and vaccine availability are expanded to include the entire population, provider and public health capacity will be severely tested. Since the seasonal peak in influenza cases is most common in February, expanding the season into the month of February is a viable strategy. We propose to work with a diverse sample of medical providers to improve annual influenza coverage by promoting use of evidence based interventions shown to improve immunization coverage expansion (ICE). The primary interventions anticipated include: patient and provider reminder/recall systems (including those incorporated in electronic medical record systems and the County's web-based immunization registry), standing orders, and assessment and feedback for providers. Many of the interventions build upon existing capabilities of providers and our County Immunization Branch. The primary goal will be to extend use of these interventions through February. To accomplish this expansion, we will investigate barriers to ICE, assess readiness and capacity for change, and prepare "tool kits" to facilitate practice changes. To allow better comparisons, after initial assessment we plan to allocate stratified or matched practice sites into two levels of intervention; intensive and information only. To assess the changes in coverage, patterns of intervention adoption and other changes in provider practices we will conduct follow-up assessments in all practices. Information will be collected from practices using a combination of qualitative and quantitative surveys. Primary outcomes include change in influenza vaccine coverage rate and reduction of missed opportunities to administer influenza vaccine. Cost analysis will assess incremental costs incurred to extend the vaccination season. Summative evaluation will include assessment of how practices overcome barriers, select and implement interventions as well as prospects for sustainability of an extended season.