GIVEASHOT - Georgia Initiative to VaccinatE during Admission or SHOrt Stay VisiTs

1项目摘要/摘要： 2. 3由经验丰富的临床医生、信息技术专家、公共卫生领导和沟通人员组成的团队 4名专家提出GIVEASHOT项目-佐治亚州倡议在入院或短期内接种疫苗 5次逗留访问。这项研究在埃默里大学中城医院和格雷迪健康系统公司进行，截然不同 6个系统，为亚特兰大庞大、多样化和医疗服务不足的患者群体提供服务。目标是确定 分析成人住院和短期免疫接种差距(24小时观察和临床决策) 8个单位，并根据疾控中心成人免疫做法标准制定和评估干预措施，以 9.缩小这些差距。工作将在3年内分三个阶段进行。第一阶段涉及具体目标1：评估 10现有的疫苗接种政策、做法以及住院和短期住院病房的疫苗接种覆盖面。我们会 11进行环境扫描，并与主要信息者(行政、医学、护理、 12药学、信息技术)，以了解确定免疫需求的政策和做法， 13访问佐治亚州免疫登记处(GRITS)，提供和记录疫苗(目标 14(1A)。我们将回顾电子健康记录(EHR)数据库和1000名患者的回顾样本 每个机构15个记录，以衡量所需、提供和记录的疫苗的流行率；记录将 16与GRITS进行比较，以评估疫苗覆盖率和信息共享(目标1B)。采访和3- 17人焦点小组将测量提供者和患者对住院患者的知识、态度和信念 18成人接种疫苗(目标1C)。在第二阶段，我们将根据第一阶段设计和实施干预措施 19项发现，包括：1)与GRITS的双向联系，允许快速信息交换；2)电子系统 20为每个患者需要的所有疫苗创建定制的常备订单，3)生成类似AFIX的报告 21季度来自EHR系统，按单位跟踪疫苗接种管理并接受将提供的服务 22分发给医院领导和临床工作人员，以及4)提供者和患者的教育材料。第三阶段将 23解决具体目标2：评估这些干预措施对疫苗提供的影响。我们将评估这一联系 24在eHR系统和GRITS之间测量信息交换的速度和完整性 25(目标2A)，评估教育工作、新的会议常规制度和类似AFIX的报告 26通过焦点小组和访谈改变了提供者的知识、信念和态度(目标2B)， 27并使用电子病历数据库和对每个机构的1000份患者记录的前瞻性审查来重新评估 28住院患者入院时的疫苗接种覆盖率、入院期间接种的疫苗、文件和 29干预措施的相关费用(目标2C)。病案数据提取的阶段性分析 30I和III将确定疫苗需求、建议、交付和文件的评估 干预后31例有明显改善。GIVEASHOT项目将生成关于以下方面差距的信息 美国医院可以采用的32种住院疫苗交付和改进方法。 33

1 Project Summary/Abstract: 2 3 An experienced team of clinicians, information technology experts, public health leaders, and communications 4 specialists are proposing Project GIVEASHOT - Georgia Initiative to VaccinatE during Admission or SHOrt 5 Stay VisiTs. The work takes place at Emory University Midtown Hospital and Grady Health Systems, distinct 6 systems serving large, diverse and medically underserved patient populations in Atlanta. Goals are to identify 7 and analyze immunization gaps of adults in inpatient and short stay (24-hour observation and clinical decision) 8 units and to develop and assess interventions based on CDC's Standards for Adult Immunization Practices to 9 close those gaps. Work will occur in three phases over 3 years. Phase I addresses Specific Aim 1: evaluate 10 existing vaccination policies, practices and vaccination coverage in inpatient and short stay units. We will 11 conduct an environmental scan and interviews with key informants (administration, medicine, nursing, 12 pharmacy, information technology) to understand policies and practices for determining immunization needs, 13 accessing the Georgia Immunization Registry (GRITS), and delivering and documenting vaccines (Objective 14 1A). We will review electronic health record (EHR) databases and a retrospective sample of 1000 patient 15 records at each institution to measure prevalence of needed, delivered, and documented vaccines; records will 16 be compared to GRITS to assess vaccine coverage and information sharing (Objective 1B). Interviews and 3- 17 person focus groups will measure provider and patient knowledge, attitudes and beliefs on inpatient 18 vaccination of adults (Objective 1C). In Phase II, we will design and implement interventions based on Phase I 19 findings, including: 1) a two-way link with GRITS that allows rapid information exchange, 2) electronic systems 20 to create customized standing orders for all vaccines each patient needs, 3) AFIX-like reports generated 21 quarterly from EHR systems to track vaccination administration by unit and admitting service that will be given 22 to hospital leadership and clinical staff, and 4) educational materials for providers and patients. Phase III will 23 address Specific Aim 2: evaluate impact of these interventions on vaccine delivery. We will evaluate the link 24 between the EHR systems and GRITS to measure the speed and completeness of information exchange 25 (Objective 2A), assess whether the educational efforts, new standing orders systems, and AFIX-like reports 26 have changed provider knowledge, beliefs, and attitudes through focus groups and interviews (Objective 2B), 27 and use EHR databases and a prospective review of 1000 patient records at each institution to reassess 28 inpatient vaccination coverage levels at admission, vaccines given during admission, documentation, and 29 associated costs of the interventions (Objective 2C). Analysis of data extracted from patient records in Phases 30 I and III will determine whether assessment of vaccine needs, recommendations, delivery, and documentation 31 improved significantly following the interventions. Project GIVEASHOT will generate information on gaps in 32 inpatient vaccine delivery and methods for improvement that can be adopted by U.S. hospitals. 33