Improving Influenza Vaccine Uptake in Acute Care Settings

流感疫苗可预防流感疾病、住院和死亡。住院儿童在 由于医学合并症，流感相关并发症的风险增加。然而，住院儿童 流感疫苗接种率低于普通人群。许多住院儿童没有 获得门诊医疗服务的良好机会，使他们能够接种疫苗。因此，医院就诊是一个 为符合条件的患者提供流感疫苗的关键重要会议。 临床决策支持（CDS）干预措施有可能提高流感疫苗接种率 和其他健康维护干预措施。我们的长期目标是识别CDS 提高急性护理环境中推荐的健康维护干预措施的接受率的战略。在这 建议，我们的目标是开发和评估CDS，以促进住院儿童的流感疫苗， 通过CDS Connect共享，供各机构使用。我们还将确定适用于CDS的见解， 更普遍地在急性护理环境中进行健康维护干预。 在本提案的目标1中，我们将使用以用户为中心的设计最佳实践来开发CDS，以促进 同一卫生系统内三家儿童医院住院患者的流感疫苗接种情况。我们将首先 与相关利益相关者一起执行用户和任务分析，以了解与 流感疫苗接种程序以及提供健康维护干预措施更多 一般来说。然后，我们将根据这些见解设计候选CDS策略，并迭代改进 他们与利益相关者通过基于ECOMO的形成性可用性测试。最后，我们将评估CDS 通过总结性可用性测试模拟的有效性。我们将在以下网站发布最终CDS策略： CDS连接。 在目标2中，我们将在三家医院的护理环境中依次实施CDS， 使用RE-AIM框架评估实施效果。我们将使用电子健康记录 查询，对运营领导人和CDS开发人员的调查，以及对承认临床医生的观察， 确定干预措施的范围、其改善流感疫苗接种的效力、 个体临床医生和组织领导者、实现保真度和维护成本。 在这个项目结束时，我们将开发和评估CDS过程，以促进流感 疫苗在儿科急性护理设置在一个单一的中心。我们还将发布CDS战略， CDS将其与卫生系统所需的关键定量和定性数据相关联， 促进实施，如预期影响、预期实施成本和当地 定制点进行调整。这些结果将为CDS的多中心研究奠定基础， 提高住院儿童的流感疫苗接种率和相关的健康维护干预措施。

Influenza vaccine prevents influenza illness, hospitalization, and death. Hospitalized children are at increased risk of influenza-related complications due to medical comorbidities. However, hospitalized children have lower influenza vaccine coverage than the general population. Many hospitalized children do not have good access to outpatient medical care where they could receive vaccine. Therefore, hospital visits are a critically important encounter to provide influenza vaccine to eligible patients. Clinical decision support (CDS) interventions have the potential to improve influenza vaccine uptake and other health maintenance interventions in hospitalized children. Our long-term objective is to identify CDS strategies that improve uptake of recommended health maintenance interventions in acute care settings. In this proposal, we aim to develop and evaluate CDS to promote influenza vaccine in hospitalized children that can be shared via CDS Connect for use across institutions. We will also identify insights that apply to CDS for health maintenance interventions in acute care settings more generally. In Aim 1 of this proposal, we will use user-centered design best practices to develop CDS to promote influenza vaccine uptake for inpatients at three children’s hospitals within a single health system. We will first perform a user and task analysis with relevant stakeholders to understand goals and barriers related to the influenza vaccine administration process as well as provision of health maintenance interventions more generally. We will then design candidate CDS strategies based on these insights and iteratively improve upon them with stakeholders through scenario-based formative usability testing. Finally, we will evaluate CDS effectiveness in simulations through summative usability testing. We will publish the final CDS strategy on CDS Connect. In Aim 2, we will implement the CDS sequentially across care settings within the three hospitals and evaluate implementation effectiveness using the RE-AIM framework. We will use electronic health record queries, surveys of operational leaders and CDS developers, and observations of admitting clinicians to determine the reach of the intervention, its efficacy to improve influenza vaccine administration, adoption by individual clinicians and organizational leaders, implementation fidelity, and costs of maintenance. At the end of this project, we will have developed and evaluated a CDS process to promote influenza vaccine in pediatric acute care settings at a single center. We will also have published the CDS strategy on CDS Connect and associated it with key quantitative and qualitative data required by health systems to facilitate implementation such as the expected impact, expected costs of implementation, and local customization points for adaptation. These results will lay the groundwork for multicenter studies of CDS to improve influenza vaccine uptake and related health maintenance interventions for hospitalized children.