From Innovation to Solutions: Autodialers, Use of Early Autumn Physicals and Vac

描述（由申请人提供）：2008年，美国疾病控制与预防中心扩大了流感疫苗接种的适应症，将6个月至18岁的儿童纳入其中，大大增加了符合条件的儿童人数。由于工作量增加以及青少年接受卫生监督的次数减少，需要采取创新战略来提高疫苗接种率。在第一年，我们将确定和制定战略，利用创新扩散理论，在实践环境中增加儿童的流感疫苗接种。鉴定将通过文献审查和阿勒格尼县免疫联盟成员和家长的焦点小组进行。然后，我们将利用我们的教学发展中心和当地媒体的图形专业知识，开发并形成评估针对家长和青少年的新的电子大众媒体信息。接下来，我们将制定一套提高接接率的战略，包括工具包、常备订单、快速疫苗接种诊所、重新设计工作流程以评估生命体征期间的疫苗接种状况、在8月提前开始接种季节，使用减毒流感活疫苗，以及自动拨号提醒。我们还将与初级保健实践合作，教育临床医生，通过审查文件和与宾夕法尼亚州全州免疫信息系统（PA-SIIS）合作，加强电子记录保存。我们将对其中一些拟议的干预措施进行试点测试。为了实现目标2，在第二年，我们将对20种不同做法进行分层、随机聚类试验，以比较干预点和对照点的疫苗接种率。干预地点将使用一套新开发的基于证据的技术，这些技术将根据其实践结构和文化进行调整。通常的护理做法不会得到这样的帮助。两个不同的基于实践的研究网络将是研究的重点。我们将使用混合方法评估干预的成功，包括定性（如焦点小组）、过程和定量措施。由于患者聚集在诊所，将进行分层线性建模，并将包括实施干预的保真度和与疫苗接种相关的实践因素。我们的多学科团队在基于实践的疫苗接种障碍和促进因素研究以及开展试验方面具有经验。我们建议在网上传播工具包和干预材料。

DESCRIPTION (provided by applicant): In 2008, the CDC expanded the indications for influenza vaccination to encompass children ages 6 months through 18 years, dramatically increasing the number of eligible children. Innovative strategies to increase vaccination rates are needed due to the increased workload and to the fact that adolescents make fewer health supervision visits. During the first year, we will identify and develop strategies to increase influenza vaccination of children in practice settings, using the Diffusion of Innovation Theory. Identification will occur by a literature review and by focus groups of Allegheny County Immunization Coalition members and parents. Then, we will develop and formatively evaluate new, electronic, mass media messages targeting parents and teens, using graphic expertise in our Center for Instructional Development and local media. Next, we will develop a package of strategies to increase rates including a toolkit, standing orders, express vaccination clinics, workflow redesign to assess vaccination status during vital signs, early start to the vaccination season in August using live attenuated influenza vaccine, and autodialed reminders. We will also work with primary care practices to educate clinicians, to enhance electronic record keeping by reviewing documentation and by collaborating with Pennsylvania's Statewide Immunization Information System (PA-SIIS). We will conduct a pilot test of some of the proposed interventions. To address Aim 2, in the second year, we will conduct a stratified, randomized cluster trial of 20 diverse practices to compare vaccination rates in intervention and control sites. Intervention sites will use a package of newly developed and evidence-based techniques that will be tailored to their practice structure and culture. Usual care practices will not receive such assistance. Two diverse practice-based research networks will be the focus of the study. We will evaluate the success of the intervention using a mixed methods approach, including qualitative (e.g., focus groups), process, and quantitative measures. As the patients are clustered in clinics, hierarchical linear modeling will be conducted and will include the fidelity of implementation of the intervention and practice factors associated with vaccination. Our multidisciplinary team has experience in practice-based research on barriers and facilitators to vaccination and in conducting trials. We propose to disseminate the toolkit and intervention materials on the web. PUBLIC HEALTH RELEVANCE: New recommendations by the Advisory Committee for Immunization Practices to vaccinate all children ages 6 months through 18 years against influenza will require innovative strategies to increase vaccination rates among groups with previously low vaccine uptake. This project will use a variety of methods to identify and develop a package of interventions to increase influenza vaccination rates among children. These strategies will be tested in a stratified random cluster trial of primary care practices.