A Vaccination SOP Toolkit in Diverse Practices Implemented & Tested with RE-AIM

描述(申请人提供)：流感和肺炎球菌疾病每年在美国造成数千人不必要的死亡，在服务不足的少数族裔中，这些疾病的死亡率更高。需要更好的工具来提高成人疫苗接种率，特别是在少数群体中。一个久经考验但未得到充分利用的疫苗接种促进者是一个长期的 订购计划(SOP)，在该计划中，符合条件的患者可以从护理人员那里获得免疫接种，而无需特定的医生订单。我们开发了一种在当地成功的方法，使用包括SOP在内的量身定制的干预措施，以提高市中心卫生中心的疫苗接种率，消除种族差异。但这种方法最近没有更新，也没有在全国范围内进行测试。根据十年来对疫苗接种障碍和促进者的研究，我们认为，持续的进步需要结合办公系统的变化，包括标准操作程序和患者信息。根据我们对初级保健医生关于成人免疫SOP的促进者和障碍的全国调查，我们开发并试点测试了一个专家评审工具包，以促进SOP的采用和提高疫苗接种率。我们建议通过实践转型仪表板增强工具包，增加TDAP，并扩大相关的在线培训材料，由社区和国家顾问委员会提供意见。这一改进进程的目的是优化工具包和培训材料的覆盖范围、采用、实施和效果。组成部分包括免疫冠军、反馈、激励和患者提醒。为了严格测试它，我们将在初级保健实践网络中进行一次密集的随机整群试验 与EMR合作，目标是将疫苗接种率提高10%-20%，消除种族差异；使用RE-AIM框架评估干预措施，并确定随后几年的维持情况。与AMA一起，利用从试验中吸取的经验教训，使用与AMA的实践改进CME一致的强度水平，对工具包进行一次全国前后试验，并使用RE-AIM框架对其进行评估。最后，我们将通过建模和成本效益分析来确定干预措施的潜在可译性和公共卫生影响。

DESCRIPTION (provided by applicant): Influenza and pneumococcal diseases cause thousands of needless deaths annually in the US, with greater mortality from these illnesses among underserved minorities. Better tools to improve adult vaccination rates, particularly in minority populations, are needed. A proven, but underutilized vaccination facilitator is a standing order program (SOP) in which an eligible patient can receive immunizations from nursing staff without a specific physician order. We developed a locally successful approach using tailored interventions that included SOPs, to increase vaccination rates in inner-city health centers and eliminate racial disparities. But this approach has not been updated recently nor tested nationally. Based on a decade of research on barriers and facilitators of vaccination, we believe that continued progress requires a combination of office system changes including SOPs and patient messages. From our national survey of primary care physicians about facilitators of and barriers to SOPs for adult immunization, we developed and pilot-tested an expert reviewed toolkit to facilitate SOP adoption and increase vaccination rates. We propose to enhance the toolkit with a Practice Transformation Dashboard, add Tdap, and expand related online training materials, shaped by input from the community and a national advisory board. The purpose of this enhancement process is to optimize the Reach, Adoption, Implementation and Effectiveness of the toolkit and training materials. Components include an immunization champion, feedback, motivation, and patient reminders. To rigorously test it, we will conduct an intensive randomized cluster trial of the "4 Pillars SOP Toolkit" in primary care practice networks with EMRs, aiming to increase vaccination rates by 10%-20% and to eliminate racial disparity; evaluate the intervention using the RE-AIM framework, and determine Maintenance in subsequent years. Together with the AMA and using lessons learned from the trial, conduct a national before-and-after trial of the toolkit, using an intensity level consistent with AMA's practice-improvement CME and evaluate it, using the RE-AIM framework. Finally, we will determine the potential translatability and public health impact of the intervention through modeling and cost-effectiveness analyses.