School Located Influenza Vaccinations for Children: Community-Wide Dissemination

学校为儿童接种流感疫苗：社区范围内的传播

• 批准号: 8266976
• 负责人: PETER G SZILAGYI
• 金额: $ 48.42万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8266976
• 关键词: Located; Influenza; Vaccinations; Children; Community

DESCRIPTION (provided by applicant): Annual influenza epidemics result in substantial mortality and morbidity among adults and children with more than $10 billion in direct medical costs. Although national guidelines recommend annual influenza vaccination of all school-aged children, less than half of these children are vaccinated. The major barrier is the short time window for vaccination: primary care practices are simply unable to vaccinate all of their pediatric patients within a few months. An alternative setting for child influenza vaccination is school-located influenza vaccinations (SLIV), yet <5% of children receive vaccine in schools. Three barriers impede SLIV: an ineffective paper-based parent consent system, ineffective parent reminders, and lack of experience with SLIV among adolescents. The goal of this project is to address these 3 barriers and to optimize influenza vaccination rates via SLIV. We will adapt two dissemination/implementation conceptual models (the Chronic Care Model and RE- AIM). We will work closely with schools, primary care practices, and local and state public health leaders, and with two national partners - CDC's National Center for Immunization and Respiratory Diseases (NCIRD) and the National Association of School Nurses (NASN). We propose a technical aim, a scientific aim, and a dissemination aim. The technical aim (Aim 1, Yr 1) is to develop, pilot, and evaluate a web-based consent and parent reminder system, using an innovative web-based informatics system. We will perform formative studies of parents, school staff, and providers, to create a useful system. The scientific aim (Aim 2, Yrs 2-4) is to perform effectiveness testing of SLIV, using web-based consent + reminders. We will randomize schools to SLIV vs. control in 3 successive annual RCTs, with increasing number of schools, and measure vaccination rates, school absences, and SLIV processes and costs. In Yr 2 we will include 5 schools districts (all elementary; 26 study, 28 control schools, n=25,078). In Yr 3 we will expand to 8 school districts and also middle/high schools (n=59,556 children); in Year 4 to 12 districts (n=79,713 children). The dissemination aim (Aim 3, Yrs 4-5) is to spread SLIV throughout Monroe County and diffuse SLIV best practices and technological innovations nationally. We will offer SLIV to all county schools (182 schools, n=112,034), and work with national partners to disseminate the consent/reminder system and a training program for SLIV across the US. This project addresses AHRQ priority area Prevention/Care Management, includes a focus on priority populations (adolescents, urban), and is a major redesign of primary care. PUBLIC HEALTH RELEVANCE: This demonstration and dissemination project addresses the problem of low influenza vaccination rates among school-aged children and subsequent morbidity to children and, through spread of infection, to adults. We will implement and evaluate a county-wide school-located influenza vaccination system in which children will receive influenza vaccination in their schools. To accomplish this, we will develop, pilot, and evaluate a web- based parent consent and parent reminder system that will simplify receipt of consent and improve participation. We will then test the effectiveness of school-located influenza vaccinations through a series of randomized clinical trials, spreading the program to an enlarging number of schools. Finally, we will disseminate the program across the county and develop, with national collaborators, a model program that can be used nationally.

描述（由申请人提供）：年度流感流行病导致成人和儿童的死亡率和发病率超过100亿美元，直接医疗费用超过100亿美元。尽管国家准则建议对所有学龄儿童进行年度流感疫苗接种，但这些儿童中只有不到一半是接种疫苗的。主要的障碍是疫苗接种的短时间窗口：初级保健实践根本无法在几个月内接种其所有儿科患者。儿童流感疫苗接种的另一种环境是学校占流感疫苗接种（SLIV），但<5％的儿童在学校接受疫苗。三个障碍阻碍了SLIV：基于纸张的父母同意系统，无效的父母提醒以及青少年缺乏SLIV的经验。该项目的目的是解决这三个障碍，并通过SLIV优化流感疫苗接种率。我们将调整两个传播/实施概念模型（慢性护理模型和重新目标）。我们将与学校，初级保健实践以及地方和州的公共卫生领导人紧密合作，以及两个国家伴侣 - CDC国家免疫和呼吸道疾病中心（NCIRD）（NCIRD）和国家学校护士协会（NASN）。我们提出了一个技术目标，一个科学目标和传播目标。技术目标（AIM 1，YR 1）是使用基于创新的网络信息学系统来开发，试点和评估基于Web的同意和父母提醒系统。我们将对父母，学校工作人员和提供者进行形成性研究，以创建一个有用的系统。科学目的（AIM 2，YRS 2-4）是使用基于Web的同意 +提醒对SLIV进行有效性测试。我们将在3个连续的年度RCT中随机将学校与SLIV与控制，并随着学校的数量增加，并衡量疫苗接种率，学校缺勤以及SLIV过程和成本。在第一年，我们将包括5个学校区（所有基础； 26个研究，28个对照学校，n = 25,078）。在3年中，我们将扩展到8个学区和中/高中（n = 59,556名儿童）；在4至12年级的地区（n = 79,713名儿童）。传播目的（AIM 3，YRS 4-5）是在整个梦露县（Monroe County）以及全国范围内的最佳实践和技术创新。我们将为所有县级学校（182所学校，n = 112,034）提供SLIV，并与国家合作伙伴合作，为整个美国的SLIV提供了同意/提醒系统和培训计划。该项目解决了AHRQ优先领域的预防/护理管理，包括关注优先人群（青少年，Urban），并且是初级保健的主要重新设计。 公共卫生相关性：该示范和传播项目解决了学龄儿童流感疫苗接种率低的问题，以及随后对儿童的发病率以及通过感染传播到成年人的问题。我们将实施和评估一个县范围内的学校疫苗接种系统，在该系统中，儿童将在学校接受流感疫苗接种。为此，我们将开发，试行和评估基于网络的父母同意和父母提醒系统，该系统将简化同意并改善参与。然后，我们将通过一系列随机临床试验来测试位于学校的流感疫苗接种疫苗的有效性，并将该计划扩大到扩大的学校。最后，我们将与国家合作者一起在全县进行整个县的计划，并开发一个可以在全国范围内使用的模型计划。