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

实施不同实践中的疫苗接种 SOP 工具包

基本信息

批准号：
8994798
负责人：
RICHARD K ZIMMERMAN
金额：
$ 7.29万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-01 至 2016-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8994798
关键词：
Vaccination SOP Toolkit Diverse Practices

项目摘要

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.

描述（由申请人提供）：在美国，流感和肺炎球菌疾病每年导致数千人不必要的死亡，而在服务不足的少数族裔中，这些疾病造成的死亡率更高。需要更好的工具来提高成人疫苗接种率，特别是少数群体的疫苗接种率。一个经过验证但未得到充分利用的疫苗接种促进者是一个常设机构订单计划 (SOP)，其中符合条件的患者可以在没有特定医生订单的情况下从护理人员那里接受免疫接种。我们开发了一种在当地取得成功的方法，采用包括标准操作程序在内的定制干预措施，以提高市中心卫生中心的疫苗接种率并消除种族差异。但这种方法最近没有更新，也没有在全国范围内进行测试。基于十年来对疫苗接种障碍和促进因素的研究，我们认为持续取得进展需要结合办公系统的变革，包括标准操作程序和患者信息。根据我们对初级保健医生进行的关于成人免疫 SOP 的促进因素和障碍的调查，我们开发并试点测试了专家审查的工具包，以促进 SOP 的采用并提高疫苗接种率。我们建议通过实践转型仪表板来增强该工具包，添加 Tdap，并根据社区和国家顾问委员会的意见扩展相关的在线培训材料。此增强过程的目的是优化工具包和培训材料的范围、采用、实施和有效性。组成部分包括免疫冠军、反馈、动机和患者提醒。为了严格测试它，我们将在初级保健实践网络中对“4 支柱 SOP 工具包”进行密集的随机整群试验借助电子病历，旨在将疫苗接种率提高 10%-20%，并消除种族差异；使用 RE-AIM 框架评估干预措施，并确定随后几年的维护。与 AMA 一起，利用从试验中吸取的经验教训，对工具包进行全国性前后试验，使用与 AMA 实践改进 CME 一致的强度水平，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确定干预措施的潜在可转化性和公共卫生影响。