AIMHi - Adolescent Immunization Vaccination in the Medical Home

AIMHi is a multi-phase study to determine and measure the effect of a chosen strategy to help practitioners increase rates of HPV vaccination.

Background

Due to the recent recommendation of three new adolescent vaccines (meningococcus, pertussis, and HPV vaccines) and two new vaccine recommendations for adolescents (influenza and varicella), adolescent vaccinations have become a major new priority area for public health. Currently, adolescent vaccination rates are low. Primary care practices or medical homes are the major sources for healthcare for the majority of adolescents across the U.S., yet evidence is needed for feasible and sustainable strategies, within medical homes, to optimize adolescent vaccination delivery.

Purpose

To implement and measure the effectiveness of a strategy that is feasible and sustainable in increasing adolescent vaccination rates in the medical home. The design of the strategy will rely on feedback from providers through surveys and key informant interviews. Our cohort consists of the Greater Rochester Practice Based Research Network (GR-PBRN), and the Continuity Clinic Research Network (CORNET), a national research network.

Study Aims

• Perform formative studies with practitioners to determine which interventions are feasible and sustainable for adolescent vaccinations in medical homes. This phase has been completed and the strategy chosen is to have prompts (either electronically for practices with electronic health records (EHR), or by a nurse for those who do not) for vaccines needed at the time of visit

• Design a matched trial to measure the effectiveness of the vaccine prompts

• Evaluate costs, cost-effectiveness, and feasibility of having prompts

Phase 1: Survey/Key Informant Interviews

• Online survey invitation to members of the GR-PBRN and CORNET

• Interviews with survey respondents who indicated an interest in participating in the intervention phase

• Survey/interview topics included:

• Strategies currently using
• Strategies interested in implementing

• Barriers to optimizing adolescent vaccination

• Demographic features of the practice

Phase 2: Intervention

• Implement the chosen intervention (prompts for vaccine at time of visit) for 12 months in 12 sites
• Provide training to practices on using the prompt features (EHR) and develop a protocol for the nurse prompts.
• Monthly team calls during intervention period to address concerns, gather feedback on the new strategy
• Perform baseline and post-intervention chart reviews to evaluate the impact of the strategy in both intervention and control site.

Phase 3: Cost Effectiveness/Feasibility

• Perform cost-analysis interviews with each intervention site
  • Gather approximate costs related to resources used for intervention
  • Ask for feedback related to feasibility of continuing the intervention and provider reactions
• Evaluate the impact of the strategy on increasing immunization rates and receipt of preventive visits