The long-term objectives of this project are to 1) decrease vaccine-preventable diseases among children, adolescents and adults by increasing implementation of the Advisory Committee on Immunization Practices' immunization recommendations and 2) create a collaborative framework between regional care collaborative organizations (RCCO) in Colorado that care for patients covered by Medicaid and the Colorado State Health Department's Immunization Information System (CIIS) for the delivery of preventive care services. Within a new RCCO-public health (RCCO-PH) collaborative the study team will implement and test an evidence-based centralized method of increasing immunization delivery using reminder/recall previously developed by our group. The evaluation will be conceptually guided by the Re-Aim framework. During year one, (Specific Aim 1) connectivity between RCCO databases and CIIS will be established and the collaborative intervention refined with input from key stakeholders, providers and patients in the communities served by the RCCO. During the second and third year (Specific Aim 2), a pragmatic trial will be conducted to assess the effectiveness and cost-effectiveness of the RCCO-PH collaborative centralized approach compared with a practice-based approach for increasing immunization rates in children and adolescents. While studying this approach in pediatric populations, we will work with the RCCOs to populate CIIS with adult immunization records and to create systems for the uploading of adult immunization data (Specific Aim 3). In year 3 (Specific Aim 4) we will extend the collaborative centralized reminder/recall approach to adult populations within the RCCOs and conduct an additional pragmatic trial. Finally, in year 5, (Specific Aim 5) we will examine models for sustainability of the RCCO-Public Health collaborative framework. Our Dissemination Plan will include direct extension to the other 5 RCCO's in Colorado as well as other national accountable care organizations, local and national practice and policy organizations, development of a toolkit about centralized collaborative delivery methods and our AHRQ-funded national Center for Research in Implementation Science and Prevention (CRISP). The study will provide data about the feasibility and effectiveness of centralized collaborative reminder/recall and about ACO and public health collaboration that will be highly relevant to efforts to build such collaborations nationally. The technical and administrative infrastructure created by this collaboration will be a platform on which the collaborative delivery of other clinical preventive services can be built locally and nationally. The study addresses research areas in multiple AHRQ R18 portfolios including the Comparative Effectiveness, the Health Information Technology and the Prevention and Care Management Portfolios, all within AHRQ priority populations.
The Institute of Medicine recently highlighted the importance of creating partnerships between accountable care organizations (ACO) and public health entities in order to broaden the scope and efficiency of delivering clinical preventive services to populations. This proposal focuses on implementing and evaluating an evidence-based collaborative method of increasing immunization rates among preschool children, adolescents and adults within an ACO-Public Health collaborative. The infrastructure we will create around immunizations will serve as the framework for future collaborative delivery of other preventive services.