Parental concerns about vaccine safety have grown in the United States and abroad, resulting in delayed or skipped immunizations (often called “vaccine hesitancy”). To address vaccine hesitancy in Washington State, a public–private partnership of health organizations implemented and evaluated a 3-year community intervention, called the “Immunity Community.” The intervention mobilized parents who value immunization and provided them with tools to engage in positive dialogue about immunizations in their communities. The evaluation used qualitative and quantitative methods, including focus groups, interviews, and pre and post online surveys of parents, to assess perceptions about and reactions to the intervention, assess facilitators and barriers to success, and track outcomes including parental knowledge and attitudes. The program successfully engaged parent volunteers to be immunization advocates. Surveys of parents in the intervention communities showed statistically significant improvements in vaccine-related attitudes: The percentage concerned about other parents not vaccinating their children increased from 81.2% to 88.6%, and the percentage reporting themselves as “vaccine-hesitant” decreased from 22.6% to 14.0%. There were not statistically significant changes in parental behaviors. This study demonstrates the promise of using parent advocates as part of a community-based approach to reduce vaccine hesitancy.
Objective
Recognition is growing that to create truly patient‐centred care, health‐care organizations need to partner with patients around care design. More research into the benefits of engaging patients and the most effective ways of partnering with them is needed.
Methods
This study assessed the process and impact of a collaborative effort to design a new clinic service that balanced the number of patient and clinical provider/staff codesigners involved and recruited patients to represent diverse perspectives. Data sources included interviews with participants, event observation and participant surveys.
Results
Our evaluation found that including patients as equal partners improved the design process by infusing a real‐world, patient perspective. The pre‐event orientation and interactive methods used in the event fostered positive collaboration, as well as personal growth for the patient codesigners.
Conclusion
This study demonstrated the feasibility and benefits of including a roughly equal number of patients and clinical providers/staff in design events and ensuring that the patients represent diverse perspectives.
The authors identified 1,800,948 patients who made 2,326,701 health care encounters eligible for HIV testing before implementation (1/08-6/12) and 1,362,479 eligible encounters after implementation (1/13-6/15). The sameday HIV testing rate increased from 36.7% to 44.1%, a significant increase. The positive test result rate increased from 0.02% to 0.04% (p < 0.001). During the postimplementation period, fewer HIVinfected patients had a CD4+ cell count below 200 and/or HIV viral load of 10,000 copies/mL or higher at diagnosis.
This retrospective, observational cohort study of mechanically ventilated patients at 21 community and 2 academic hospitals demonstrated that in 28,758 derivation cohort admissions, every 10% increase in SpO2/ FiO2 time at risk (SF-TAR) was associated with a 24% increase in adjusted odds of hospital mortality. The SF-TAR can identify ventilated patients at increased risk of death, offering modest improvements compared with single SpO2/FiO2 and P/F ratios. This longitudinal, noninvasive, and broadly generalizable tool may have particular utility for early phenotyping and risk stratification.
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