PROJECT SUMMARY/ABSTRACT: This proposal describes a five-year research and career development training plan that will prepare Dr. Bryan to achieve her career goal of becoming an independent pediatric clinical researcher focused on improving healthcare outcomes for hospitalized children by accelerating the translation of evidence-based interventions into clinical practice using innovative technologies. This proposal is focused on improving vaccination rates in hospitalized children, a high priority population and issue for NICHD. Up to 74% of hospitalized children are missing ≥1 non-influenza vaccines. Currently, hospitalization is a missed opportunity to vaccinate as ~2% of hospitalized children receive any non-influenza vaccines. Integrating implementation science and user- centered design methods, Dr. Bryan’s project goal is to design and test a user-centered intervention that optimizes the integration of Immunization Information Systems data into hospital Electronic Health Records to improve vaccine delivery for hospitalized children. In Aim 1, Dr. Bryan will conduct a mixed methods study of a local and national sample of pediatric hospitalists, nurses and pharmacists to identify determinants and contextual factors for an intervention to identify undervaccinated children and offer needed vaccines using the Consolidated Framework for Implementation Research (CFIR). In Aim 2, she will engage with parents, nurses, pharmacists, physicians, and health information technology experts through workshops and rapid cycle prototyping to develop a prototype for a user-centered intervention that meets the user needs and context identified in Aim 1. She will conduct usability testing and expert evaluation to ensure the design meets the requirements prior to the intervention build and workflow integration. In Aim 3, Dr. Bryan will deploy and pilot test the designed intervention to assess feasibility and acceptability for clinicians and parents. This pilot test will inform a future multicenter cluster-randomized effectiveness-implementation trial to improve vaccine delivery in hospitalized children. To complete this research, Dr. Bryan will develop new competencies in: 1) implementation science, 2) user-centered design methods, and 3) technology-based intervention design. To prepare for the future clinical trial to test the developed intervention, she will also develop skills in clinical trials design and analytic methods for vaccine communication during the award period. Dr. Bryan has assembled a multidisciplinary mentorship team with expertise in vaccine communication research, implementation science, user-centered design, and technology-based intervention design. Her mentors are dedicated to ensuring the success of this project and her career development into an independent researcher. By accomplishing the aims in this proposal, Dr. Bryan will address key gaps in our ability to increase vaccination rates in hospitalized children. Ultimately, this proposal will provide Dr. Bryan the skills she needs in implementation science, user- centered design, technology-based intervention design, clinical trials design and analytic methods for health communication for a research career dedicated to improving healthcare outcomes in hospitalized children.

PROJECT NARRATIVE Hospitalized children are at high risk of being undervaccinated; this has important public health implications as undervaccinated children are at risk for acquiring and transmitting vaccine preventable diseases as seen in the recent measles outbreak in 2019. Currently, hospitalization is a missed opportunity to vaccinate with few children receiving any needed vaccines during hospitalization. This proposal will engage with nurses, pharmacists, physicians and parents to develop and test a technology-based intervention to identify undervaccinated children and improve vaccine delivery during hospitalization.