PROJECT SUMMARY Vaccine preventable infections (VPIs) are a serious complication following pediatric solid organ transplantation that lead to significant morbidity, mortality, and costs in transplant recipients. Immunizations are a minimally invasive and cost-effective approach to reducing VPIs. Despite evidence of the importance of pre-transplant immunization, the majority of pediatric solid organ transplant recipients are not up-to-date on vaccines at the time of transplant. The purpose of this project is to identify transplant specific immunization barriers. The central hypothesis is that a health information technology tool can be created to coordinate vaccine delivery and address transplant specific immunization barriers, thus increasing immunization rates before transplant, decreasing VPIs post-transplant, and improving outcomes for transplant recipients. This career development award is designed to support the transition of Amy Feldman, MD, MSCS, an Assistant Professor of Pediatrics at the University of Colorado, into an independent clinician-scientist and to achieve her long-term career goal of becoming a national leader in pediatric transplant outcomes research. The specific aims are to: (1) conduct semi-structured interviews of key stakeholders in pediatric solid organ transplant to identify barriers to immunization of transplant candidates; (2) adapt an existing immunization health information tool for healthy children into ImmunizePT, a transplant-specific immunization tool; and (3) use a modified RE-AIM framework to pilot acceptability, feasibility and effectiveness of ImmunizePT to improve immunization rates in solid organ transplant candidates at three centers nationally. This project, coupled with guidance from a renowned mentorship team (Dr. Allison Kempe-health services research, Dr. Ronald Sokol-transplant hepatology, Dr. Megan Morris-qualitative research and Dr. Sheana Bull-health information technology) and advanced training in qualitative methods, health informatics, and pragmatic trial design and implementation will provide Dr. Feldman with the foundation needed to successfully develop and implement large-scale multi-center pragmatic trials to improve transplant outcomes. The University of Colorado provides a unique environment to conduct outcomes research utilizing health information technology, supported by collaborative partnerships between The Adult and Child Consortium for Health Outcomes Research and Delivery Science, The University of Colorado Mobile Health Impact Lab, and the Children’s Hospital Colorado Transplant Center. This proposal addresses AHRQ’s priority populations of children and individuals with special health care and chronic care needs; as well as AHRQ’s goals to design tools that disseminate evidence-based protocols within the learning health system, engage patients and providers in shared decision-making, enhance communication amongst team members, and improve safety and quality outcomes by reducing missed opportunities to provide recommended care. This tool has the potential to have widespread applicability to all children with chronic diseases who require co-management by subspecialists and primary care providers.

PROJECT NARRATIVE Vaccine preventable infections (VPIs) pose a significant problem after pediatric solid organ transplant; however, the majority of transplant patients are under-immunized at the time of transplant. This project investigates the barriers to immunization of pediatric transplant candidates and develops a health information technology tool to overcome these barriers, increase pre-transplant immunization rates, decrease VPIs post- transplant, and ultimately improve the health of transplant recipients. This tool has the potential to have widespread applicability to all children with chronic diseases and complex medical needs who require co- management by subspecialists and primary care providers.