Feldman Amy G, Beaty Brenda L, Moore Susan L, Bull Sheana, Wilson Kumanan, Atkinson Katherine M, Bell Cameron, Denize Kathryn M, Kempe Allison
Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado, 13123 E 16th Ave, Aurora, CO, 80045, United States, 1 720-777-5354.
Digestive Health Institute, Children's Hospital Colorado, Aurora, CO, United States.
JMIR Form Res. 2025 Apr 15;9:e68855. doi: 10.2196/68855.
Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. Despite intensive medical care in the pretransplant period, less than 20% of children are up to date for age-appropriate vaccines at the time of transplant. Mobile health apps have the potential to improve pretransplant vaccine rates.
This paper aimed to perform phase 2 beta testing of the smartphone app, Immunize PediatricTransplant, to determine (1) if it was effective in achieving up-to-date vaccine status by the time of transplant in a cohort of children awaiting transplants and (2) if the app was feasible and acceptable to parent and transplant provider users.
We recruited 25 dyads of parents and providers of a child awaiting a liver, kidney, or heart transplant at Children's Hospital Colorado, Ann and Robert H. Lurie Children's Hospital, and the Children's Hospital of Philadelphia. Parents and providers filled out an entry questionnaire before app use to gather baseline information. A research team member entered the child's vaccine records into the app. The parent and provider downloaded and used the app until the transplant to view vaccine records, read vaccine education, communicate with team members, and receive overdue vaccine reminders. After the transplant (or on April 1, 2024, the conclusion of the study), the parent and provider filled out an exit questionnaire to explore feasibility and acceptability of the app. The child's vaccine records were reviewed to determine if the child was up to date on vaccines at the time of transplant.
Twenty-five parent and provider dyads were enrolled; 56% (14/25) had a child awaiting a liver transplant, 28% (7/25) had a child awaiting a kidney transplant, and 16% (4/25) had a child awaiting a heart transplant. At the conclusion of the study, 96% (24/25) of the children were up to date on vaccines. Of the 36 parents and providers who filled out an exit questionnaire, 97% (n=35) agreed or strongly agreed that they felt knowledgeable about pretransplant vaccine use and 86% (n=31) agreed or strongly agreed that communication around vaccines was good after using the app. Further, 91% (20/22) of parents and 79% (11/14) of providers recommended the app to future parents and providers of transplant candidates. Parents and providers suggested that in the future the app should connect directly to the electronic medical record or state vaccine registries to obtain vaccine data.
The overwhelming majority of children whose parents and providers used the Immunize PediatricTransplant app were up to date on vaccines at the time of transplant. The majority of app users felt the app was feasible and acceptable. In future iterations of the app and subsequent clinical trials, we will explore whether application programming interfaces might be used to extract vaccine data from the electronic medical record. If implemented broadly, this app has the potential to improve pretransplant vaccine rates, resulting in fewer posttransplant infections and improved posttransplant outcomes.
疫苗可预防的感染在儿科移植受者中会导致严重的发病、死亡和成本。尽管在移植前期进行了强化医疗护理，但不到20%的儿童在移植时按年龄接种了适当的疫苗。移动健康应用程序有可能提高移植前的疫苗接种率。
本文旨在对智能手机应用程序Immunize PediatricTransplant进行2期β测试，以确定（1）在一组等待移植的儿童中，该应用程序在移植时能否有效地使疫苗接种状态达到最新；（2）该应用程序对家长和移植医疗服务提供者用户是否可行且可接受。
我们招募了25对家长和医疗服务提供者，他们的孩子正在科罗拉多州儿童医院、安和罗伯特·H·卢里儿童医院以及费城儿童医院等待肝脏、肾脏或心脏移植。家长和医疗服务提供者在使用应用程序前填写一份入门问卷，以收集基线信息。一名研究团队成员将孩子的疫苗记录输入应用程序。家长和医疗服务提供者下载并使用该应用程序，直到移植时查看疫苗记录、阅读疫苗教育内容、与团队成员沟通并接收逾期疫苗提醒。移植后（或在2024年4月1日，即研究结束时），家长和医疗服务提供者填写一份退出问卷，以探讨该应用程序的可行性和可接受性。对孩子的疫苗记录进行审查，以确定孩子在移植时疫苗接种是否最新。
招募了25对家长和医疗服务提供者；56%（14/25）的孩子等待肝脏移植，28%（7/25）的孩子等待肾脏移植，16%（4/25）的孩子等待心脏移植。在研究结束时，96%（24/25）的孩子疫苗接种最新。在填写退出问卷的36名家长和医疗服务提供者中，97%（n = 35）同意或强烈同意他们对移植前疫苗使用有足够了解，86%（n = 31）同意或强烈同意使用该应用程序后围绕疫苗的沟通良好。此外，91%（20/22）的家长和79%（11/14）的医疗服务提供者向未来移植候选者的家长和医疗服务提供者推荐了该应用程序。家长和医疗服务提供者建议，未来该应用程序应直接连接到电子病历或州疫苗登记处，以获取疫苗数据。
绝大多数家长和医疗服务提供者使用Immunize PediatricTransplant应用程序的儿童在移植时疫苗接种最新。大多数应用程序用户认为该应用程序可行且可接受。在该应用程序的未来迭代和后续临床试验中，我们将探索是否可以使用应用程序编程接口从电子病历中提取疫苗数据。如果广泛实施，该应用程序有可能提高移植前的疫苗接种率，从而减少移植后感染并改善移植后结局。
