PDF(Pubmed)
Abstract：
BACKGROUND: The electronic National Immunization Information System (NIIS) was introduced nationwide in Vietnam in 2017. Health workers were expected to use the NIIS alongside the legacy paper-based system. Starting in 2018, Hanoi and Son La provinces transitioned to paperless reporting. Interventions to support this transition included data guidelines and training, internet-based data review meetings, and additional supportive supervision visits.
OBJECTIVE: This study aims to assess (1) changes in NIIS data quality and use, (2) changes in immunization program outcomes, and (3) the economic costs of using the NIIS versus the traditional paper system.
METHODS: This mixed methods study took place in Hanoi and Son La provinces. It aimed to analyses pre- and postintervention data from various sources including the NIIS; household and health facility surveys; and interviews to measure NIIS data quality, data use, and immunization program outcomes. Financial data were collected at the national, provincial, district, and health facility levels through record review and interviews. An activity-based costing approach was conducted from a health system perspective.
RESULTS: NIIS data timeliness significantly improved from pre- to postintervention in both provinces. For example, the mean number of days from birth date to NIIS registration before and after intervention dropped from 18.6 (SD 65.5) to 5.7 (SD 31.4) days in Hanoi (P<.001) and from 36.1 (SD 94.2) to 11.7 (40.1) days in Son La (P<.001). Data from Son La showed that the completeness and accuracy improved, while Hanoi exhibited mixed results, possibly influenced by the COVID-19 pandemic. Data use improved; at postintervention, 100% (667/667) of facilities in both provinces used NIIS data for activities beyond monthly reporting compared with 34.8% (202/580) in Hanoi and 29.4% (55/187) in Son La at preintervention. Across nearly all antigens, the percentage of children who received the vaccine on time was higher in the postintervention cohort compared with the preintervention cohort. Up-front costs associated with developing and deploying the NIIS were estimated at US $0.48 per child in the study provinces. The commune health center level showed cost savings from changing from the paper system to the NIIS, mainly driven by human resource time savings. At the administrative level, incremental costs resulted from changing from the paper system to the NIIS, as some costs increased, such as labor costs for supportive supervision and additional capital costs for equipment associated with the NIIS.
CONCLUSIONS: The Hanoi and Son La provinces successfully transitioned to paperless reporting while maintaining or improving NIIS data quality and data use. However, improvements in data quality were not associated with improvements in the immunization program outcomes in both provinces. The COVID-19 pandemic likely had a negative influence on immunization program outcomes, particularly in Hanoi. These improvements entail up-front financial costs.
OBJECTIVE: This study aims to assess (1) changes in NIIS data quality and use, (2) changes in immunization program outcomes, and (3) the economic costs of using the NIIS versus the traditional paper system.
METHODS: This mixed methods study took place in Hanoi and Son La provinces. It aimed to analyses pre- and postintervention data from various sources including the NIIS; household and health facility surveys; and interviews to measure NIIS data quality, data use, and immunization program outcomes. Financial data were collected at the national, provincial, district, and health facility levels through record review and interviews. An activity-based costing approach was conducted from a health system perspective.
RESULTS: NIIS data timeliness significantly improved from pre- to postintervention in both provinces. For example, the mean number of days from birth date to NIIS registration before and after intervention dropped from 18.6 (SD 65.5) to 5.7 (SD 31.4) days in Hanoi (P<.001) and from 36.1 (SD 94.2) to 11.7 (40.1) days in Son La (P<.001). Data from Son La showed that the completeness and accuracy improved, while Hanoi exhibited mixed results, possibly influenced by the COVID-19 pandemic. Data use improved; at postintervention, 100% (667/667) of facilities in both provinces used NIIS data for activities beyond monthly reporting compared with 34.8% (202/580) in Hanoi and 29.4% (55/187) in Son La at preintervention. Across nearly all antigens, the percentage of children who received the vaccine on time was higher in the postintervention cohort compared with the preintervention cohort. Up-front costs associated with developing and deploying the NIIS were estimated at US $0.48 per child in the study provinces. The commune health center level showed cost savings from changing from the paper system to the NIIS, mainly driven by human resource time savings. At the administrative level, incremental costs resulted from changing from the paper system to the NIIS, as some costs increased, such as labor costs for supportive supervision and additional capital costs for equipment associated with the NIIS.
CONCLUSIONS: The Hanoi and Son La provinces successfully transitioned to paperless reporting while maintaining or improving NIIS data quality and data use. However, improvements in data quality were not associated with improvements in the immunization program outcomes in both provinces. The COVID-19 pandemic likely had a negative influence on immunization program outcomes, particularly in Hanoi. These improvements entail up-front financial costs.
摘要：
背景：电子国家免疫信息系统（NIIS）于2017年在越南全国范围内推出。预计卫生工作者将与传统的纸质系统一起使用NIIS。从2018年开始，河内和SonLa省过渡到无纸化报告。支持这一转变的干预措施包括数据指南和培训，基于互联网的数据审查会议，和额外的支持性监督访问。
目的：本研究旨在评估（1）NIIS数据质量和使用的变化，(2)免疫规划结果的变化，(3)使用NIIS与传统纸张系统的经济成本。
方法：这项混合方法研究在河内和SonLa省进行。它旨在分析来自各种来源的干预前和干预后数据，包括NIIS;家庭和医疗机构调查;和访谈，以衡量NIIS数据质量，数据使用，和免疫计划结果。财务数据是在全国收集的，省,区,通过记录审查和访谈，以及医疗机构的水平。从卫生系统的角度进行了基于活动的成本核算方法。
结果：从干预前后，两个省份的NIIS数据时效性均有显著改善。例如,从出生日期到NIIS登记干预前后的平均天数在河内从18.6(SD65.5)降至5.7(SD31.4)天(P<.001),在SonLa(P<.001)从36.1(SD94.2)降至11.7(40.1)天。SonLa的数据表明，完整性和准确性得到了提高，虽然河内表现出好坏参半的结果，可能受到COVID-19大流行的影响。数据使用得到改善；在干预后，在干预前，两个省份的100％（667/667）的设施使用NIIS数据进行月度报告以外的活动，而河内的34.8％（202/580）和SonLa的29.4％（55/187）。在几乎所有的抗原中，与干预前队列相比,干预后队列中按时接种疫苗的儿童百分比更高.在研究省份，与开发和部署NIIS相关的前期费用估计为每名儿童0.48美元。公社卫生中心级别显示了从纸质系统更改为NIIS的成本节省，主要是由人力资源时间的节省。在行政层面,从纸质系统更改为NIIS导致的增量成本，随着一些成本的增加，例如支持监督的人工成本和与NIIS相关的设备的额外资本成本。
结论：河内省和SonLa省成功过渡到无纸化报告，同时保持或改善NIIS数据质量和数据使用。然而,在两个省份,数据质量的改善与免疫计划结局的改善无关.COVID-19大流行可能对免疫计划结果产生负面影响，特别是在河内。这些改进需要前期财务成本。
目的：本研究旨在评估（1）NIIS数据质量和使用的变化，(2)免疫规划结果的变化，(3)使用NIIS与传统纸张系统的经济成本。
方法：这项混合方法研究在河内和SonLa省进行。它旨在分析来自各种来源的干预前和干预后数据，包括NIIS;家庭和医疗机构调查;和访谈，以衡量NIIS数据质量，数据使用，和免疫计划结果。财务数据是在全国收集的，省,区,通过记录审查和访谈，以及医疗机构的水平。从卫生系统的角度进行了基于活动的成本核算方法。
结果：从干预前后，两个省份的NIIS数据时效性均有显著改善。例如,从出生日期到NIIS登记干预前后的平均天数在河内从18.6(SD65.5)降至5.7(SD31.4)天(P<.001),在SonLa(P<.001)从36.1(SD94.2)降至11.7(40.1)天。SonLa的数据表明，完整性和准确性得到了提高，虽然河内表现出好坏参半的结果，可能受到COVID-19大流行的影响。数据使用得到改善；在干预后，在干预前，两个省份的100％（667/667）的设施使用NIIS数据进行月度报告以外的活动，而河内的34.8％（202/580）和SonLa的29.4％（55/187）。在几乎所有的抗原中，与干预前队列相比,干预后队列中按时接种疫苗的儿童百分比更高.在研究省份，与开发和部署NIIS相关的前期费用估计为每名儿童0.48美元。公社卫生中心级别显示了从纸质系统更改为NIIS的成本节省，主要是由人力资源时间的节省。在行政层面,从纸质系统更改为NIIS导致的增量成本，随着一些成本的增加，例如支持监督的人工成本和与NIIS相关的设备的额外资本成本。
结论：河内省和SonLa省成功过渡到无纸化报告，同时保持或改善NIIS数据质量和数据使用。然而,在两个省份,数据质量的改善与免疫计划结局的改善无关.COVID-19大流行可能对免疫计划结果产生负面影响，特别是在河内。这些改进需要前期财务成本。
