Defining the current models of immunization of immunocompromised patients in Spain, and how to improve them: results of the CARABELA-IP initiative

Objective The CARABELA initiative for the immunocompromised patient (IP) aims to optimize the management of these patients by focusing on four specific objectives: (i) the description of care pathway phases (diagnosis, immunization, and follow-up) and management models for IPs in Spain; (ii) the identification of improvement areas in IP care and potential solutions; (iii) the definition of healthcare quality indicators; and (iv) the dissemination of these findings to enable reference centers to guide others in the management of IP. Material and methods The CARABELA-IP initiative was developed in three phases: (1) characterization, identifying immunization models, improvement areas, and potential solutions in five pilot centers; (2) validation, through a national multidisciplinary meeting and a Delphi survey to agree on healthcare quality indicators; and (3) dissemination and implementation strategies beyond pilot centers, with a digital Playbook designed to guide the evolution of IP care. Results Three immunization models were identified based on coordination among departments, highlighting the role of preventive medicine and public health departments and nursing. Nine improvement areas and 24 potential solutions were defined. Furthermore, 28 healthcare quality indicators were validated to monitor the evolution of the immunization models. Conclusions Coordinated, multidisciplinary strategies are needed to ensure appropriate immunization in the face of diverse and heterogeneous IP management strategies. CARABELA-IP proposes a comprehensive model encompassing the identification, stratification, and protocolized referral of IPs, and promoting the training of healthcare professionals and the education of patients and their household contacts.