Increasing HPV vaccine uptake in community-based pediatric practices

提高社区儿科实践中 HPV 疫苗的接种率

• 批准号: 10301234
• 负责人: Pamela Carmen Hull
• 金额: $ 42.74万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-12-20 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10301234
• 关键词: 13 year old; 21 year old; Address; Adolescent; Adoption; Age; Attitude; Caring; Characteristics; Child; Childhood; Clinic; Clinical effectiveness; Communities; Computer software; Data; Data Collection; Dose; Effectiveness; Electronic Health Record; Etiology; Evidence based intervention; Female; Future; Goals; Guideline Adherence; Guidelines; HPV-High Risk; Health Personnel; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Immune response; Immunization; Incidence; Intervention; Knowledge; Link; Malignant Vaginal Neoplasm; Malignant neoplasm of anus; Malignant neoplasm of cervix uteri; Malignant neoplasm of penis; Malignant neoplasm of vulva; Measures; Mediating; Modality; Online Systems; Parents; Patient-Focused Outcomes; Patients; Persons; Preventive service; Primary Health Care; Process; Provider; Quality of Care; Randomized; Recommendation; Resources; Role; Series; System; Technology; Tennessee; Testing; Time; Translations; Vaccination; Vaccines; Visit; Visualization; Work; arm; base; cancer prevention; care outcomes; cervical and anal cancer; control trial; cost; cost effective; cost effectiveness; human mortality; implementation research; implementation science; improved; innovation; intervention effect; male; malignant oropharynx neoplasm; online resource; post intervention; prevent; primary care setting; provider adherence; relative cost; theories; trial design; uptake; vaccination outcome; vaccine acceptance

PROJECT SUMMARY The human papillomavirus (HPV) vaccine offers the unprecedented opportunity to prevent nearly all cervical and anal cancers and a high proportion of vaginal, oropharyngeal, vulvar and penile cancers, where HPV is the etiologic agent. HPV vaccination is recommended for all children ages 11-12, with catch up for females to age 26 and males to age 21. However, despite clear and indisputable value in cancer prevention, uptake and completion of the HPV vaccine series has lagged far behind the goal of 80%. Provider recommendation is the strongest determinant of HPV vaccination, but slow translation of guidelines for preventive services, such as immunizations, into practice is a known challenge. Practice Facilitation (PF) is a multicomponent quality improvement intervention approach that has well-established efficacy, in which external support and resources are provided to build the internal capacity of practices to improve quality of care and patient outcomes. Our central goal is to identify the optimal approach to implementing an evidence-based intervention for the uptake and completion of HPV vaccine among adolescents receiving care in the community, guided by implementation science theory. AIM 1: Determine the clinical effectiveness and cost-effectiveness of two modalities for delivering a multi-component PF intervention to increase HPV vaccination initiation and completion in community-based pediatric practices. We will compare the traditional in-person Coach PF modality to a lower-resource Web-Based PF modality. The primary patient outcome is HPV vaccination. We will also examine and compare the sustainability of practice changes on vaccination rates and the effects over time for each intervention modality. H1: Both interventions will result in significant increases in HPV vaccination from baseline over time. H2: Increases in the rate of HPV vaccination will be higher and sustained for a longer period of time in the Coach PF Arm as compared with the Web-Based PF Arm. H3: The Web-Based PF Arm will be more cost-effective than the Coach PF Arm. AIM 2. Understand mechanisms of why the PF intervention may work better for some pediatric practices than others for HPV vaccination. We will examine theory-based determinants at the organizational, provider, and patient levels that may mediate (explain) or moderate (change) the effects of the PF intervention on vaccination outcomes. H4: Adoption of changes (process variables) and patient factors will mediate effects of the intervention on HPV vaccination outcomes. H5: Organizational factors, provider attitudes, and intervention characteristics will moderate intervention effects on HPV vaccination outcomes. The findings will inform organizations about which PF modality to use among their constituent practices to improve HPV vaccination rates, with potential for future national dissemination.

项目摘要 人类乳头瘤病毒（HPV）疫苗提供了前所未有的机会，以防止几乎所有宫颈 和肛门癌以及高比例的阴道，口咽，外阴和阴茎癌，其中HPV为 病因剂。建议所有11-12岁儿童进行HPV疫苗接种，并追赶女性到年龄 26和21岁的男性。但是，尽管预防癌症，摄取和 HPV疫苗系列的完成远远落后于80％。提供者建议是 HPV疫苗接种的决定因素最强，但对预防服务准则的转换缓慢，例如 免疫，实践是一个已知的挑战。实践促进（PF）是多组分质量 改进干预方法具有良好的功效，外部支持和资源 提供以建立实践的内部能力，以提高护理质量和患者的结果。我们的 核心目标是确定实施基于证据的干预措施的最佳方法 以及在社区接受护理的青少年中完成HPV疫苗的完成 实施科学理论。目标1：确定两个的临床有效性和成本效益 提供多组分PF干预以增加HPV疫苗接种开始和 以社区为基础的儿科实践完成。我们将比较传统的面对面教练PF 基于低资源的基于Web的PF模式的模态。主要的患者结果是HPV疫苗接种。我们 还将检查和比较实践对疫苗接种率的可持续性变化及影响的影响 每种干预方式的时间。 H1：两种干预措施都将导致HPV疫苗接种显着增加 从基线随着时间的推移。 H2：HPV疫苗接种率的提高将更高并维持更长的时间 与基于Web的PF组相比，教练PF组的时间。 H3：基于网络的PF臂 比教练PF部门更具成本效益。目标2。了解为什么PF干预的机制 对于某些儿科实践，可能比其他小儿疫苗接种更好。我们将研究基于理论的 组织，提供者和患者级别的决定因素，可以调节（解释）或中等 （更改）PF干预对疫苗接种结果的影响。 H4：采用变化（过程 变量）和患者因素将介导干预对HPV疫苗接种结果的影响。 H5： 组织因素，提供者的态度和干预特征将对干预对 HPV疫苗接种结果。这些发现将向组织提供有关其在其之间使用哪种PF模式的信息 提高HPV疫苗接种率的组成习惯，并有可能未来的民族传播。

项目成果

Measurement of provider fidelity to immunization guidelines: a mixed-methods study on the feasibility of documenting patient refusals of the human papillomavirus vaccine.

• DOI: 10.1186/s12911-022-02083-2
• 发表时间: 2022-12-22
• 期刊: BMC MEDICAL INFORMATICS AND DECISION MAKING
• 影响因子: 3.5
• 作者: Chang, Rachel S. S.;Shing, Jaimie Z. Z.;Erves, Jennifer C. C.;Du, Liping;Koyama, Tatsuki;Deppen, Stephen;Rentuza, Alyssa B. B.;McAfee, Caree;Stroebel, Christine;Cates, Janet;Harnack, Lora;Andrews, David;Bramblett, Robert;Hull, Pamela C. C.
• 通讯作者: Hull, Pamela C. C.