Effectiveness and Mechanisms of Multilevel Implementation Strategies to Improve Provider Recommendation and Advance HPV Vaccination: a Cluster Randomized Trial

改善提供者推荐和推进 HPV 疫苗接种的多层次实施策略的有效性和机制:整群随机试验

基本信息

  • 批准号:
    10450821
  • 负责人:
  • 金额:
    $ 64.96万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2021
  • 资助国家:
    美国
  • 起止时间:
    2021-07-15 至 2026-06-30
  • 项目状态:
    未结题

项目摘要

Project Abstract Millions of US teens remain at risk of developing human papillomavirus (HPV)-related cancers due to inadequate HPV vaccine uptake, despite strong endorsement in clinical guidelines and substantial prior intervention efforts. A 2018 national survey showed that HPV vaccine complete series coverage for teens age 13-15 years was only 50%, far below the 80% target of Healthy People 2020. Prior research has identified strong provider recommendation as the most powerful facilitator of HPV vaccine uptake. Yet, little is known about how to leverage this and other facilitators. Additionally, studies have also revealed multilevel, multifactorial barriers to improving HPV vaccination including negative parental perceptions and limitations of health system support. Furthermore, evidence suggests that HPV vaccine barriers can vary across demographic subgroups, communities and clinics. Despite this knowledge, many prior intervention studies focus on single-level, single component interventions, leaving many barriers unaddressed. Of studies that are multilevel and/or multi-component, interventions are often pre-selected to address “typical” barriers but are not responsive to unique local barriers and local context. To address this critical gap, we propose a 3-arm cluster randomized controlled trial (RCT) to compare implementation strategies that are multilevel and multicomponent and guided by in-depth understanding of how multilevel factors in the practice settings modify the impact of key facilitators such as provider recommendation. We will use mixed methods (surveys, interviews, electronic health records) throughout; initially we will evaluate baseline associations between patient-, provider-, and clinic-level factors and variations in HPV vaccination rates and the quality of the provider recommendation (Aim 1). In Aim 2, we will compare the effectiveness of: 1) A novel “local-tailored” implementation strategy, co- designed with local care teams to address local barriers and contexts; versus 2) A “prescribed” strategy, typical of most health systems, that involves pre-specified interventions addressing pre-selected vaccination barriers; versus 3) Usual care. We will evaluate the effectiveness of these strategies on improving HPV vaccination (primary outcome) and strengthening provider recommendation (secondary outcome) as well as analyzing cost effectiveness. We will also study mechanisms of effect of the implementation strategies (Aim 3). Although the need of local tailoring seems intuitive, it is unknown if local tailoring will yield superior outcomes that could offset the extra investment required, supporting the need for this RCT. We will conduct the study within Kaiser Permanente Southern California, one of the largest community-based pediatric care organizations in the US. Our study will be guided by the Consolidated Framework for Implementation Research and the Multilevel Factors Across the Cancer Care Continuum framework. Completion of these Aims will generate important insights into the multilevel factors associated with provider recommendation and HPV vaccine uptake. This study has high potential to generate guidance for diverse health care settings to improve HPV vaccination.
项目摘要 由于以下原因,数百万美国青少年仍然面临患人乳头瘤病毒 (HPV) 相关癌症的风险 尽管临床指南大力支持且前期大量研究表明 HPV 疫苗接种不足 2018 年全国干预力度调查显示,HPV 疫苗已实现青少年全系列覆盖。 13-15岁仅为50%,远低于2020年健康人口80%的目标。此前研究已发现 提供者强烈推荐作为 HPV 疫苗接种最有力的促进者。然而,人们知之甚少。 此外,关于如何利用这一促进因素和其他促进因素,研究还揭示了多层次的、 改善 HPV 疫苗接种的多因素障碍,包括父母的负面看法和局限性 此外,有证据表明,HPV 疫苗的障碍可能因人而异。 尽管有这些知识,但许多先前的干预研究。 重点关注单一水平、单一成分的干预措施,导致许多研究障碍尚未解决。 多层次和/或多组成部分的干预措施通常是预先选择的,以解决“典型”障碍,但并非如此 为了应对这一关键差距,我们提出了一个三臂集群。 随机对照试验 (RCT),用于比较多层次和多组成部分的实施策略 并以深入了解实践环境中的多层次因素如何改变关键的影响为指导 我们将使用混合方法(调查、访谈、电子方式)。 健康记录);最初,我们将评估患者、提供者和患者之间的基线关联 HPV 疫苗接种率和提供者推荐质量的临床层面因素和变化(目标 1) 在目标 2 中,我们将比较以下方面的有效性: 1) 一种新颖的“本地定制”实施策略,即: 与当地护理团队一起设计,以解决当地障碍和环境;对比 2) 典型的“规定”策略; 大多数卫生系统涉及预先指定的干预措施,以解决预先选择的疫苗接种障碍; 3) 我们将评估这些策略对改善 HPV 疫苗接种的有效性。 (主要成果)和加强提供者推荐(次要成果)以及分析成本 我们还将研究实施策略的效果机制(目标 3)。 本地定制的需求似乎是直观的,但尚不清楚本地定制是否会产生能够产生更好的结果 抵消所需的额外投资,支持本次随机对照试验的需要,我们将在 Kaiser 内部进行这项研究。 南加州永久医疗机构是美国最大的社区儿科护理组织之一。 我们的研究将以实施研究综合框架和多层次框架为指导 癌症护理连续体框架中的因素 完成这些目标将产生重要的成果。 深入了解与提供者推荐和 HPV 疫苗接种相关的多层次因素。 研究很有可能为不同的医疗保健机构提供指导,以改善 HPV 疫苗接种。

项目成果

期刊论文数量(0)
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会议论文数量(0)
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Chun R. Chao其他文献

An unmasking phenomenon in an observational post-licensure safety study of adolescent girls and young women.
对青春期女孩和年轻女性进行的观察性许可后安全研究中揭示的现象。
  • DOI:
  • 发表时间:
    2012
  • 期刊:
  • 影响因子:
    5.5
  • 作者:
    Steven J. Jacobsen;L. Sy;B. Ackerson;Chun R. Chao;J. M. Slezak;T. Cheetham;H. Takhar;C. Velicer;John R Hansen;Nicola P. Klein
  • 通讯作者:
    Nicola P. Klein

Chun R. Chao的其他文献

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{{ truncateString('Chun R. Chao', 18)}}的其他基金

Effectiveness and Mechanisms of Multilevel Implementation Strategies to Improve Provider Recommendation and Advance HPV Vaccination: a Cluster Randomized Trial
改善提供者推荐和推进 HPV 疫苗接种的多层次实施策略的有效性和机制:整群随机试验
  • 批准号:
    10296607
  • 财政年份:
    2021
  • 资助金额:
    $ 64.96万
  • 项目类别:
A Case-Control Study to Evaluate Broad-Spectrum Antibiotic use and High Birth Weight as Potential Risk Factors for Early-Onset Colorectal Cancer
一项病例对照研究,评估广谱抗生素的使用和高出生体重作为早发性结直肠癌的潜在危险因素
  • 批准号:
    10304590
  • 财政年份:
    2021
  • 资助金额:
    $ 64.96万
  • 项目类别:
Effectiveness and Mechanisms of Multilevel Implementation Strategies to Improve Provider Recommendation and Advance HPV Vaccination: a Cluster Randomized Trial
改善提供者推荐和推进 HPV 疫苗接种的多层次实施策略的有效性和机制:整群随机试验
  • 批准号:
    10650395
  • 财政年份:
    2021
  • 资助金额:
    $ 64.96万
  • 项目类别:
A Case-Control Study to Evaluate Broad-Spectrum Antibiotic use and High Birth Weight as Potential Risk Factors for Early-Onset Colorectal Cancer
一项病例对照研究,评估广谱抗生素的使用和高出生体重作为早发性结直肠癌的潜在危险因素
  • 批准号:
    10687185
  • 财政年份:
    2021
  • 资助金额:
    $ 64.96万
  • 项目类别:
Follow-up care and preventive service use among survivors of adolescent and young adult cancer.
青少年和青年癌症幸存者的后续护理和预防服务使用。
  • 批准号:
    9178444
  • 财政年份:
    2016
  • 资助金额:
    $ 64.96万
  • 项目类别:
Prognostic Markers for HIV-Postive Diffuse Large B-Cell Lymphoma
HIV 阳性弥漫性大 B 细胞淋巴瘤的预后标志物
  • 批准号:
    7691293
  • 财政年份:
    2008
  • 资助金额:
    $ 64.96万
  • 项目类别:
Prognostic Markers for HIV-Postive Diffuse Large B-Cell Lymphoma
HIV 阳性弥漫性大 B 细胞淋巴瘤的预后标志物
  • 批准号:
    8120890
  • 财政年份:
    2008
  • 资助金额:
    $ 64.96万
  • 项目类别:

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