A Bundled, Practice-Based Intervention to Increase HPV Vaccination.

IF 6.2 2区医学 Q1 PEDIATRICS Pediatrics Pub Date : 2025-01-06 DOI:10.1542/peds.2024-068145

Peter G Szilagyi, Alexander G Fiks, Cynthia M Rand, Mary Kate Kelly, A Russell Localio, Christina S Albertin, Sharon G Humiston, Robert W Grundmeier, Jennifer Steffes, Kristin Davis, Laura P Shone, Greta McFarland, Dianna E Abney, Alisa J Stephens-Shields

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Abstract

Background and objectives: Human papillomavirus (HPV) vaccination rates are suboptimal, and missed vaccination opportunities are common. We hypothesized that a bundled intervention improves missed HPV vaccination opportunities.

Methods: We used a pre-post design to assess differences in HPV vaccine missed opportunities (visits when vaccine-eligible adolescents are not vaccinated). We compared rates for a 12-month period before vs those for a 6-month period (February 23, 2022, to August 9, 2022) during a bundled intervention. We implemented the bundled intervention in 24 primary care pediatric practices that had been usual care controls for a prior randomized trial. The bundled intervention involved 3 components: online clinician training on HPV vaccine communication, performance feedback on missed HPV vaccination opportunities, and clinician prompts for HPV vaccination. As a secondary analysis, we compared missed opportunities for these 24 practices vs 48 contemporaneous comparison group practices identified retrospectively.

Results: For well-child care (WCC) visits, missed HPV vaccination opportunities were improved during vs before the intervention by 4.8 percentage points (95% CI, -7.2% to -2.4%) for initial HPV vaccine doses and a modest 2.2 percentage points (95% CI, -4.4% to -0.0%) for subsequent doses. For other visit types, findings ruled out changes beyond minimal improvements. Missed vaccination opportunity rates for initial HPV vaccination at WCC visits were similar for the 24 intervention practices vs the 48 comparison practices for a 4.5-year period before the intervention, but they improved for intervention practices and worsened for comparison practices during the intervention period (difference, -6.6%; 95% CI, -9.3% to -3.8%).

Conclusions: This bundled intervention appeared to improve HPV vaccination during WCC visits.

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背景和目的：人乳头瘤病毒 (HPV) 疫苗接种率不理想，错过接种机会的情况很普遍。我们假设捆绑式干预措施能改善错过的 HPV 疫苗接种机会：方法：我们采用了前后期设计来评估 HPV 疫苗错过接种机会（符合接种条件的青少年未接种疫苗时的就诊情况）的差异。我们比较了捆绑干预前 12 个月与捆绑干预期间 6 个月（2022 年 2 月 23 日至 2022 年 8 月 9 日）的接种率。我们在 24 个初级保健儿科诊所实施了捆绑干预，这些诊所是之前随机试验的常规护理对照诊所。捆绑干预包括三个部分：HPV 疫苗沟通的在线临床医生培训、错过 HPV 疫苗接种机会的绩效反馈以及临床医生对 HPV 疫苗接种的提示。作为辅助分析，我们比较了这 24 家诊所与回顾性发现的 48 家同期对比组诊所错过的机会：结果：就健康儿童保健（WCC）就诊而言，与干预前相比，干预期间错过的 HPV 疫苗接种机会增加了 4.8 个百分点（95% CI，-7.2% 至 -2.4%），而后续剂量则略微增加了 2.2 个百分点（95% CI，-4.4% 至 -0.0%）。对于其他就诊类型，研究结果排除了微小改善之外的变化。在干预前的 4.5 年中，24 个干预实践与 48 个对比实践相比，在 WCC 就诊时初次接种 HPV 疫苗的错过接种机会率相似，但在干预期间，干预实践的错过接种机会率有所改善，而对比实践的错过接种机会率则有所恶化（差异，-6.6%；95% CI，-9.3% 至 -3.8%）：这一捆绑式干预措施似乎改善了在 WCC 访问期间的 HPV 疫苗接种情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatrics 医学-小儿科

CiteScore

12.80

自引率

5.00%

发文量

791

审稿时长

2-3 weeks

期刊介绍： The Pediatrics® journal is the official flagship journal of the American Academy of Pediatrics (AAP). It is widely cited in the field of pediatric medicine and is recognized as the leading journal in the field. The journal publishes original research and evidence-based articles, which provide authoritative information to help readers stay up-to-date with the latest developments in pediatric medicine. The content is peer-reviewed and undergoes rigorous evaluation to ensure its quality and reliability. Pediatrics also serves as a valuable resource for conducting new research studies and supporting education and training activities in the field of pediatrics. It aims to enhance the quality of pediatric outpatient and inpatient care by disseminating valuable knowledge and insights. As of 2023, Pediatrics has an impressive Journal Impact Factor (IF) Score of 8.0. The IF is a measure of a journal's influence and importance in the scientific community, with higher scores indicating a greater impact. This score reflects the significance and reach of the research published in Pediatrics, further establishing its prominence in the field of pediatric medicine.

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