Impact of a Multi-Level, Multi-Component, System Intervention on HPV Vaccination in a Federally Qualified Health Center.
Impact of a Multi-Level, Multi-Component, System Intervention on HPV Vaccination in a Federally Qualified Health Center.
复制标题
DOI：
10.1158/1055-9965.epi-22-0156
复制
发表时间：
2022-10-04
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
人乳头瘤病毒（HPV）疫苗可以显着降低HPV相关癌症的负担，但仍未得到充分利用。我们评估了一种多成分的系统级干预措施，以改善大型联邦合格卫生中心（WHC）的HPV疫苗接种，该中心主要为低收入拉丁裔人口提供服务。从2015年1月到2017年3月，我们在随机分配到研究条件的8个诊所（4个干预，4个常规护理）中评估了多组分系统级干预措施提高HPV疫苗接种率的有效性。干预措施包括提醒父母完成HPV疫苗系列，提供者培训，诊所级审计和反馈，以及修改工作流程以减少错过接种疫苗的机会。使用差异中的差异方法，我们比较了11-17岁患者在12个月干预前和15个月干预期间的HPV疫苗接种率。使用线性混合模型来估计干预对疫苗启动和完成的影响。样本包括每个季度约15，000名青少年（范围14，773 - 15，571;平均年龄14岁，51%女性，88%拉丁裔）。与常规护理诊所相比，干预措施的HPV疫苗接种率季度增幅显著更大（增幅高0.75个百分点，p < 0.001），相当于每季度增加114名青少年接种疫苗。干预导致男孩的HPV疫苗完成率增加更多（增加0.65个百分点，p<0.001），但不是女孩。我们的系统水平干预与HPV疫苗启动总体和男孩完成的适度改善相关。研究结果对减少安全网人群中的HPV相关癌症具有意义。
Human papillomavirus (HPV) vaccines can significantly reduce the burden of HPV-associated cancers, but remain underutilized. We evaluated a multi-component, system-level intervention to improve HPV vaccination in a large Federally Qualified Health Center (FQHC) that serves a primarily low income Latino population. From January 2015 through March 2017, we evaluated the effectiveness of a multi-component, system-level intervention to improve HPV vaccination rates in 8 clinics randomly assigned to study condition (4 intervention, 4 usual care). The intervention included parent reminders for HPV vaccine series completion, provider training, clinic-level audit and feedback, and workflow modifications to reduce missed opportunities for vaccination. Using a difference-in-differences approach, we compared HPV vaccination rates among patients ages 11–17 during a 12-month pre-intervention period and a 15-month intervention period. Linear mixed models were used to estimate intervention effects on vaccine initiation and completion. The sample included approximately 15,000 adolescents each quarter (range 14,773–15,571; mean age 14 years, 51% female, 88% Latino). A significantly greater quarterly increase in HPV vaccine initiation was observed for intervention compared to usual care clinics (0.75 percentage point greater increase, p < 0.001), corresponding to 114 additional adolescents vaccinated per quarter. The intervention led to a greater increase in HPV vaccine completion rates among boys (0.65 percentage point greater increase, p<0.001), but not girls. Our system-level intervention was associated with modest improvements in HPV vaccine initiation overall and completion among boys. Study findings have implications for reducing HPV-related cancers in safety net populations.