Improving HPV Vaccination Rates: A Stepped-Wedge Randomized Trial
Improving HPV Vaccination Rates: A Stepped-Wedge Randomized Trial
复制标题
DOI：
10.1542/peds.2019-2737
复制
发表时间：
2020-07-01
期刊：
影响因子：
8
通讯作者：
Hanchate, Amresh
中科院分区：
文献类型：
--
作者：
Perkins, Rebecca B.;Legler, Aaron;Hanchate, Amresh
提示：为了评估一个阶梯楔形随机试验的有效性的发展系统和教育的人乳头瘤病毒疫苗接种（剂量HPV），一个多层次intervention.METHODS：剂量HPV是一个7届会议的计划，包括跨专业提供者教育，沟通培训，数据反馈，和量身定制的系统更改。2016年至2018年期间，五个初级保健儿科和/或家庭医学实践完成了干预措施;所有人都选择在9至10岁时开始接种疫苗。我们使用适用于阶梯楔形设计的随机效应广义线性回归模型比较了9至17岁儿童在干预前、干预后和干预后的疫苗接种率，考虑了日历时间和按提供者和诊所划分的患者群。结果包括（1）合格患者在门诊访视期间接受疫苗接种的可能性;（2）青少年在13岁之前完成系列接种的可能性;（3）对人群水平疫苗接种开始率和完成率的累积效应。结果：在干预和干预后期间，9至10岁和11至12岁儿童在合格访视时接种疫苗的调整可能性增加了>10个百分点，13岁时完成疫苗接种增加了4个百分点（所有比较P < .001）。人口水平的疫苗启动覆盖率从75%（干预前）增加到84%（干预）到90%（干预后），完成率从60%（干预前）增加到63%（干预）到69%（干预后）。结论：多层次的干预措施，包括提供者教育，数据反馈，量身定制的系统变化，早期启动的人乳头瘤病毒疫苗系列可能会提高疫苗系列的启动和完成超出干预期的结论。
OBJECTIVES:To evaluate the effectiveness of a stepped-wedge randomized trial of Development of Systems and Education for Human Papillomavirus Vaccination (DOSE HPV), a multilevel intervention.METHODS:DOSE HPV is a 7-session program that includes interprofessional provider education, communication training, data feedback, and tailored systems change. Five primary care pediatric and/or family medicine practices completed interventions between 2016 and 2018; all chose to initiate vaccination at ages 9 to 10. We compared vaccination rates in the preintervention, intervention, and postintervention periods among 9- to 17-year-olds using random-effects generalized linear regression models appropriate for stepped-wedge design, accounting for calendar time and clustering of patients by providers and clinic. Outcomes included (1) the likelihood that eligible patients would receive vaccination during clinic visits; (2) the likelihood that adolescents would complete the series by age 13; and (3) the cumulative effect on population-level vaccine initiation and completion rates. Postintervention periods ranged from 6 to 18 months.RESULTS:In the intervention and postintervention periods, the adjusted likelihood of vaccination at an eligible visit increased by >10 percentage points for ages 9 to 10 and 11 to 12, and completion of the vaccine series by age 13 increased by 4 percentage points (P < .001 for all comparisons). Population-level vaccine initiation coverage increased from 75% (preintervention) to 84% (intervention) to 90% (postintervention), and completion increased from 60% (preintervention) to 63% (intervention) to 69% (postintervention).CONCLUSIONS:Multilevel interventions that include provider education, data feedback, tailored systems changes, and early initiation of the human papillomavirus vaccine series may improve vaccine series initiation and completion beyond the conclusion of the intervention period.