Implementation Challenges and Opportunities Related to HPV Vaccination Quality Improvement in Primary Care Clinics in a Rural State
Implementation Challenges and Opportunities Related to HPV Vaccination Quality Improvement in Primary Care Clinics in a Rural State
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DOI：
10.1007/s10900-019-00676-z
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发表时间：
2019-08-01
影响因子：
5.9
通讯作者：
Callaghan, Donald
中科院分区：
文献类型：
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作者：
Askelson, Natoshia M.;Ryan, Grace;Callaghan, Donald
了解低人乳头瘤病毒疫苗覆盖率的努力使我们探索了质量改进(QI)决策计划和过程，以增加疫苗接种量。这些QI计划通常包括AFIX(评估反馈激励交换)计划建议的干预措施，该计划支持儿童疫苗(VFC)诊所。然而，关于干预措施的选择或实施程度的决策知之甚少。与中西部农村的州公共卫生部门合作，调查人员开发了一项调查，以探索VFC诊所与疫苗相关的QI。调查通过电子邮件分发给所有VFC诊所(n=605)；结果来自初级保健诊所(n=115)。受访者(VFC联络员)报告说，有关疫苗QI的决定是由自己诊所内的多个参与者(45.1%)、负责多个诊所的诊所经理(33.0%)和/或中央行政办公室(35.2%)做出的。此外，大多数受访者认为外部行为者，如保险公司(52.7%)或医疗补助/医疗保险(50.5%)，对决策过程很重要。最常见的干预措施集中在提供者知识和患者教育上。最不常用的干预措施需要系统的改变，如提醒/召回和错过约会后的后续行动。这项初步研究表明，在诊所和卫生保健系统中有多个决策点，因此所有点上的变革推动者都需要参与。最常见的干预措施侧重于提供者和患者，重点是教育。需要系统一级改变和使用电子健康记录的干预措施不太常见，应更多地关注此类干预措施。
Efforts to understand low human papillomavirus vaccine coverage led us to explore quality improvement (QI) decision-making programs and processes to increase vaccine uptake. These QI programs often include interventions recommended by the AFIX (Assessment Feedback Incentives eXchange) Program that supports Vaccines for Children (VFC) clinics. However, little is known about decision-making around intervention selection or extent of implementation. In collaboration with the state public health department in the rural Midwestern, investigators developed a survey to explore vaccine-related QI in VFC clinics. The survey was distributed via email to all VFC clinics (n=605); results presented are from the primary care clinics (n=115). Respondents (VFC liaisons) reported decisions about vaccine QI were made by multiple actors within their own clinics (45.1%), by a clinic manager in charge of multiple clinics (33.0%) and/or at a centralized administrative office (35.2%). Additionally, the majority of respondents considered external actors, like insurance companies (52.7%) or Medicaid/Medicare (50.5%), important to the decision-making process. Most commonly implemented interventions focused on provider knowledge and patient education. Least commonly implemented interventions required systematic changes, such as reminder/recall and follow-up after missed appointments. This preliminary research indicates there are multiple points of decision-making within clinics and health care systems, and therefore change agents at all points need to be involved. The most commonly implemented interventions focus on providers and patients, with an emphasis on education. Interventions requiring system-level changes and use of electronic health records are less common and more attention should be directed towards such interventions.