Quality Improvement Initiative to Improve Human Papillomavirus Vaccine Initiation at 9 Years of Age
Quality Improvement Initiative to Improve Human Papillomavirus Vaccine Initiation at 9 Years of Age
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DOI：
10.1016/j.acap.2018.05.005
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发表时间：
2018-09-01
影响因子：
3.1
通讯作者：
Morack, Jennifer
中科院分区：
文献类型：
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作者：
Goleman, Martha J.;Dolce, Millie;Morack, Jennifer
目的：青少年人乳头瘤病毒（HPV）疫苗接种率仍然很低。早期接种可提高疫苗的效力和免疫率；然而，临床医生并没有常规地对青少年提出强烈建议。本研究评估了在9岁时常规接种疫苗的可行性。方法：在俄亥俄州哥伦布市低收入社区的初级保健网络中实施了三项连续质量改善（QI）干预措施，以将HPV疫苗的起始时间转移到9岁。第一次干预将HPV疫苗的电子医疗记录警报从11岁改为9岁，并在与家庭讨论疫苗时侧重于癌症预防。第二次干预是组成HPV QI小组。第三项干预措施是对HPV捕获机会率的临床激励。采用统计过程控制图监测免疫接种率，比较9岁和10岁儿童样本与11岁和12岁儿童样本的HPV免疫接种率。结果：在QI计划开始后的6个月内，11岁前接受HPV疫苗接种的患者比例从4.6%增加到35.7%，在项目开始后的18个月内增加到60.8%。相比之下，11岁和12岁儿童样本中的HPV疫苗接种率在18个月后从78.7%增加到82.8%。结论：该QI项目采用多种干预措施，在为不同低收入人群服务的大型初级保健网络中增加9岁人群的HPV疫苗接种。
OBJECTIVE: Adolescent human papillomavirus (HPV) vaccine rates remain low. Early vaccination may improve the efficacy of the vaccine and immunization rates; however, clinicians have not routinely made a strong recommendation for younger adolescents. This study assessed the feasibility of routine vaccination at 9 years of age.METHODS: Three sequential quality improvement (QI) interventions were implemented to shift the initiation of the HPV vaccine to 9 years of age in a primary care network in low-income neighborhoods in Columbus, Ohio. The first intervention changed the electronic medical record alert for the HPV vaccine from 11 to 9 years of age and focused on cancer prevention when discussing the vaccine with families. The second intervention was formation of an HPV QI team. The third intervention was a clinic incentive for HPV captured opportunity rates. Immunization rates were monitored using statistical process control charts to compare the HPV immunization rate in a sample of 9- and 10-year-old children with a sample of 11- and 12-year-old children.RESULTS: The percentage of patients receiving an HPV vaccine before 11 years increased from 4.6% to 35.7% during the 6 months after the QI initiative began and to 60.8% 18 months after the project began. In comparison, the HPV vaccination rate in the sample of 11- and 12-year-olds increased from 78.7% to 82.8% 18 months later.CONCLUSIONS: This QI project used multiple interventions to increase HPV vaccination at 9 years of age in a large primary care network serving a diverse low-income population.