Coaching primary care clinics for HPV vaccination quality improvement: Comparing in-person and webinar implementation
Coaching primary care clinics for HPV vaccination quality improvement: Comparing in-person and webinar implementation
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DOI：
10.1093/tbm/iby008
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发表时间：
2019-02-01
影响因子：
3.6
通讯作者：
Brewer, Noel T.
中科院分区：
文献类型：
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作者：
Calo, William A.;Gilkey, Melissa B.;Brewer, Noel T.
州卫生部门通常使用质量改进指导作为提高低人乳头瘤病毒（HPV）疫苗接种覆盖率的实施战略，但这种指导可能是资源密集型的。为了探索提高效率的机会，我们比较了面对面和网络研讨会的指导会议的实施结果，包括范围、可接受性和交付成本。2015年，我们在伊利诺伊州、密歇根州和华盛顿州随机分配了148家大容量初级保健诊所，让他们接受面对面或网络研讨会的指导。辅导课程持续约1小时，并使用我们的免疫报告卡来促进评估和反馈。诊所服务了超过213,000名年龄在11-17岁的患者。我们使用供应商调查和交付成本评估来收集实施数据。本报告专门侧重于干预措施的执行方面。与网络研讨会辅导会议相比，更多的医疗服务提供者参加了面对面的辅导会议（平均每个诊所分别有9个和5个医疗服务提供者，p = 0.004）。与网络研讨会相比，更多的医疗服务提供者在诊所员工面对面会议上分享免疫报告卡（49%对20%；p = 0.029）。在两组中，提供者认为他们诊所的HPV疫苗接种覆盖率太低的信念增加了，他们帮助诊所改善的自我效能感也增加了（p < 0.05）。在可接受性方面，提供者对两组训练课程的评价是一样高的。每个诊所的现场指导费用为733美元，而网络研讨会指导费用为461美元。面对面和网络研讨会的指导很受欢迎，并提高了提供者对HPV疫苗质量改进的信念和自我效能。总而言之，每个诊所的面对面指导成本高于网络研讨会指导，但有更多的提供者。需要进一步的实施研究，以了解如何以及对谁来说网络研讨会指导可能是合适的。
State health departments commonly use quality improvement coaching as an implementation strategy for improving low human papillomavirus (HPV) vaccination coverage, but such coaching can be resource intensive. To explore opportunities for improving efficiency, we compared in-person and webinar delivery of coaching sessions on implementation outcomes, including reach, acceptability, and delivery cost. In 2015, we randomly assigned 148 high-volume primary care clinics in Illinois, Michigan, and Washington State to receive either in-person or webinar coaching. Coaching sessions lasted about 1 hr and used our Immunization Report Card to facilitate assessment and feedback. Clinics served over 213,000 patients ages 11-17. We used provider surveys and delivery cost assessment to collect implementation data. This report is focused exclusively on the implementation aspects of the intervention. More providers attended in-person than webinar coaching sessions (mean 9 vs. 5 providers per clinic, respectively, p = .004). More providers shared the Immunization Report Card at clinic staff meetings in the in-person than webinar arm (49% vs. 20%; p = .029). In both arms, providers' belief that their clinics' HPV vaccination coverage was too low increased, as did their self-efficacy to help their clinics improve (p < .05). Providers rated coaching sessions in the two arms equally highly on acceptability. Delivery cost per clinic was $733 for in-person coaching versus $461 for webinar coaching. In-person and webinar coaching were well received and yielded improvements in provider beliefs and self-efficacy regarding HPV vaccine quality improvement. In summary, in-person coaching cost more than webinar coaching per clinic reached, but reached more providers. Further implementation research is needed to understand how and for whom webinar coaching may be appropriate.