Multi-level quality improvement strategies to optimize HPV vaccination starting at the 9-year well child visit: Success stories from two private pediatric clinics.
Multi-level quality improvement strategies to optimize HPV vaccination starting at the 9-year well child visit: Success stories from two private pediatric clinics.
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DOI：
10.1080/21645515.2022.2163807
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发表时间：
2023-12-31
影响因子：
4.8
通讯作者：
中科院分区：
文献类型：
--
作者：
HPV 疫苗接种率仍远低于目标，导致许多青少年无法预防未来与 HPV 相关的癌症。 9 岁时开始接种 HPV 疫苗可能会改善青春期前的及时疫苗接种。 “HPV Vax at 9”质量改进干预措施将 HPV 疫苗接种与 9 岁和 10 岁儿童就诊相结合，并于 2018 年至 2022 年间在华盛顿的两家儿科诊所（n = 9 个地点）进行了试点。支持干预措施包括检查室中的标准化免疫时间表海报、电子病历支持、提供者和员工培训、强有力的提供者建议、印刷教育资源和同行冠军辅导。提供者和诊所的接受度很高，9 岁和 10 岁儿童就诊中 68-86% 的人接种了 HPV 疫苗。在第一年，每个诊所 9-10 岁的 HPV 感染率增加了 30 个百分点或更多。启动和系列完成方面持续改善，11-12 岁的完成率从 22% 上升到 62%，提高了 40 个百分点。 COVID-19 大流行对 HPV 疫苗接种率的下行压力得到缓解。将 HPV 疫苗与 9 岁和 10 岁儿童就诊相结合、公布标准化免疫计划以及在 9 岁时为 HPV 提供 EMR 支持可能是简化诊所工作流程并增加及时 HPV 疫苗接种的有效且可持续的策略。
HPV vaccination rates remain far below goal, leaving many adolescents unprotected against future HPV-related cancers. Starting HPV vaccine at age 9 may improve timely preteen vaccination. The “HPV Vax at 9” Quality Improvement intervention paired HPV vaccination with 9- and 10-year well child visits and was piloted at two pediatric clinics (n = 9 sites) in Washington between 2018 and 2022. Supporting interventions included standardized immunization schedule posters in exam rooms, electronic medical record supports, provider and staff training, strong provider recommendations, printed educational resources, and peer-to-peer champion coaching. Provider and clinic acceptance was high with HPV vaccine administration occurring at 68–86% of the 9- and 10-year well child visits. During the first year, HPV initiation rates at age 9–10 increased by 30 percentage points or more at each clinic. Sustained improvements in initiation and series completion were seen with completion at age 11–12 rising as much as 40 percentage points from 22 to 62%. Downward pressure of the COVID-19 pandemic on HPV vaccination rates was mitigated. Pairing HPV vaccine with 9- and 10-year well child visits, posting the standardized immunization schedule, and instituting EMR supports for HPV at 9 may be effective and sustainable strategies to simplify clinic workflows and increase timely HPV vaccination.
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