IMPACT Project 1 – The impact of standing orders support on HPV vaccine communication and uptake

IMPACT 项目 1 — 常规订单支持对 HPV 疫苗传播和采用的影响

• 批准号: 10493153
• 负责人: Noel Todd Brewer
• 金额: $ 46.07万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-23 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10493153
• 关键词: Address; Adolescent; Age; Area; Child; Clinic; Clinic Visits; Clinical; Communication; Complement; Cost Effectiveness Analysis; Data; Development; Educational Intervention; Educational workshop; Healthcare; Healthcare Systems; Hour; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Immunization; Intervention; Interview; Language; Laws; Medical; Mississippi; Missouri; Motivation; Nurses; Outcome; Parents; Participant; Patients; Persuasive Communication; Primary Health Care; Program Research Project Grants; Provider; Publications; Randomized; Randomized Clinical Trials; Recommendation; Registered nurse; Research; Role; Rural; Series; Slide; Specific qualifier value; Surveys; System; Testing; Texas; Training; Training Programs; Trust; Update; Vaccines; Work; arm; base; cancer prevention; cost; cost effectiveness; implementation determinants; implementation intervention; implementation outcomes; improved; informant; innovation; intervention program; meetings; member; patient population; pilot test; programs; rural area; rural patients; rurality; skills; support tools; training project; uptake; vaccine acceptance; vaccine delivery

ABSTRACT – Project 1 An ongoing and pressing cancer prevention challenge in the US is low HPV vaccine coverage, due in part to infrequent and low-quality provider recommendations. Our 1-hour Announcement Approach Training (AAT) teaches providers to use presumptive announcements that presume the child will receive vaccines and to use best practices for respectfully addressing parent concerns when they arise. The AAT increases HPV vaccine initiation and is an NCI-designated Research-Tested Intervention Program. To increase the impact of the AAT, we propose to leverage the whole primary care team, including registered nurses (RNs) and medical assistants (MAs), by supporting the implementation of existing standing orders. Standing orders are widely available but often underused. As part of the P01 Program Project, “Improving Provider Announcement Communication Training (IMPACT),” Project 1 will focus on AAT enhanced with standing orders support to expand the whole primary care team's involvement in HPV vaccine recommendations. We will do this work in healthcare systems serving rural and nonrural areas. Aim 1 is to characterize the role of RNs and MAs and standing orders in HPV vaccination. We will conduct formative interviews (n=20) and then a national primary care team survey (n=2,500) with our P01's Data Core to better understand how to expand the role of RNs and MAs in recommending HPV vaccine and to implement existing standing orders for HPV vaccine. Aim 2 is to evaluate the impact of supporting the implementation of existing standing orders for the whole primary care team on HPV vaccine communication and uptake in an RCT. The standing orders support will be a series of activation meetings that use persuasion and skills building with system leaders, clinic leaders and clinic staff. We will conduct a trial in 40 primary care clinics in Mississippi, Missouri, and Texas that have HPV vaccination standing orders, serve patients from rural and nonrural areas, and are part of a healthcare system. Clinics will be randomized to AAT or AAT enhanced with standing orders support. The primary trial outcome will be clinic- verified HPV vaccine initiation among children ages 11-12. We hypothesize that AAT with standing orders support increases HPV vaccine uptake by improving HPV vaccine communication. Aim 3 is to generate guidance for healthcare systems to support implementation of HPV vaccine standing orders to leverage the whole primary care team. We will gather and share intervention data (cost, impact, and implementation data) with Project 4 to support cost-effectiveness analyses and development of their decision support tool. We will examine intervention implementation determinants and outcomes with our P01's Intervention Core. Finally, we will contribute modules to the AAT Intervention Package that provides guidance to healthcare systems for improving HPV vaccination. Project 1 addresses the IMPACT Program Project theme by building capacity for HPV vaccine communication interventions among primary care teams in healthcare systems.

摘要 – 项目 1 美国持续且紧迫的癌症预防挑战是 HPV 疫苗覆盖率低，部分原因是 不频繁且低质量的提供商推荐。我们的 1 小时公告方法培训 (AAT) 教导提供者使用假定儿童将接种疫苗的推定公告并使用 尊重地解决家长出现的问题的最佳实践。 AAT 增加 HPV 疫苗接种 启动，是 NCI 指定的研究测试干预计划。为了增加 AAT 的影响力， 我们建议利用整个初级保健团队，包括注册护士 (RN) 和医疗助理 （MA），通过支持现有常规命令的实施。长期订单广泛存在，但 经常未得到充分利用。作为 P01 计划项目的一部分，“改善提供商公告沟通 培训（IMPACT）”，项目 1 将重点关注通过常规订单支持增强的 AAT，以扩大整个 初级保健团队参与 HPV 疫苗建议。我们将在医疗保健系统中开展这项工作 服务农村和非农村地区。目标 1 是描述 RN 和 MA 的作用以及常规命令 HPV 疫苗接种。我们将进行形成性访谈 (n=20)，然后进行全国初级保健团队调查 (n=2,500) 与我们的 P01 数据核心一起更好地了解如何扩大 RN 和 MA 的作用 推荐 HPV 疫苗并执行现有的 HPV 疫苗常规指令。目标 2 是评估 支持执行现有常规命令对整个初级保健的影响 小组在一项随机对照试验中研究 HPV 疫苗的传播和吸收。常规订单支持将是一系列 与系统领导、诊所领导和诊所工作人员进行说服和技能建设的激活会议。 我们将在密西西比州、密苏里州和德克萨斯州 40 个接种 HPV 疫苗的初级保健诊所进行试验 常规订单，为来自农村和非农村地区的患者提供服务，并且是医疗保健系统的一部分。诊所将 随机接受 AAT 或通过常规指令支持增强的 AAT。主要试验结果将是临床- 已验证 11-12 岁儿童是否已开始接种 HPV 疫苗。我们假设 AAT 有常规订单 支持通过改善 HPV 疫苗沟通来增加 HPV 疫苗的接种。目标 3 是生成 为医疗保健系统提供支持 HPV 疫苗常规指令实施的指南 整个初级保健团队。我们将收集并共享干预数据（成本、影响和实施情况） 数据）与项目 4 一起支持成本效益分析和决策支持工具的开发。我们 将通过 P01 的干预核心检查干预实施的决定因素和结果。最后， 我们将为 AAT 干预包提供模块，该包为医疗保健系统提供指导 改善 HPV 疫苗接种。项目 1 通过能力建设来解决 IMPACT 计划的项目主题 医疗保健系统初级保健团队之间的 HPV 疫苗沟通干预。