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

摘要-项目1 在美国，一个持续而紧迫的癌症预防挑战是HPV疫苗覆盖率低，部分原因是 不经常和低质量的供应商推荐。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假定公告， 最佳做法，尊重解决父母的关切，当他们出现。AAT增加HPV疫苗 启动，是一个NCI指定的研究测试干预计划。为了扩大AAT的影响， 我们建议利用整个初级保健团队，包括注册护士和医疗助理 (MAs)，支持执行现有的常规。长期订单是广泛可用的， 经常被低估。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将侧重于通过长期订单支持加强AAT，以扩大整个 初级保健团队参与HPV疫苗的建议。我们将在医疗保健系统中开展这项工作 服务于农村和非农村地区。目的1是描述RN和MA以及常规订单在以下方面的作用 HPV疫苗。我们将进行形成性访谈（n=20），然后进行国家初级保健团队调查 （n= 2，500）与我们的P01的数据核心，以更好地了解如何扩大RN和MA的作用， 建议接种人类乳头瘤病毒疫苗，并执行现有的人类乳头瘤病毒疫苗常规。目标2：评估 支持执行现有的初级保健常规的影响 在RCT中进行HPV疫苗交流和摄取。常规支持将是一系列 与系统领导者、诊所领导者和诊所工作人员举行动员会议，使用说服和技能建设。 我们将在密西西比、密苏里州和得克萨斯州的40家有HPV疫苗接种的初级保健诊所进行试验 长期订单，为农村和非农村地区的患者提供服务，是医疗保健系统的一部分。诊所将 被随机分配到AAT或AAT增强与长期订单支持。主要试验结果将是临床- 在11-12岁的儿童中开始接种HPV疫苗。我们假设AAT和常规命令 支持通过改善HPV疫苗宣传来增加HPV疫苗的接种。目标3：生成 卫生保健系统指南，以支持实施HPV疫苗常规指令， 整个初级保健团队。我们将收集和共享干预数据（成本、影响和实施 数据），以支持成本效益分析和开发其决策支持工具。我们 将检查干预实施的决定因素和结果与我们的P01的干预核心。最后， 我们将为AAT干预包提供模块，为医疗保健系统提供指导， 改善HPV疫苗接种。项目1通过以下方面的能力建设来解决影响方案项目主题： 在医疗保健系统的初级保健团队之间进行HPV疫苗沟通干预。

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.