PCOM2 - The Physician Communication Intervention, Version 2.0

项目摘要/摘要 人乳头瘤病毒(HPV)感染90%的人口，导致30,000人宫颈、肛门和 口咽癌每年都有。HPV疫苗自2006年以来一直在美国上市，但在11个国家中只有54%- 12岁的儿童接种了疫苗--远低于80%的国家目标。作为本条例所适用的票面价值的名称- Ttion Response建议(PAR-19-360)，“将供应商的建议与青少年HPV疫苗联系起来- Take“是增加青少年HPV疫苗接种的关键战略。许多研究表明，一个主要的驱动力 低质量的青少年HPV疫苗接种是供应商推荐的质量较差的HPV疫苗。虽然很多人 虽然已经制定了解决这一问题的干预措施，但在严格的试验中几乎没有发现增加疫苗接种的情况。 而且在繁忙的临床环境中实施也是可行的。一个例外是医生通信， 或PCOM，由我们小组开发的干预措施。PCOM专注于教学提供者使用2步口头 他们建议的沟通流程：1)以“假定”的形式开始疫苗讨论 (即“让我们今天就做好HPV疫苗”)和2)使用动机访谈(MI)技术来解决 如果需要，父母疫苗会犹豫不决。在一项大型整群随机试验中，PCOM增加了青少年HPV 11-12岁儿童的疫苗接种率比对照组高8个百分点(PP)-相对 疫苗接种干预效果大。限制PCOM的广泛传播是 研究团队需要促进教授实践如何使用PCOM组件。为了解决这个问题，我们 建议开发PCOM干预的“虚拟”版本(“PCOM-虚拟”)，并测试其非自卑性 为了增加青少年人乳头瘤病毒疫苗的接种，对原来的PCOM干预措施(“PCOM标准”)进行了改进。通过使用 在整个过程中传播和实施(D&I)科学原则，并收集关于 背景实践、提供者和患者因素如何影响PCOM的使用，我们预计会创建一个 准备好“版本的多氯联苯和相关的”用户手册“，以促进传播。我们的目标是： 1.在已有原型的基础上，利用D&I科学原理，开发出“PCOM-虚拟”干预方法。 2.比较“PCOM-虚拟”与改善青少年人乳头瘤病毒感染的“PCOM标准” 电影利用率。年，将在30个初级保健诊所中进行整群随机非自卑试验 堪萨斯州--这是全国青少年HPV疫苗接种率最低的地区。 3.检查实践、患者和提供者的特征是否与变异性有关 PCOM的功效-虚拟和PCOM-标准。混合方法和PRISM框架将促进 了解环境如何影响干预措施的实施，以便向用户手册提供信息。 通过创建一个易于实施的PCOM干预版本，并广泛传播它，我们相信 我们可以对青少年HPV疫苗接种水平产生重大影响。

PROJECT SUMMARY/ABSTRACT Human Papillomaviruses (HPV) infect >90% of the population and cause >30,000 cervical, anogenital, and oropharyngeal cancers annually. HPV vaccines have been available in the US since 2006 but only 54% of 11- 12 years-olds are vaccinated - well below national goals of 80%. As the title of the PAR to which this applica- tion responds suggests (PAR-19-360), “Linking the Provider Recommendation to Adolescent HPV Vaccine Up- take” is a key strategy for increasing adolescent HPV vaccination. Many studies show that a primary driver of low adolescent HPV vaccination is a poor quality HPV vaccine recommendation from providers. While many interventions to address this have been developed, few have been found in rigorous trials to increase vaccina- tion and also be feasible to implement in busy clinical settings. An exception is the Physician Communication, or PCOM, intervention developed by our group. PCOM focuses on teaching providers to use a 2-step verbal communication process for their recommendation:1) start the vaccine discussion using a “presumptive” format (i.e. “Let's get the HPV vaccine done today”) and 2) use motivational interviewing (MI) techniques to address parental vaccine hesitancy, if needed. In a large, cluster-randomized trial, PCOM increased adolescent HPV vaccine initiation rates among 11-12 year olds by 8 percentage points (PP) more than controls– a relatively large effect size for a vaccination intervention. Limiting broad dissemination of PCOM is the significant level of research team facilitation needed to teach practices how to use the PCOM components. To address this, we propose to develop a “Virtual” version of the PCOM intervention (“PCOM-Virtual”) and test it for non-inferiority to the original PCOM intervention (“PCOM-Standard”) for increasing adolescent HPV vaccination. By using Dissemination & Implementation (D&I) science principles throughout the process and collecting information on how contextual practice, provider and patient factors influence PCOM use, we anticipate creating a “shelf ready” version of PCOM with an associated “User Manual” to foster dissemination. Our Aims are to: 1. Develop the “PCOM-Virtual” intervention using principles of D&I Science from existing prototypes. 2. Compare the efficacy of “PCOM-Virtual” vs. “PCOM-Standard” in improving adolescent HPV vac- cine utilization. A cluster-randomized non-inferiority trial will be conducted in 30 primary care practices in Kansas – a locale with some of the lowest adolescent HPV vaccination rates nationally. 3. Examine whether practice, patient and provider characteristics are associated with variability in the efficacy of PCOM-Virtual and PCOM-Standard. Mixed methods and the PRISM framework will facili- tate understanding how context influences the interventions' implementation to inform a User Manual. By creating an easily implementable version of the PCOM intervention, and disseminating it widely we believe we can have a substantial impact on adolescent HPV vaccination levels.