Maximizing HPV vaccination: Real-time Reminders, Guidance, and Recommendations

 描述(由申请人提供)：尽管人类乳头瘤病毒(HPV)疫苗在预防癌症方面的潜力令人印象深刻，但错失的临床机会导致HPV疫苗在美国的覆盖率很低。通过系统地纳入循证战略以增加临床护理中的疫苗接种机会，可以提高HPV疫苗接种率。我们的长期目标是在美国现实世界初级保健的不同环境中提高男孩和女孩的HPV疫苗接种率。该应用程序的目标是增强、实施和评估现有的卫生信息技术(HIT)系统，以在不同的初级保健环境中提供基于证据的疫苗接种改进战略。中心假设是，用符合创新扩散的策略解决HIT系统使用的障碍，用符合社会认知理论的质量改进策略实施HIT系统，将增加HIT系统的覆盖范围、有效性、采用、实施和维护(RE-AIM)，从而在预防HPV相关癌症方面产生巨大的公共卫生影响。这项建议的具体目标是：(1)加强HPV疫苗HIT系统在不同初级保健诊所的整合；以及(2)通过可行性试验评估我们增强的HIT系统的RE-AIM组件。为了最大限度地提高HIT系统对提供者和诊所的吸引力，将实施三项改进：(1)通过提高HIT系统的效率，降低提供者参与的复杂性；(2)通过自动链接跨多个数据来源的疫苗接种记录，并包括定制的父母和提供者决策支持，增加HIT系统的相对优势；以及(3)通过研究和定制工作流程，提高HIT系统的兼容性。一项分组随机试验，将6个配对的诊所分配到增强的HIT系统或对照(延迟干预)，将评估HIT系统。诊所将从一个佛罗里达癌症控制网络中选择：该网络由22家医院、416家诊所和3250名医生组成的合作伙伴关系，分布在佛罗里达州所有67个县，涵盖佛罗里达州39%的患者人口。实施将得到六种基于理论和证据的质量改进技术的支持(即，实践促进、外部和内部提供商同行意见领袖、提供商审计和基准反馈、诊所范围的工作人员参与以及提供商激励)。这种方法是创新的，因为它通过自动合并来自多个来源的疫苗数据来推进提供者提醒，通过征求和解决父母的关切来与父母接触，为AIDE的提供者提供量身定制的支持，并且独立于任何一个电子健康记录系统。这项拟议的研究具有重要意义，因为HIT系统结合了基于理论和证据的策略，以促进提供者实时推荐，有望通过减少错过的临床机会来增加HPV疫苗接种。最终，这样的系统有可能改进其他疫苗接种目标，并扩展到更多的癌症预防领域。

 DESCRIPTION (provided by applicant): Despite the impressive potential of human papillomavirus (HPV) vaccines to prevent cancer, missed clinical opportunities lead to low HPV vaccine coverage rates in the United States. HPV vaccination rates could be improved by systematically incorporating evidence-based strategies to increase vaccination opportunities in clinical care. Our long-term goal is to increase HPV vaccination rates among boys and girls within the diverse settings of real-world primary care in the United States. The objective of this application is to enhance, implement, and evaluate an existing health information technology (HIT) system in delivering evidence-based vaccination improvement strategies across diverse primary care settings. The central hypothesis is that addressing barriers to HIT system use with strategies consistent with Diffusion of Innovation and implementing the HIT system with quality improvement strategies consistent with Social Cognitive Theory will increase the HIT system's Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) resulting in a large public health impact on preventing HPV-related cancers. The specific aims of this proposal are: (1) Enhance integration of a HPV vaccine HIT system within diverse primary care clinics; and (2) Evaluate the RE-AIM components of our enhanced HIT system with a feasibility trial. To maximize the HIT system's appeal to providers and clinics, three improvements will be implemented: (1) complexity of provider involvement will be reduced by improving the HIT system's efficiency; (2) the HIT system's relative advantage will be increased by automatically linking vaccination records across multiple data sources and including tailored parent and provider decision supports; and (3) the HIT's systems' compatibility will be improved by studying and tailoring workflow. A group-randomized trial of six pair-matched clinics assigned to the enhanced HIT system or control (delayed intervention) will evaluate the HIT system. Clinics will be selected from the One Florida Cancer Control Network: a partnership of 22 hospitals, 416 clinic settings and 3,250 physician providers located in all of Florida's 67 counties and encompassing 39% of Florida's patient population. Implementation will be supported by six theory- and evidence- based quality improvement techniques (i.e., practice facilitation, external and internal provider peer opinion leaders, provider audit and feedback with benchmarking, clinic-wide staff involvement, and provider incentives). The approach is innovative because it advances provider reminders by automatically incorporating vaccine data from multiple sources, engages parents by soliciting and addressing their concerns, aide's providers with tailored supports, and is independent from any one electronic health record system. The proposed research is significant because a HIT system incorporating theory- and evidence-based strategies to facilitate provider recommendation in real-time promises to increase HPV vaccination by reducing missed clinical opportunities. Ultimately, such a system has potential to improve other vaccination goals and expand to additional areas of cancer prevention.