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

最大限度地提高 HPV 疫苗接种率：实时提醒、指导和建议

• 批准号: 9020055
• 负责人: Stephanie A S Staras
• 金额: $ 20.35万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-02-08 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9020055
• 关键词: 17 year old; 21 year old; Address; Adolescent; Adoption; Adult; Area; Benchmarking; Cancer Control; Child health care; Client; Clinic; Clinical; Clinical Decision Support Systems; Clinical Research; Communities; County; Data; Data Sources; Diffusion of Innovation; Disadvantaged; Dose; Effectiveness; Electronic Health Record; Evaluation; Feedback; Florida; Future; Goals; Health Insurance; Health Personnel; Health Promotion; Hospitals; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Immunization; Incentives; Information Systems; Intervention; Lead; Life; Link; Location; Maintenance; Malignant Neoplasms; Medicaid; Medical Records; Minority; Online Systems; Outcome; Parents; Physicians; Population; Poverty; Prevention; Preventive service; Primary Health Care; Provider; Public Health; Randomized; Recommendation; Records; Registries; Reporting; Research; Research Institute; Research Project Grants; Sampling; Scientist; Series; Source; System; Techniques; Testing; Time; Translational Research; United States; United States National Institutes of Health; Universities; Vaccination; Vaccines; Visit; aged; anticancer research; biomedical scientist; boys; cancer prevention; clinical care; disorder prevention; evidence base; girls; health information technology; improved; innovation; patient population; peer; prevent; primary care setting; public health relevance; randomized trial; social cognitive theory; technology validation; theories

 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.

 描述（由申请人提供）：尽管人乳头瘤病毒（HPV）疫苗预防癌症的潜力令人印象深刻，但错过的临床机会导致美国HPV疫苗覆盖率较低。HPV疫苗接种率可以通过系统地纳入循证策略来提高，以增加临床护理中的疫苗接种机会。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。该应用程序的目的是加强，实施和评估现有的卫生信息技术（HIT）系统，在不同的初级保健环境中提供基于证据的疫苗接种改进策略。中心假设是，解决与创新扩散相一致的策略和实施与社会认知理论相一致的质量改进策略的HIT系统使用的障碍，将增加HIT系统的覆盖范围，有效性，采用，实施和维护（RE-AIM），从而对预防HPV相关癌症产生巨大的公共卫生影响。该提案的具体目标是：（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）通过自动链接多个数据源的疫苗接种记录，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;（3）通过对工作流程的研究和剪裁，提高哈工大系统的兼容性。一项由6个配对诊所组成的分组随机试验将对HIT系统进行评估，这些诊所被分配到增强HIT系统或对照（延迟干预）。诊所将从一个佛罗里达癌症控制网络中选出：该网络由22家医院、416家诊所和3,250名医生组成，分布在佛罗里达的67个县，占佛罗里达患者人数的39%。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，外部和内部提供者同行意见领袖，提供者审计和基准反馈，诊所范围内的工作人员参与和提供者激励）。该方法是创新的，因为它通过自动整合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担忧来吸引父母，为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。拟议的研究是重要的，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，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善其他疫苗接种目标，并扩展到其他癌症预防领域。