Effectiveness and Mechanisms of Multilevel Implementation Strategies to Improve Provider Recommendation and Advance HPV Vaccination: a Cluster Randomized Trial

改善提供者推荐和推进 HPV 疫苗接种的多层次实施策略的有效性和机制：整群随机试验

• 批准号: 10650395
• 负责人: Chun R. Chao
• 金额: $ 62.73万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650395
• 关键词: Address; Advisory Committees; Affect; Age; California; Caring; Childhood; Clinic; Clinical; Cluster randomized trial; Communication; Communities; Consolidated Framework for Implementation Research; Continuity of Patient Care; Cost Effectiveness Analysis; Data; Effectiveness; Electronic Health Record; Environment; Family; Guidelines; Health Personnel; Health system; Healthy People 2020; Heterogeneity; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Immunization; Intervention; Intervention Studies; Interview; Intuition; Investments; Knowledge; Measures; Mediation; Methods; Nature; Office Visits; Outcome; Parenting Education; Parents; Patients; Perception; Provider; Public Health; Randomized, Controlled Trials; Recommendation; Research; Resources; Risk; Series; Site; Specific qualifier value; Subgroup; Support System; Surveys; Teenagers; Testing; Thinking; Training; Vaccination; Variant; Work; arm; cancer care; community setting; compare effectiveness; cost effectiveness; design; effective intervention; effectiveness evaluation; health care settings; implementation framework; implementation science; implementation strategy; improved; innovation; insight; intervention refinement; multi-component intervention; novel; practice setting; preadolescence; primary outcome; process evaluation; programs; response; secondary outcome; success; treatment as usual; vaccine acceptance

Project Abstract Millions of US teens remain at risk of developing human papillomavirus (HPV)-related cancers due to inadequate HPV vaccine uptake, despite strong endorsement in clinical guidelines and substantial prior intervention efforts. A 2018 national survey showed that HPV vaccine complete series coverage for teens age 13-15 years was only 50%, far below the 80% target of Healthy People 2020. Prior research has identified strong provider recommendation as the most powerful facilitator of HPV vaccine uptake. Yet, little is known about how to leverage this and other facilitators. Additionally, studies have also revealed multilevel, multifactorial barriers to improving HPV vaccination including negative parental perceptions and limitations of health system support. Furthermore, evidence suggests that HPV vaccine barriers can vary across demographic subgroups, communities and clinics. Despite this knowledge, many prior intervention studies focus on single-level, single component interventions, leaving many barriers unaddressed. Of studies that are multilevel and/or multi-component, interventions are often pre-selected to address “typical” barriers but are not responsive to unique local barriers and local context. To address this critical gap, we propose a 3-arm cluster randomized controlled trial (RCT) to compare implementation strategies that are multilevel and multicomponent and guided by in-depth understanding of how multilevel factors in the practice settings modify the impact of key facilitators such as provider recommendation. We will use mixed methods (surveys, interviews, electronic health records) throughout; initially we will evaluate baseline associations between patient-, provider-, and clinic-level factors and variations in HPV vaccination rates and the quality of the provider recommendation (Aim 1). In Aim 2, we will compare the effectiveness of: 1) A novel “local-tailored” implementation strategy, co- designed with local care teams to address local barriers and contexts; versus 2) A “prescribed” strategy, typical of most health systems, that involves pre-specified interventions addressing pre-selected vaccination barriers; versus 3) Usual care. We will evaluate the effectiveness of these strategies on improving HPV vaccination (primary outcome) and strengthening provider recommendation (secondary outcome) as well as analyzing cost effectiveness. We will also study mechanisms of effect of the implementation strategies (Aim 3). Although the need of local tailoring seems intuitive, it is unknown if local tailoring will yield superior outcomes that could offset the extra investment required, supporting the need for this RCT. We will conduct the study within Kaiser Permanente Southern California, one of the largest community-based pediatric care organizations in the US. Our study will be guided by the Consolidated Framework for Implementation Research and the Multilevel Factors Across the Cancer Care Continuum framework. Completion of these Aims will generate important insights into the multilevel factors associated with provider recommendation and HPV vaccine uptake. This study has high potential to generate guidance for diverse health care settings to improve HPV vaccination.

项目摘要

项目成果

Trends in HPV vaccine administration and HPV vaccine coverage in children by race/ethnicity and socioeconomic status during the COVID-19 pandemic in an integrated health care system in California.

• DOI: 10.1016/j.vaccine.2022.09.073
• 发表时间: 2022-11-02
• 期刊: VACCINE
• 影响因子: 5.5
• 作者: Chao, Chun R.;Xu, Lanfang;Cannizzaro, Nancy;Bronstein, David;Choi, Yunsun;Riewerts, Robert;Mittman, Brian;Zimmerman, Richard K.;Gilkey, Melissa;Glenn, Beth;Shen, Ernest;Hsu, Chunyi;Hahn, Erin E.
• 通讯作者: Hahn, Erin E.