IMPACT Project 2 – The impact of clinic-level financial incentives on HPV vaccine communication and uptake

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ABSTRACT – Project 2 Human papillomavirus (HPV) vaccination is effective and recommended to protect against six types of cancer, but HPV vaccine coverage remains low. Provider communication has a powerful influence on HPV vaccine uptake. Our program team has demonstrated that Announcement Approach Training (AAT) effectively improves provider communication and increases HPV vaccination uptake. A promising tool to expand the impact of AAT is clinic-level financial incentives, which can motivate providers to apply what they learn in the AAT workshop. Financial incentives are increasingly a central part of payment reform efforts focusing on better aligning financial incentives in healthcare systems with quality of care. No studies have adequately established whether financial incentives motivate providers to recommend HPV vaccination. As part of the proposed P01 Program Project, “Improving Provider Announcement Communication Training (IMPACT),” the goal of this randomized clinical trial (RCT) is to test promising alternatives to motivate providers to improve HPV vaccine communication. We propose to examine whether financial incentives tied to clinic-level improvement in HPV vaccination rates can improve HPV vaccine communication and uptake. To achieve this goal, in Aim 1, we will characterize providers’ perceptions of financial incentives tied to HPV vaccination and behavioral nudges via a national primary care team survey. We will also refine a feedback report to track HPV vaccination rates paired with improvement targets to providers and clinics. In Aim 2, we will conduct the RCT, randomizing clinics to one of two arms: 1) AAT and 2) AAT plus financial incentive tied to clinic-level improvement in HPV vaccination rates. In Aim 3, we will evaluate intervention implementation, including cost per additional adolescent initiating HPV vaccine. This RCT is significant because it will demonstrate whether and how financial incentives improve provider communication and increase vaccine uptake to achieve HPV vaccination goals. The proposed research addresses the IMPACT Program Project theme of amplifying the impact of a Research-Tested Intervention Program to improve HPV vaccine communication in healthcare systems via financial incentives to motivate providers to make needed recommendations.