Advancing the implementation of evidence-based strategies for HPV vaccination in safety-net primary care settings

推动在安全网初级保健机构中实施基于证据的 HPV 疫苗接种策略

• 批准号: 10242629
• 负责人: Jennifer Tsui
• 金额: $ 37.17万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-20 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242629
• 关键词: Adolescent; Adopted; Adoption; Advocacy; Age; Belief; Cervical; Clinic; Clinical; Communities; Complex; Computerized Medical Record; Data; Ensure; Federally Qualified Health Center; Foundations; Future; Geography; Health system; Healthcare; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Human papilloma virus infection; Incidence; Interview; Knowledge; Level of Evidence; Low income; Maintenance; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measures; Methods; Modeling; Motivation; Parents; Patients; Physicians; Play; Policies; Population; Prevention strategy; Primary Health Care; Primary Prevention; Process; Provider; RQ2; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recording of previous events; Research; Resources; Sampling; Site; Surveys; System; Translating; Underserved Population; Vaccination; age group; base; clinical care; concept mapping; ethnic minority population; evidence base; follow-up; health care delivery; health care settings; implementation strategy; improved; mortality; multidisciplinary; parental role; pragmatic trial; primary care setting; racial and ethnic; safety net; scale up; stakeholder perspectives; vaccine acceptance; vaccine access

ABSTRACT There is a critical need to accelerate and sustain the adoption of evidence-based strategies (EBS) for Human Papillomavirus (HPV) vaccination into safety-net healthcare settings given the suboptimal vaccination rates in recommended age groups (11-12 years) and persistent disparities in cervical and other HPV-associated cancers among low-income, racial/ethnic minority populations. Although recommended EBS to improve HPV vaccination are available, few studies have fully examined the interrelationships among provider, clinic, and health system levels that enable or inhibit successful integration of EBS for HPV vaccination into routine clinical care. The proposed four-year sequential mixed-methods study seeks to (1) identify factors at multiple levels that are associated with implementation of EBS and (2) improve suboptimal HPV vaccination uptake for underserved adolescents within safety-net settings. Guided by the Practice Change Model, we will engage stakeholders to systematically and comprehensively examine implementation of actionable EBS for HPV vaccination and apply findings in a demonstration study of three purposively selected clinic sites within an urban, multi-site federally qualified health center (FQHC). We then use the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to characterize and understand the implementation of EBS for HPV vaccination in demonstration clinic sites. The study will: identify how diverse stakeholders view, prioritize, and adapt actionable provider, clinic and system-level EBS for increasing HPV vaccination through depth interviews and concept mapping (Aim 1); conduct a demonstration project to implement actionable EBS, identified from Aim 1, through practice-facilitated approaches in a purposive sample of three clinic sites within a multi-site FQHC system (Aim 2); and examine practice-based factors associated with implementation of EBS for HPV vaccination using practice observation, depth interviews, and surveys with physicians, clinic staff, and FQHC leaders (Aim 3). Successful implementation of healthcare setting-based EBS to increase HPV vaccination will require a systematic understanding of dynamic relationships within and between healthcare settings that influence practice change. Study findings will identify critical motivators and barriers to translating EBSs for HPV vaccination in safety-net settings and inform the processes needed to prioritize, adapt, and implement EBS for practice change within the safety-net context. The study also establishes an opportunity for subsequent examination of maintenance and scale-up of EBS across practice sites, to be assessed in a longer follow-up period, as well as a foundation for a larger trial to be conducted with more clinics across varying healthcare settings.

摘要 迫切需要加速和持续采用循证战略， 鉴于2011年的疫苗接种率不理想， 推荐的年龄组（11-12岁）和宫颈癌和其他HPV相关癌症的持续差异 在低收入、少数民族/种族人口中。虽然推荐EBS以改善HPV疫苗接种 但是，很少有研究充分研究提供者、诊所和卫生系统之间的相互关系 能够或抑制将用于HPV疫苗接种的EBS成功整合到常规临床护理中的水平。的 拟议的四年连续混合方法研究旨在（1）确定多个层面的因素， 与EBS的实施相关;（2）改善服务不足者的次优HPV疫苗接种率 安全网环境中的青少年。在实践变革模式的指导下，我们将让利益相关者参与， 系统和全面地检查HPV疫苗接种可操作EBS的实施情况， 在一个城市，多站点联邦范围内有目的地选择的三个诊所站点的示范研究中发现， 合格的健康中心（CIMHC）。然后，我们使用范围，有效性，采用，实施和 维护（RE-AIM）框架，以表征和了解HPV EBS的实施 在示范门诊点接种疫苗。该研究将：确定不同利益攸关方如何看待，优先考虑， 通过深入访谈，调整可操作的提供者、诊所和系统级EBS，以增加HPV疫苗接种 和概念图绘制（目标1）;开展一个示范项目，以实施可操作的企业预算系统， 目的1，通过实践促进的方法，在一个多地点的CNOHC内的三个诊所地点的有目的样本中 系统（目标2）;并研究与实施EBS进行HPV疫苗接种相关的实践因素 通过实践观察、深度访谈和对医生、诊所工作人员和卫生和健康委员会领导人的调查（Aim （3）第三章。成功实施基于医疗保健设置的EBS以增加HPV疫苗接种将需要 系统地理解影响实践的医疗环境内部和之间的动态关系 变化研究结果将确定在HPV疫苗接种中转化EBSs的关键动机和障碍， 安全网设置，并告知优先化、调整和实施EBS以实现实践变更所需的流程 在安全网的背景下。这项研究还为以后审查下列问题提供了机会： 将在较长的随访期内评估在各实践地点维持和扩大EBS的情况，以及 为在不同医疗环境中的更多诊所进行更大规模的试验奠定了基础。