Using Health Information Technology to Improve Delivery of HPV Vaccine

描述(由申请人提供)：此K08申请支持辛西娅·兰德，硕士，医学，公共卫生硕士，学术普通儿科医生，结合卫生服务研究和市中心的儿科实践的教师发展。该项目将评估卫生信息技术(HIT)干预措施在改善纽约州罗切斯特市中心初级保健诊所向女性青少年提供HPV疫苗接种方面的有效性。该奖项将为兰德博士在临床研究、使用HIT提高护理、免疫接种和卫生服务研究的质量方面提供严格的教学和指导培训计划。教学计划包括医学信息学、质量改进、统计分析和定性研究方法论的课程作业。HPV是美国最常见的性传播感染，也是宫颈癌的原因。建议11-12岁和13-26岁未接种疫苗的女性接种HPV疫苗。许多障碍阻碍了疫苗接种，包括青少年不经常使用医疗保健，相互竞争的医疗保健优先事项，以及在医疗保健就诊期间错过接种疫苗的机会。HPV疫苗接种率很低。这项研究的重点将是将提供免疫接种的循证做法转化为向青少年提供HPV疫苗。在一个经验丰富的团队的指导下，兰德博士将在市中心的诊所开发和实施HIT干预措施，以改善向服务不足的青少年提供HPV疫苗的情况。该项目的目标是(1)在4个城市实践中衡量错过HPV疫苗接种机会的基线比率、接种间隔、总体HPV接种率和卫生保健就诊率，(2a)在所有实践中实施基于HIT的提供者提示，并衡量前后对错失机会的影响，(2b)在市中心实践中开发和实施基于HIT的干预措施(通过短信、电子邮件或社交网站进行患者电子提醒)，以缩短HPV疫苗接种之间的间隔，提高总体HPV疫苗接种率，(3)测量干预后的比率和干预对错失的机会、接种间隔、总的HPV接种率和健康维护就诊的影响。结果将指导R01(目标4)的开发，以广泛测试干预措施。这一奖项将使兰德博士做好准备，进行基于HIT的独立卫生服务研究，以改善对青少年的预防性卫生保健服务。该项目支持AHRQ的几项任务：这项工作侧重于AHRQ优先考虑的市中心人口，主要是少数民族青春期女性。它使用HIT来支持医疗决策和以患者为中心的护理。该项目也代表了转化研究的本质：采用最近开发的疫苗，并了解如何改进其对目标人群的交付。这项工作旨在提高为低收入少数族裔青少年及时完成HPV疫苗接种系列的工作。向所有年轻女性提供HPV疫苗最终将降低她们患宫颈癌和生殖器疣的风险，并降低她们一生的医疗费用。使用电子手段接触青少年可以改善他们接受预防服务的情况，并改善整体健康状况。

DESCRIPTION (provided by the applicant): This K08 application supports the faculty development of Cynthia Rand, MS, MD, MPH, an academic general pediatrician who combines health services research with inner-city pediatric practice. The project will evaluate the effectiveness of a health information technology (HIT) intervention in improving HPV vaccination delivery to female adolescents in inner-city primary care practices in Rochester, NY. The award will provide Dr. Rand with a rigorous didactic and mentored training program in clinical research, the use of HIT to improve quality of care, immunization delivery, and health services research. The didactic program includes coursework in medical informatics, quality improvement, statistical analysis, and qualitative research methodology. HPV is the most common sexually transmitted infection in the U.S., and the cause of cervical cancer. The HPV vaccine is recommended for females 11-12 years and those 13-26 years who are unvaccinated. Multiple barriers impede vaccine receipt, including infrequent use of healthcare by teens, competing healthcare priorities, and missed opportunities for vaccination during healthcare visits. HPV vaccination rates are low. This study will focus on the translation of evidence-based practices of immunization delivery to the delivery of HPV vaccine to teens. Under guidance of an experienced team, Dr. Rand will develop and implement an HIT intervention in inner-city clinics to improve delivery of HPV vaccine to underserved teens. The project aims are to (1) measure baseline rates of missed opportunities for HPV vaccination, vaccination intervals, overall HPV vaccination rates, and rates of health maintenance visits in 4 urban practices, (2a) implement provider prompting based on HIT in all practices and measure the before and after impact on missed opportunities, (2b) develop and implement, using a RCT (randomizing practices), an HIT-based intervention (patient electronic reminders, via text messaging, e-mail or social networking sites) in inner-city practices to decrease intervals between HPV vaccination doses and increase overall HPV vaccination rates, (3) measure post-intervention rates and the impact of the intervention on missed opportunities, vaccination intervals, overall HPV vaccination rates, and health maintenance visits. Results will guide development of an R01 (Aim 4) to test the intervention widely. This award will prepare Dr. Rand to perform independent HIT-based health services research to improve preventive health care delivery to adolescents. This project supports several of AHRQ's missions: This work focuses on an AHRQ priority population of inner-city, mostly minority, adolescent females. It uses HIT to support both health care decision making and patient-centered care. The project also represents the essence of translational research: taking a recently developed vaccine, and understanding how to improve its delivery to the targeted population. This work aims to improve timely completion of the HPV vaccination series for low income, minority adolescents. Delivering HPV vaccine to all young women will ultimately reduce their risk for cervical cancer and genital warts, and decrease their lifetime healthcare costs. Using electronic means to reach adolescents can improve their receipt of preventive services, and overall health outcomes.