Using Health Information Technology to Improve Delivery of HPV Vaccine

描述（由申请人提供）：此K 08应用程序支持辛西娅兰德，MS，MD，MPH，学术全科儿科医生谁结合卫生服务研究与内城儿科实践的教师发展。该项目将评估健康信息技术（HIT）干预在改善纽约州罗切斯特市中心初级保健实践中女性青少年HPV疫苗接种的有效性。该奖项将为兰德博士提供严格的教学和指导培训计划，在临床研究，使用HIT来提高护理质量，免疫接种和卫生服务研究。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的课程。HPV是美国最常见的性传播感染，和宫颈癌的病因。HPV疫苗推荐给11-12岁的女性和13-26岁未接种疫苗的女性。多重障碍阻碍了疫苗接种，包括青少年不经常使用医疗保健，竞争医疗保健优先事项，以及在医疗保健访问期间错过接种疫苗的机会。HPV疫苗接种率很低。本研究将重点关注将免疫接种的循证实践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诊所制定和实施HIT干预措施，以改善HPV疫苗向服务不足的青少年的提供。该项目的目的是（1）测量4个城市实践中错过HPV疫苗接种机会的基线率、疫苗接种间隔、总体HPV疫苗接种率和健康维护访视率，（2a）在所有实践中实施基于HIT的提供者提示，并测量错过机会的前后影响，（2b）使用RCT制定和实施（随机化实践），基于HIT的干预（患者电子提醒，通过短信，电子邮件或社交网站）在市中心的做法，以减少HPV疫苗接种剂量之间的间隔，并提高整体HPV疫苗接种率，（3）衡量干预后的比率和干预对错失机会的影响，疫苗接种间隔、总体HPV疫苗接种率和健康维护访视。结果将指导R 01（目标4）的开发，以广泛测试干预措施。该奖项将准备博士兰德进行独立的HIT为基础的卫生服务研究，以改善预防保健提供给青少年。这一项目支持亚洲人权Q的几项任务：这项工作的重点是亚洲人权Q的一个优先人口，即市中心，主要是少数民族，青少年女性。它使用HIT来支持医疗保健决策和以患者为中心的护理。该项目还代表了转化研究的本质：采用最近开发的疫苗，并了解如何改善其向目标人群的交付。这项工作旨在改善低收入少数民族青少年HPV疫苗接种系列的及时完成。为所有年轻女性提供HPV疫苗将最终降低她们患宫颈癌和生殖器疣的风险，并降低她们的终身医疗费用。利用电子手段接触青少年可以改善他们获得预防服务的情况，并改善总体健康结果。

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.