Increasing HPV vaccine uptake in community-based pediatric practices

项目摘要 人乳头瘤病毒（HPV）疫苗为预防几乎所有宫颈癌提供了前所未有的机会。 和肛门癌以及阴道癌、口咽癌、外阴癌和阴茎癌的高比例，其中HPV是 病原体建议所有11-12岁的儿童接种HPV疫苗，女性应赶上年龄 26岁和男性到21岁。然而，尽管在癌症预防方面具有明确和无可争议的价值， HPV疫苗系列的完成远远落后于80%的目标。提供商建议是 HPV疫苗接种的最强决定因素，但预防服务指南的翻译缓慢， 免疫接种是一个已知的挑战。实践促进（PF）是一个多方面的素质 改善干预方法，具有良好的效果，其中外部支持和资源 提供这些服务是为了建立内部的实践能力，以提高护理质量和病人的治疗效果。我们 中心目标是确定实施循证干预的最佳方法， 在社区接受护理的青少年中完成HPV疫苗接种， 实施科学理论。目的1：确定两种药物的临床有效性和成本效益 提供多组分PF干预以增加HPV疫苗接种开始的方式， 在社区儿科实践中完成。我们将比较传统的面对面教练PF 模式到低资源基于Web的PF模式。患者的主要结局是HPV疫苗接种。我们 还将检查和比较疫苗接种率实践变化的可持续性以及对 每种干预方式的时间。H1：这两种干预措施将导致HPV疫苗接种的显着增加 从基线开始。H2：HPV疫苗接种率的增加将更高，持续时间更长 与基于网络的PF组相比，教练PF组的时间段。H3：基于网络的PF组 将比教练PF臂更具成本效益。了解PF干预的机制 可能对某些儿科实践比其他人更适合HPV疫苗接种。我们将研究基于理论 组织、提供者和患者层面上的决定因素，这些决定因素可能会起到中介（解释）或调节作用 （改变）PF干预对疫苗接种结果的影响。H4：采用变更（流程 变量）和患者因素将介导干预对HPV疫苗接种结果的影响。H5： 组织因素、提供者态度和干预特征将调节干预效果。 HPV疫苗接种结果。调查结果将告知各组织在其工作中使用哪种PF模式。 该计划旨在提高HPV疫苗接种率，并有可能在未来全国推广。

PROJECT SUMMARY The human papillomavirus (HPV) vaccine offers the unprecedented opportunity to prevent nearly all cervical and anal cancers and a high proportion of vaginal, oropharyngeal, vulvar and penile cancers, where HPV is the etiologic agent. HPV vaccination is recommended for all children ages 11-12, with catch up for females to age 26 and males to age 21. However, despite clear and indisputable value in cancer prevention, uptake and completion of the HPV vaccine series has lagged far behind the goal of 80%. Provider recommendation is the strongest determinant of HPV vaccination, but slow translation of guidelines for preventive services, such as immunizations, into practice is a known challenge. Practice Facilitation (PF) is a multicomponent quality improvement intervention approach that has well-established efficacy, in which external support and resources are provided to build the internal capacity of practices to improve quality of care and patient outcomes. Our central goal is to identify the optimal approach to implementing an evidence-based intervention for the uptake and completion of HPV vaccine among adolescents receiving care in the community, guided by implementation science theory. AIM 1: Determine the clinical effectiveness and cost-effectiveness of two modalities for delivering a multi-component PF intervention to increase HPV vaccination initiation and completion in community-based pediatric practices. We will compare the traditional in-person Coach PF modality to a lower-resource Web-Based PF modality. The primary patient outcome is HPV vaccination. We will also examine and compare the sustainability of practice changes on vaccination rates and the effects over time for each intervention modality. H1: Both interventions will result in significant increases in HPV vaccination from baseline over time. H2: Increases in the rate of HPV vaccination will be higher and sustained for a longer period of time in the Coach PF Arm as compared with the Web-Based PF Arm. H3: The Web-Based PF Arm will be more cost-effective than the Coach PF Arm. AIM 2. Understand mechanisms of why the PF intervention may work better for some pediatric practices than others for HPV vaccination. We will examine theory-based determinants at the organizational, provider, and patient levels that may mediate (explain) or moderate (change) the effects of the PF intervention on vaccination outcomes. H4: Adoption of changes (process variables) and patient factors will mediate effects of the intervention on HPV vaccination outcomes. H5: Organizational factors, provider attitudes, and intervention characteristics will moderate intervention effects on HPV vaccination outcomes. The findings will inform organizations about which PF modality to use among their constituent practices to improve HPV vaccination rates, with potential for future national dissemination.