Increasing HPV vaccine uptake in community-based pediatric practices

项目总结 人类乳头瘤病毒(HPV)疫苗为预防几乎所有宫颈病变提供了前所未有的机会 和肛门癌，以及高比例的阴道癌、口咽癌、外阴癌和阴道癌，其中HPV是 致病因素。建议所有11-12岁的儿童接种HPV疫苗，女性适龄时应及时接种。 26岁，男性至21岁。然而，尽管在癌症预防方面具有明确和无可争辩的价值，但摄取和 HPV疫苗系列的完成远远落后于80%的目标。提供商的建议是 HPV疫苗接种的最大决定因素，但预防服务指南的翻译速度较慢，例如 将免疫接种付诸实践是一项众所周知的挑战。练习促进(PF)是一种多成分的质量 具有良好效果的改进干预方法，其中包括外部支持和资源 是为了建立实践的内部能力，以改善护理质量和患者结果。我们的 中心目标是确定实施以证据为基础的干预措施的最佳方法 在社区接受护理的青少年中完成HPV疫苗接种，由 实施科学理论。目的1：确定两种方案的临床疗效和成本-效果 提供多组分PF干预以增加HPV疫苗接种启动和 完成以社区为基础的儿科实践。我们将比较传统的面对面教练PF 一种基于Web的低资源PF医疗模式。患者的主要结果是接种HPV疫苗。我们 还将检查和比较实践改变对疫苗接种率的可持续性以及 每种干预方式的时间。H1：这两种干预措施都将导致HPV疫苗接种量大幅增加 随着时间的推移，从基线开始。H2：HPV疫苗接种率的增加将更高，并将持续更长时间 与基于Web的PF手臂相比，在教练PF手臂中的时间段。H3：基于Web的PF ARM 将比教练的PF手臂更具成本效益。目标2.理解PF为什么干预的机制 在一些儿科实践中可能比在接种HPV疫苗方面效果更好。我们将考察基于理论的 组织、提供者和患者层面的决定因素，可能会调解(解释)或缓和 (变化)PF干预对疫苗接种结果的影响。H4：采用变更(流程 变量)和患者因素将在干预对HPV疫苗接种结果的影响中起中介作用。H5： 组织因素、提供者态度和干预特征对干预效果有调节作用 HPV疫苗接种结果。这些发现将为组织提供关于在其 提高HPV疫苗接种率的构成做法，具有未来在全国推广的潜力。

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.