Standing Orders to Improve HPV Vaccination

每年在美国，≥ 20，000名女性和14，000名男性受HPV相关癌症影响，包括 宫颈癌和口咽癌。然而，在2020年，只有59%的13 - 17岁的美国青少年达到了 HPV疫苗接种日期，以及11 - 12岁儿童的接种率，HPV疫苗接种的主要目标年龄组 (when免疫反应更好，在暴露于HPV感染之前），甚至更低。会议常规 （书面协议，授权医疗保健团队的指定成员接种疫苗，而无需首先获得 患者专用医嘱）已被证明在住院患者和成人中有效，但 HPV疫苗的评估，一些家长认为有争议。同时， 组织对变革的准备情况（资源、动机、工作人员属性、领导支持和文化） 没有研究过常规的调节作用。医生的建议与 HPV疫苗的接受，我们已经开发了一个成功的在线，互动，沟通教育 该计划将被调整，以培训护士和工作人员除了医生。我们建议测试站 在纽约西部的责任护理组织（ACO）订购HPV疫苗，并评估 哪些供应商和实践因素缓和了常规的效果。此设置的优点包括 农村、城市和郊区的各种实践，ACO提供数据基础设施和分析 这使得实践能够真实的评估疫苗接种率。我们的目标是：目标1：应用混合方法（在- 深入访谈和实践调查），以确定提供者和实践层面的障碍和促进因素， 实施青少年HPV疫苗接种的SO;目的2：使用2组随机分组试验（n = 40 实践），我们将评估常规（SO）+HPV沟通教育的有效性 （干预组）相对于单独进行HPV疫苗接种的HPV沟通教育（对照组）， 岁。第二个目的是使用半结构化访谈来衡量战略目标的执行情况， 目标3：衡量干预措施的成本和成本效益。如果成功，这项研究将增加一个 深入了解如何使SO有效提高HPV疫苗接种率。

Each year in the U.S., ≥20,000 women and 14,000 men are affected by HPV-related cancers, including cervical and oropharyngeal cancer. However, in 2020, only 59% of U.S. adolescents aged 13-17 were up-to- date for HPV vaccination, and rates for 11-12 year olds, the primary target age group for HPV vaccination (when the immune reaction is better and before exposure to HPV infection), are even lower. Standing orders (written protocols that authorize designated members of the healthcare team to vaccinate without first obtaining a patient-specific physician order) have been shown to work in inpatient settings and for adults, but have not been evaluated for HPV vaccine, which some parents consider controversial. Also, the ways in which organizational readiness for change (resources, motivation, staff attributes, leadership support and culture) moderate the effect of standing orders has not been studied. A physician’s recommendation is correlated with HPV vaccine acceptance, and we have developed a successful online, interactive, communication education program that will be adapted to train nurses and staff in addition to physicians. We propose testing standing orders for HPV vaccine in an Accountable Care Organization (ACO) in Western New York, and assessing which provider and practice factors moderate the effect of standing orders. Advantages of this setting include a diverse group of rural, urban and suburban practices, and the ACO provides data infrastructure and analytics that allow practices to evaluate vaccination rates in real time. Our aims are: Aim 1: Apply mixed methods (in- depth interviews and practice surveys) to identify provider- and practice-level barriers and facilitators to implementing SOs for adolescent HPV vaccination; Aim 2: Using a 2-arm cluster randomized trial (n=40 practices), we will assess the effectiveness of standing orders (SO) + HPV communication education (intervention arm) relative to HPV communication education alone (control arm) on HPV vaccination for 11-17 year-olds. A secondary aim is to measure the implementation of SOs using semi-structured interviews and surveys; Aim 3: Measure costs and cost-effectiveness of the interventions. If successful, this study will add a deep understanding of how to make SOs effective to raise HPV vaccination rates.