TY - JOUR
T1 - Provider communication, prompts, and feedback to improve HPV vaccination rates in resident clinics
AU - Rand, Cynthia M.
AU - Schaffer, Stanley J.
AU - Dhepyasuwan, Nui
AU - Blumkin, Aaron
AU - Albertin, Christina
AU - Serwint, Janet R.
AU - Darden, Paul M.
AU - Humiston, Sharon G.
AU - Mann, Keith J.
AU - Stratbucker, William
AU - Szilagyi, Peter G.
N1 - Funding Information:
clinics serving mostly low-income populations; findings may not be generalizable to other settings. Academic practices may be particularly motivated to implement newer guidelines and are expected to teach current recommendations. On the other hand, these large practices with rotating residents are complex environments in which to implement practice change. There may be selection bias in practices volunteering to participate. The practices received a modest incentive for performing the randomly selected chart reviews. Also, the research and LC faculty leads were supported by grant funding. To scale up this intervention, we would need to integrate such core funding into local, state, or national QI efforts.
Publisher Copyright:
© 2018 by the American Academy of Pediatrics.
PY - 2018/4
Y1 - 2018/4
N2 - BACKGROUND AND OBJECTIVES: Human papillomavirus (HPV) vaccination rates lag behind vaccination rates for other adolescent vaccines; a bundled intervention may improve HPV vaccination rates. Our objective is to evaluate the impact of quality improvement (QI) training plus a bundled practice-based intervention (provider prompts plus communication skills training plus performance feedback) on improving HPV vaccinations in pediatric resident continuity clinics. METHODS: Staff and providers in 8 resident clinics participated in a 12-month QI study. The intervention included training to strengthen provider communication about the HPV vaccine. Clinics also implemented provider prompts, received monthly performance feedback, and participated in learning collaborative calls. The primary outcome measure was eligible visits with vaccination divided by vaccine-eligible visits (captured HPV vaccination opportunities). Practices performed chart audits that were fed into monthly performance feedback on captured HPV vaccination opportunities. We used conditional logistic regression (conditioning on practice) to assess captured vaccination opportunities, with the time period of the study (before and after the QI intervention) as the independent variable. RESULTS: Overall, captured opportunities for HPV vaccination increased by 16.4 percentage points, from 46.9% to 63.3%. Special cause was demonstrated by centerline shift, with 8 consecutive points above the preintervention mean. On adjusted analyses, patients were more likely to receive a vaccine during, versus before, the intervention (odds ratio: 1.87; 95% confidence interval: 1.54-2.28). Captured HPV vaccination rates improved at both well-child and other visits (by 11.7 and 13.0 percentage points, respectively). CONCLUSIONS: A bundled intervention of provider prompts and training in communication skills plus performance feedback increased captured opportunities for HPV vaccination.
AB - BACKGROUND AND OBJECTIVES: Human papillomavirus (HPV) vaccination rates lag behind vaccination rates for other adolescent vaccines; a bundled intervention may improve HPV vaccination rates. Our objective is to evaluate the impact of quality improvement (QI) training plus a bundled practice-based intervention (provider prompts plus communication skills training plus performance feedback) on improving HPV vaccinations in pediatric resident continuity clinics. METHODS: Staff and providers in 8 resident clinics participated in a 12-month QI study. The intervention included training to strengthen provider communication about the HPV vaccine. Clinics also implemented provider prompts, received monthly performance feedback, and participated in learning collaborative calls. The primary outcome measure was eligible visits with vaccination divided by vaccine-eligible visits (captured HPV vaccination opportunities). Practices performed chart audits that were fed into monthly performance feedback on captured HPV vaccination opportunities. We used conditional logistic regression (conditioning on practice) to assess captured vaccination opportunities, with the time period of the study (before and after the QI intervention) as the independent variable. RESULTS: Overall, captured opportunities for HPV vaccination increased by 16.4 percentage points, from 46.9% to 63.3%. Special cause was demonstrated by centerline shift, with 8 consecutive points above the preintervention mean. On adjusted analyses, patients were more likely to receive a vaccine during, versus before, the intervention (odds ratio: 1.87; 95% confidence interval: 1.54-2.28). Captured HPV vaccination rates improved at both well-child and other visits (by 11.7 and 13.0 percentage points, respectively). CONCLUSIONS: A bundled intervention of provider prompts and training in communication skills plus performance feedback increased captured opportunities for HPV vaccination.
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U2 - 10.1542/peds.2017-0498
DO - 10.1542/peds.2017-0498
M3 - Article
C2 - 29540572
AN - SCOPUS:85042780626
VL - 141
JO - Pediatrics
JF - Pediatrics
SN - 0031-4005
IS - 4
M1 - e20170498
ER -