Cynthia M Rand1, Stanley J Schaffer2, Nui Dhepyasuwan3, Aaron Blumkin2, Christina Albertin4, Janet R Serwint5, Paul M Darden6, Sharon G Humiston7, Keith J Mann7, William Stratbucker8, Peter G Szilagyi9. 1. Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York; cynthia_rand@urmc.rochester.edu. 2. Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York. 3. Academic Pediatric Association, McLean, Virginia. 4. Albertin Health Services Research, LLC, Indianapolis, Indiana. 5. Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University, Baltimore, Maryland. 6. Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. 7. Department of Pediatrics, School of Medicine, University of Missouri-Kansas City and Children's Mercy Hospital, Kansas City, Missouri. 8. Department of Pediatrics, Michigan State University and Helen DeVos Children's Hospital, Grand Rapids, Michigan; and. 9. Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California.
Abstract
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.
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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