Rebecca B Perkins1, Aaron Legler2, Emily Jansen3, Judith Bernstein4, Natalie Pierre-Joseph2, Terresa J Eun5, Dea L Biancarelli4, Thomas J Schuch6, Karin Leschly7, Anny T H R Fenton8, William G Adams2, Jack A Clark4, Mari-Lynn Drainoni4,9,10, Amresh Hanchate11. 1. Departments of Obstetrics and Gynecology and rbperkin@bu.edu. 2. Pediatrics and Adolescent Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts. 3. Continuing Medical Education Office. 4. Department of Health Law, Policy and Management, School of Public Health. 5. Department of Sociology, Stanford University, Stanford, California. 6. South Boston Community Health Center, Boston, Massachusetts. 7. East Boston Neighborhood Health Center, Boston, Massachusetts; and. 8. Center for Outcomes, Research, and Evaluation, Maine Medical Center Research Institute, Portland, Maine. 9. Evans Center for Implementation and Improvement Sciences. 10. Sections of Infectious Diseases and. 11. General Internal Medicine, Department of Medicine, and.
Abstract
OBJECTIVES: To evaluate the effectiveness of a stepped-wedge randomized trial of Development of Systems and Education for Human Papillomavirus Vaccination (DOSE HPV), a multilevel intervention. METHODS: DOSE HPV is a 7-session program that includes interprofessional provider education, communication training, data feedback, and tailored systems change. Five primary care pediatric and/or family medicine practices completed interventions between 2016 and 2018; all chose to initiate vaccination at ages 9 to 10. We compared vaccination rates in the preintervention, intervention, and postintervention periods among 9- to 17-year-olds using random-effects generalized linear regression models appropriate for stepped-wedge design, accounting for calendar time and clustering of patients by providers and clinic. Outcomes included (1) the likelihood that eligible patients would receive vaccination during clinic visits; (2) the likelihood that adolescents would complete the series by age 13; and (3) the cumulative effect on population-level vaccine initiation and completion rates. Postintervention periods ranged from 6 to 18 months. RESULTS: In the intervention and postintervention periods, the adjusted likelihood of vaccination at an eligible visit increased by >10 percentage points for ages 9 to 10 and 11 to 12, and completion of the vaccine series by age 13 increased by 4 percentage points (P < .001 for all comparisons). Population-level vaccine initiation coverage increased from 75% (preintervention) to 84% (intervention) to 90% (postintervention), and completion increased from 60% (preintervention) to 63% (intervention) to 69% (postintervention). CONCLUSIONS: Multilevel interventions that include provider education, data feedback, tailored systems changes, and early initiation of the human papillomavirus vaccine series may improve vaccine series initiation and completion beyond the conclusion of the intervention period.
RCT Entities:
OBJECTIVES: To evaluate the effectiveness of a stepped-wedge randomized trial of Development of Systems and Education for Human Papillomavirus Vaccination (DOSE HPV), a multilevel intervention. METHODS: DOSE HPV is a 7-session program that includes interprofessional provider education, communication training, data feedback, and tailored systems change. Five primary care pediatric and/or family medicine practices completed interventions between 2016 and 2018; all chose to initiate vaccination at ages 9 to 10. We compared vaccination rates in the preintervention, intervention, and postintervention periods among 9- to 17-year-olds using random-effects generalized linear regression models appropriate for stepped-wedge design, accounting for calendar time and clustering of patients by providers and clinic. Outcomes included (1) the likelihood that eligible patients would receive vaccination during clinic visits; (2) the likelihood that adolescents would complete the series by age 13; and (3) the cumulative effect on population-level vaccine initiation and completion rates. Postintervention periods ranged from 6 to 18 months. RESULTS: In the intervention and postintervention periods, the adjusted likelihood of vaccination at an eligible visit increased by >10 percentage points for ages 9 to 10 and 11 to 12, and completion of the vaccine series by age 13 increased by 4 percentage points (P < .001 for all comparisons). Population-level vaccine initiation coverage increased from 75% (preintervention) to 84% (intervention) to 90% (postintervention), and completion increased from 60% (preintervention) to 63% (intervention) to 69% (postintervention). CONCLUSIONS: Multilevel interventions that include provider education, data feedback, tailored systems changes, and early initiation of the human papillomavirus vaccine series may improve vaccine series initiation and completion beyond the conclusion of the intervention period.
Authors: Rebecca B Perkins; Bolanle Banigbe; Anny T Fenton; Amanda K O'Grady; Emily M Jansen; Judith L Bernstein; Natalie P Joseph; Terresa J Eun; Dea L Biancarelli; Mari-Lynn Drainoni Journal: Hum Vaccin Immunother Date: 2020-05-13 Impact factor: 3.452
Authors: Mari-Lynn Drainoni; Dea Biancarelli; Emily Jansen; Judith Bernstein; Natalie Joseph; Terresa J Eun; Anny H T R Fenton; Jack A Clark; Amresh Hanchate; Aaron Legler; Thomas J Schuch; Karin Leschly; Rebecca B Perkins Journal: J Contin Educ Health Prof Date: 2021-07-01 Impact factor: 1.355
Authors: Brigid K Grabert; Rachel Kurtzman; Jennifer Heisler-MacKinnon; Jennifer Leeman; Adam Bjork; Maddy Kameny; Amy Liu; Karen Todd; Susan Alton Dailey; Kevin Smith; Noel T Brewer; Melissa B Gilkey Journal: Transl Behav Med Date: 2022-01-18 Impact factor: 3.626
Authors: Monica L Kasting; Katharine J Head; Andrea L DeMaria; Monica K Neuman; Allissa L Russell; Sharon E Robertson; Caroline E Rouse; Gregory D Zimet Journal: J Womens Health (Larchmt) Date: 2021-01-11 Impact factor: 3.017
Authors: Brigid K Grabert; Jennifer Heisler-MacKinnon; Amy Liu; Marjorie A Margolis; Elizabeth D Cox; Melissa B Gilkey Journal: Hum Vaccin Immunother Date: 2021-06-21 Impact factor: 4.526