Mari-Lynn Drainoni1, 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. 1. Dr. Drainoni: Research Professor, Boston University Schools of Medicine and Public Health, Boston, MA; Codirector, Evans Center for Implementation and Improvement Sciences, Boston, MA. Ms. Biancarelli: Consultant, Accenture, Boston, MA. Ms. Jansen: Senior Program Manager, Boston University School of Medicine, Boston, MA. Dr. Bernstein: Emeritus Professor, Boston University School of Public Health; Professor of Emergency Medicine, Boston University School of Medicine, Boston, MA. Dr. Joseph: Clinical Associate Professor of Adolescent Medicine and Pediatrics, Boston University School of Medicine, Boston, MA. Ms. Eun: PhD Student, Department of Sociology, Stanford University, Boston, MA. Dr. Fenton: Postdoctoral Fellow, Center for Outcomes Research & Evaluation, Maine Medical Center Research Institute, Boston, MA. Dr. Clark: Professor, Boston University School of Public Health, Boston, MA. Dr. Hanchate: Associate Professor, Boston University Schools of Medicine and Public Health; Health Economist, VA Boston Healthcare System, Boston, MA. Mr. Legler: Senior Healthcare Statistician, Boston VA Healthcare System, Boston, MA. Dr. Schuch: Chief Information Officer, Pediatrician at South Boston Community Health Center, Boston, MA. Dr. Leschly: Assistant Professor, Boston University School of Medicine; Medical Director, East Boston Neighborhood Health Center, Boston, MA. Dr. Perkins: Associate Professor, Boston University School of Medicine, Boston, MA.
Abstract
INTRODUCTION: Few studies have rigorously evaluated the drivers of successful implementation of interventions to improve human papillomavirus (HPV) vaccination rates. The aim of this study was to evaluate the implementation of Development of Systems and Education for HPV Vaccination (DOSE HPV), a performance improvement intervention. METHODS: Primary care providers (PCPs), nurses, and individuals with leadership roles from pediatric and family medicine practices who attended DOSE HPV intervention sessions participated in qualitative interviews immediately following intervention completion. The study team professionally transcribed interviews and performed qualitative coding using inductive methods. Final analysis employed the Promoting Action on Research implementation in Health Services (PARiHS) model. RESULTS: Twenty-six individuals participated: 12 PCPs, 5 nurses, and 9 individuals with dual leadership and PCP roles. Participants described five factors that they felt contributed to program success: (1) evidence-based, goal-directed education; (2) personalized data feedback; (3) clinical leadership support; (4) collaborative facilitation; (5) repeated contacts/longitudinal structure of the intervention. Barriers to implementing the intervention included: (1) inability to standardize workflow across practices; (2) low pediatric volume, (3) competing priorities/lack of incentives, (4) ineffective involvement of nurses, (5) poor communication between clinical leadership and staff. DISCUSSION: Although many HPV testing interventions have been implemented, findings have been mixed. It is clear that having an effective, evidence-based intervention by itself is not enough to get it into practice. Rather, it is crucial to consider implementation factors to ensure consistent implementation and sustainability. Key factors for the success of the DOSE HPV intervention appear to include a collaborative approach, provision of useful evidence to motivate behavior change, and repeated contacts to ensure accountability for implementing changes. Workflow issues, ineffective lines of communication, and competing priorities at both the visit and the patient and population management levels can hinder implementation.
INTRODUCTION: Few studies have rigorously evaluated the drivers of successful implementation of interventions to improve human papillomavirus (HPV) vaccination rates. The aim of this study was to evaluate the implementation of Development of Systems and Education for HPV Vaccination (DOSE HPV), a performance improvement intervention. METHODS: Primary care providers (PCPs), nurses, and individuals with leadership roles from pediatric and family medicine practices who attended DOSE HPV intervention sessions participated in qualitative interviews immediately following intervention completion. The study team professionally transcribed interviews and performed qualitative coding using inductive methods. Final analysis employed the Promoting Action on Research implementation in Health Services (PARiHS) model. RESULTS: Twenty-six individuals participated: 12 PCPs, 5 nurses, and 9 individuals with dual leadership and PCP roles. Participants described five factors that they felt contributed to program success: (1) evidence-based, goal-directed education; (2) personalized data feedback; (3) clinical leadership support; (4) collaborative facilitation; (5) repeated contacts/longitudinal structure of the intervention. Barriers to implementing the intervention included: (1) inability to standardize workflow across practices; (2) low pediatric volume, (3) competing priorities/lack of incentives, (4) ineffective involvement of nurses, (5) poor communication between clinical leadership and staff. DISCUSSION: Although many HPV testing interventions have been implemented, findings have been mixed. It is clear that having an effective, evidence-based intervention by itself is not enough to get it into practice. Rather, it is crucial to consider implementation factors to ensure consistent implementation and sustainability. Key factors for the success of the DOSE HPV intervention appear to include a collaborative approach, provision of useful evidence to motivate behavior change, and repeated contacts to ensure accountability for implementing changes. Workflow issues, ineffective lines of communication, and competing priorities at both the visit and the patient and population management levels can hinder implementation.
Authors: Peter G Szilagyi; Janet R Serwint; Sharon G Humiston; Cynthia M Rand; Stanley Schaffer; Phyllis Vincelli; Nui Dhepyasuwan; Aaron Blumkin; Christina Albertin; C Robinette Curtis Journal: Acad Pediatr Date: 2015 Mar-Apr Impact factor: 3.107
Authors: Stephanie L Mayne; Nathalie E duRivage; Kristen A Feemster; A Russell Localio; Robert W Grundmeier; Alexander G Fiks Journal: Am J Prev Med Date: 2014-11-18 Impact factor: 5.043
Authors: Rebecca B Perkins; Aaron Legler; Emily Jansen; Judith Bernstein; Natalie Pierre-Joseph; Terresa J Eun; Dea L Biancarelli; Thomas J Schuch; Karin Leschly; Anny T H R Fenton; William G Adams; Jack A Clark; Mari-Lynn Drainoni; Amresh Hanchate Journal: Pediatrics Date: 2020-06-15 Impact factor: 7.124
Authors: Tanja Y Walker; Laurie D Elam-Evans; David Yankey; Lauri E Markowitz; Charnetta L Williams; Benjamin Fredua; James A Singleton; Shannon Stokley Journal: MMWR Morb Mortal Wkly Rep Date: 2019-08-23 Impact factor: 17.586
Authors: Virginia Senkomago; S Jane Henley; Cheryll C Thomas; Jacqueline M Mix; Lauri E Markowitz; Mona Saraiya Journal: MMWR Morb Mortal Wkly Rep Date: 2019-08-23 Impact factor: 17.586