Advertisement

Impact of a Multilevel Quality Improvement Intervention Using National Partnerships on Human Papillomavirus Vaccination Rates

      Abstract

      Objective

      To evaluate the effectiveness of a multilevel intervention using national partnerships on human papillomavirus (HPV) vaccination rates.

      Methods

      The American Cancer Society's Vaccinate Adolescents against Cancer program is a multilevel intervention focusing on systems and providers. The 2017 cohort introduced national partnerships to deliver intervention elements and Maintenance of Certification and continuing medical education credits for physicians. Eleven federally qualified health center (FQHC) systems completed interventions in 2017. Interventions included provider training and ≥1 other evidence-based systems improvement. We compared adolescent vaccination rates in the preintervention period (2016) and intervention period (2017) among adolescents who turned 13 during the calendar year. Intervention effectiveness was assessed using repeated measures paired t tests and Cohen's d effect size for vaccination rate change.

      Results

      All FQHC systems implemented provider training plus an average of 2.3 additional systems improvements. Series initiation increased by an average of 23.6 percentage points (47.2%–70.8%). HPV completion rates increased by an average of 22.7 percentage points (24.6%–46.3%). Meningococcal and Tdap vaccination rates increased by 23.3 and 25.9 percentage points respectively (47.9%–71.2% and 48.8%–74.7%). All changes were statistically significant (all P < .05) and indicated large effect sizes (Cohen's d3 1.15). Among clinicians completing postintervention surveys, 90% reported making changes to their health care system or direct patient care based on what they had learned.

      Conclusions

      Multilevel interventions focusing on provider training and systems changes can substantially improve on-time adolescent vaccination coverage and can be successfully performed using national partnerships and a train-the-trainer model.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • ACIP
        Recommendationson the use of quadrivalent human papillomavirus vaccine in males—Advisory Committee on Immunization Practices (ACIP), 2011.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1705-1708
        • ACIP
        Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices.
        MMWR Morb Mortal Wkly Rep. 2007; 56 (No RR-2)
        • Elam-Evans LD
        • Yankey D
        • Singleton JA
        • et al.
        National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years—United States, 2019.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1109-1116https://doi.org/10.15585/mmwr.mm6933a1
      1. HealthyPeople2020. Healthy people 2020. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives Accessed July 2, 2019.

        • Eun TJ
        • Hanchate A
        • Fenton AT
        • et al.
        Relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt.
        Hum Vaccines Immunother. 2019; : 1-6https://doi.org/10.1080/21645515.2019.1591138
        • Bynum SA
        • Staras SAS
        • Malo TL
        • et al.
        Factors associated with Medicaid providers’ recommendation of the HPV vaccine to low-income adolescent girls.
        J Adolesc Health. 2014; 54: 190-196https://doi.org/10.1016/j.jadohealth.2013.08.006
        • Gilkey MB
        • Calo WA
        • Moss JL
        • et al.
        Provider communication and HPV vaccination: the impact of recommendation quality.
        Vaccine. 2016; 34: 1187-1192https://doi.org/10.1016/j.vaccine.2016.01.023
        • Vadaparampil ST
        • Kahn JA
        • Salmon D
        • et al.
        Missed clinical opportunities: provider recommendations for HPV vaccination for 11-12 year old girls are limited.
        Vaccine. 2011; 29: 8634-8641
        • Suh CA
        • Saville A
        • Daley MF
        • et al.
        Effectiveness and net cost of reminder/recall for adolescent immunizations.
        Pediatrics. 2012; 129: e1437-e1445https://doi.org/10.1542/peds.2011-1714
        • Szilagyi PG
        • Albertin C
        • Humiston SG
        • et al.
        A randomized trial of the effect of centralized reminder/recall on immunizations and preventive care visits for adolescents.
        Acad Pediatr. 2013; 13: 204-213https://doi.org/10.1016/j.acap.2013.01.002
        • Zimet G
        • Dixon BE
        • Xiao S
        • et al.
        Simple and elaborated clinician reminder prompts for human papillomavirus vaccination: a randomized clinical trial.
        Acad Pediatr. 2018; 18: S66-S71https://doi.org/10.1016/j.acap.2017.11.002
        • Perkins RB
        • Clark JA
        • Apte G
        • et al.
        Missed opportunities for HPV vaccination in adolescent girls: a qualitative study.
        Pediatrics. 2014; 134: e666-e674https://doi.org/10.1542/peds.2014-0442
        • Fisher-Borne M
        • Preiss AJ
        • Black M
        • et al.
        Early outcomes of a multilevel human papillomavirus vaccination pilot intervention in federally qualified health centers.
        Acad Pediatr. 2018; 18: S79-S84https://doi.org/10.1016/j.acap.2017.11.001
        • Paskett ED
        • Krok-Schoen JL
        • Pennell ML
        • et al.
        Results of a multilevel intervention trial to increase human papillomavirus (HPV) vaccine uptake among adolescent girls.
        Cancer Epidemiol Biomarkers Prev. 2016; 25: 593-602https://doi.org/10.1158/1055-9965.EPI-15-1243
        • Perkins RB
        • Legler A
        • Jansen E
        • et al.
        Improving HPV vaccination rates: a stepped-wedge randomized trial.
        Pediatrics. 2020; 146https://doi.org/10.1542/peds.2019-2737
        • Zisblatt L
        • Kues JR
        • Davis N
        • et al.
        The long-term impact of a performance improvement continuing medical education intervention on osteoporosis screening.
        J Contin Educ Health Prof. 2013; 33: 206-214https://doi.org/10.1002/chp.21200
        • Fiks AG
        • Luan X
        • Mayne SL
        Improving HPV vaccination rates using maintenance-of-certification requirements.
        Pediatrics. 2016; 137e20150675https://doi.org/10.1542/peds.2015-0675
      2. Research Tested Intervention Program. DOSE HPV: development of systems and education for HPV vaccination. Available at: https://rtips.cancer.gov/rtips/programDetails.do?programId=25930477. Accessed January 3, 2021.

        • Perkins RB
        • Zisblatt L
        • Legler A
        • et al.
        Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls.
        Vaccine. 2014; https://doi.org/10.1016/j.vaccine.2014.11.021
      3. IHI. Institute for Healthcare Improvement. Available at: http://www.ihi.org/about/Pages/ScienceofImprovement.aspx Accessed January 3, 2021.

        • Niccolai LM
        • Hansen CE
        Practice- and community-based interventions to increase human papillomavirus vaccine coverage: a systematic review.
        JAMA Pediatr. 2015; 169: 686https://doi.org/10.1001/jamapediatrics.2015.0310
        • StataCorp
        Stata Statistical Software: Release 14.
        StataCorp LP, College Station, Tex2016
        • Neath Ian
        Effect size calculator.
        2020 (Available at:)
        • Magnusson K
        Interpreting Cohen's d effect size.
        2020 (Available at:)
        https://rpsychologist.com/cohend/
        Date accessed: November 27, 2020
        • Gilkey MB
        • Dayton AM
        • Moss JL
        • et al.
        Increasing provision of adolescent vaccines in primary care: a randomized controlled trial.
        Pediatrics. 2014; 134: e346-e353https://doi.org/10.1542/peds.2013-4257
        • Brewer NT
        • Hall ME
        • Malo TL
        • et al.
        Announcements versus conversations to improve HPV vaccination coverage: a randomized trial.
        Pediatrics. 2017; 139https://doi.org/10.1542/peds.2016-1764
        • Madah-Amiri D
        • Clausen T
        • Lobmaier P
        Utilizing a train-the-trainer model for multi-site naloxone distribution programs.
        Drug Alcohol Depend. 2016; 163: 153-156https://doi.org/10.1016/j.drugalcdep.2016.04.007
        • Delaney C
        • Fortinsky R
        • Doonan L
        • et al.
        Depression screening and interventions for older home health care patients: program design and training outcomes for a train-the-trainer model.
        Home Health Care Manag Pract. 2011; 23: 435-445https://doi.org/10.1177/1084822311405459
        • Shire SY
        • Kasari C
        Train the trainer effectiveness trials of behavioral intervention for individuals with autism: a systematic review.
        Am J Intellect Dev Disabil. 2014; 119: 436-451https://doi.org/10.1352/1944-7558-119.5.436
        • Gilkey MB
        • Bednarczyk RA
        • Gerend MA
        • et al.
        Getting human papillomavirus vaccination back on track: protecting our national investment in human papillomavirus vaccination in the COVID-19 era.
        J Adolesc Health. 2020; 67: 633-634https://doi.org/10.1016/j.jadohealth.2020.08.013
        • Fisher-Borne M
        • Preiss AJ
        • Black M
        • et al.
        Early outcomes of a multilevel human papillomavirus vaccination pilot intervention in federally qualified health centers.
        Acad Pediatr. 2018; 18: S79-S84
        • Walker TY
        • Elam-Evans LD
        • Yankey D
        • et al.
        National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years—United States, 2017.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 909-917https://doi.org/10.15585/mmwr.mm6733a1
        • Walker TY
        • Elam-Evans LD
        • Singleton JA
        • et al.
        National, regional, state,and selected local area vaccination coverage among adolescents aged 13-17 years—United States, 2016.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 874-882https://doi.org/10.15585/mmwr.mm6633a2