Effectiveness of decision support for families, clinicians, or both on HPV vaccine receipt.

TitleEffectiveness of decision support for families, clinicians, or both on HPV vaccine receipt.
Publication TypeJournal Article
Year of Publication2013
AuthorsFiks AG, Grundmeier RW, Mayne SL, Song L, Feemster KA, Karavite D, Hughes CC, Massey J, Keren R, Bell LM, Wasserman RC, A Localio R
JournalPediatrics
Volume131
Issue6
Pagination1114-24
Date Published2013 Jun
ISSN1098-4275
KeywordsAdolescent, Child, Decision Support Systems, Clinical, Electronic Health Records, Family, Female, Humans, Papillomavirus Infections, Papillomavirus Vaccines, Physicians, Physicians, Primary Care
Abstract

OBJECTIVE: To improve human papillomavirus (HPV) vaccination rates, we studied the effectiveness of targeting automated decision support to families, clinicians, or both.

METHODS: Twenty-two primary care practices were cluster-randomized to receive a 3-part clinician-focused intervention (education, electronic health record-based alerts, and audit and feedback) or none. Overall, 22, 486 girls aged 11 to 17 years due for HPV vaccine dose 1, 2, or 3 were randomly assigned within each practice to receive family-focused decision support with educational telephone calls. Randomization established 4 groups: family-focused, clinician-focused, combined, and no intervention. We measured decision support effectiveness by final vaccination rates and time to vaccine receipt, standardized for covariates and limited to those having received the previous dose for HPV #2 and 3. The 1-year study began in May 2010.

RESULTS: Final vaccination rates for HPV #1, 2, and 3 were 16%, 65%, and 63% among controls. The combined intervention increased vaccination rates by 9, 8, and 13 percentage points, respectively. The control group achieved 15% vaccination for HPV #1 and 50% vaccination for HPV #2 and 3 after 318, 178, and 215 days. The combined intervention significantly accelerated vaccination by 151, 68, and 93 days. The clinician-focused intervention was more effective than the family-focused intervention for HPV #1, but less effective for HPV #2 and 3.

CONCLUSIONS: A clinician-focused intervention was most effective for initiating the HPV vaccination series, whereas a family-focused intervention promoted completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt.

DOI10.1542/peds.2012-3122
Alternate JournalPediatrics
PubMed ID23650297
PubMed Central IDPMC3666111
Grant ListHHSA 290-07-10013 / / PHS HHS / United States
K23 HD059919 / HD / NICHD NIH HHS / United States
K23HD059919 / HD / NICHD NIH HHS / United States
P30 HS021645 / HS / AHRQ HHS / United States