Performance Feedback for HPV Vaccination: A Randomized Trial from the AAP PROS Research Network.

TitlePerformance Feedback for HPV Vaccination: A Randomized Trial from the AAP PROS Research Network.
Publication TypeJournal Article
Year of Publication2022
AuthorsFiks AG, Stephens-Shields AJ, Kelly MKate, Localio R, Hannan C, Grundmeier RW, Shone LP, Steffes J, Wright M, Breck A, Rand CM, Albertin C, Humiston SG, McFarland G, Abney DE, Szilagyi PG
JournalAcad Pediatr
Date Published2022 Jul 16

OBJECTIVES: To test the hypothesis that a feedback-based intervention would reduce HPV vaccine missed opportunities.

METHODS: In a longitudinal cluster randomized controlled trial of 48 pediatric primary care practices, we allocated half the practices to receive a sequential, multi-component intervention phased over consecutive periods. In a prior trial (period 1), communication skills training reduced missed opportunities for the initial HPV vaccine dose at well visits but not at acute/chronic visits. The current trial (period 2) evaluated the added value of performance feedback to clinicians after communication training. Performance feedback consisted of an introductory training module, weekly electronic "Quick Tips," and 3 individualized performance feedback reports to clinicians. We fit logistic regression models for the primary outcome of HPV vaccination missed opportunities using generalized estimating equations with independence working correlation, accounting for clustering at the practice level.

RESULTS: Performance feedback resulted in a 3.4 (95% CI: -6.8, 0.0) percentage point greater reduction in missed HPV vaccine opportunities for the intervention versus control group during acute/chronic visits for subsequent HPV vaccinations (dose 2 or 3). However, during well visits for HPV vaccination dose #1, intervention practices increased missed opportunities (worsened) by 4.2 (95% CI: 1.0, 7.4) percentage points more than control practices, reducing the prior period 1 improvements and blunting the overall effect of performance feedback. We did not observe differences for the other visit/dose categories.

CONCLUSIONS: Performance feedback improved HPV vaccination for one subset of visits (acute/chronic, subsequent HPV vaccinations due), but not for well visits.

Alternate JournalAcad Pediatr
PubMed ID35853600