Zimmerman Richard K, Raviotta Jonathan M, Nowalk Mary Patricia, Moehling Krissy K, Reis Evelyn Cohen, Humiston Sharon G, Lin Chyongchiou Jeng
Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Vaccine. 2017 Oct 27;35(45):6180-6186. doi: 10.1016/j.vaccine.2017.09.039. Epub 2017 Sep 22.
To report the results of an intervention using the 4 Pillars™ Practice Transformation Program (4 Pillars™ Program) to increase adolescent vaccinations including human papillomavirus vaccine (HPV) and influenza vaccines, which remain underutilized in this population.
Eleven pediatric and family medicine practices, previously control sites from a randomized controlled cluster trial, with ≥50 adolescent patients participated. The 4 Pillars™ Program was the foundation of the intervention. De-identified demographic, office visit and vaccination data were derived from electronic medical record extractions for patients whose date of birth was 4/1/1997 to 4/1/2004 (ages 11-17years at baseline). Vaccination rates for HPV, influenza, tetanus-pertussis-diphtheria (Tdap) and meningococcal (MenACWY) vaccines were determined for all eligible patients pre- and post intervention (i.e., vaccination rates on 4/1/2015 and 4/30/2016).
Among 9473 patients ages 11-17years at baseline (4/1/2015), mean pre-intervention vaccination rates for HPV initiation and completion, meningococcal, Tdap and influenza vaccines were below national levels. Rates increased significantly post intervention (P<0.001) for HPV initiation which increased 17.1 percentage points (PP) from 51.4%; HPV completion increased 14.8PP from 30.7%, meningococcal vaccine uptake increased 16.6PP from 79.1%, Tdap vaccine uptake increased 14.6PP from 76.9%. Influenza vaccine uptake did not increase significantly (2.3PP from 40.1%). In the regression using generalized estimating equations, odds of vaccination were higher for younger, non-white adolescents for all vaccines; being in a smaller practice decreased the odds of Tdap vaccination but increased the odds of influenza vaccination.
Clinically and statistically significant improvements in HPV series initiation and completion, and meningococcal and Tdap vaccinations were observed in primary care practices implementing the 4 Pillars™ Practice Transformation Program. Clinical Trial Registry Number: NCT02165722.
报告采用“四大支柱”实践转型项目（“四大支柱”项目）进行干预，以提高青少年疫苗接种率的结果，这些疫苗包括人乳头瘤病毒疫苗（HPV）和流感疫苗，而在这一人群中这些疫苗的利用率仍然较低。
11家儿科和家庭医学诊所参与了研究，这些诊所之前是一项随机对照整群试验的对照站点，每家诊所至少有50名青少年患者。“四大支柱”项目是干预措施的基础。通过电子病历提取，获取出生日期为1997年4月1日至2004年4月1日（基线时年龄为11 - 17岁）患者的匿名人口统计学、门诊就诊和疫苗接种数据。确定干预前后所有符合条件患者的HPV、流感、破伤风 - 百日咳 - 白喉（Tdap）和脑膜炎球菌（MenACWY）疫苗接种率（即2015年4月1日和2016年4月30日的接种率）。
在基线时（2015年4月1日）年龄为11 - 17岁的9473名患者中，HPV起始接种和全程接种、脑膜炎球菌、Tdap和流感疫苗的干预前平均接种率低于全国水平。干预后，HPV起始接种率显著提高（P<0.001），从51.4%提高了17.1个百分点（PP）；HPV全程接种率从30.7%提高了14.8个百分点，脑膜炎球菌疫苗接种率从79.1%提高了16.6个百分点，Tdap疫苗接种率从76.9%提高了14.6个百分点。流感疫苗接种率没有显著提高（从40.1%提高了2.3个百分点）。在使用广义估计方程的回归分析中，所有疫苗中，年龄较小、非白人青少年接种疫苗的几率更高；诊所规模较小会降低Tdap疫苗接种几率，但会增加流感疫苗接种几率。
在实施“四大支柱”实践转型项目的基层医疗诊所中，观察到HPV系列疫苗起始接种和全程接种以及脑膜炎球菌和Tdap疫苗接种在临床和统计学上有显著改善。临床试验注册号：NCT02165722。
