基于学习协作的模式提高初级保健中的人乳头瘤病毒疫苗接种率。

A Learning Collaborative Model to Improve Human Papillomavirus Vaccination Rates in Primary Care.

机构信息

Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.

Academic Pediatrics Association, McLean, Va.

出版信息

Acad Pediatr. 2018 Mar;18(2S):S46-S52. doi: 10.1016/j.acap.2018.01.003.

DOI:10.1016/j.acap.2018.01.003

PMID:29502638

Abstract

OBJECTIVE

Human papillomavirus (HPV) vaccination rates remain low, in part because of missed opportunities (MOs) for vaccination. We used a learning collaborative quality improvement (QI) model to assess the effect of a multicomponent intervention on reducing MOs.

METHODS

Study design: pre-post using a QI intervention in 33 community practices and 14 pediatric continuity clinics over 9 months to reduce MOs for HPV vaccination at all visit types.

MEASURES

outcome measures comprised baseline and postproject measures of 1) MOs (primary outcome), and 2) HPV vaccine initiation and completion. Process measures comprised monthly chart audits of MOs for HPV vaccination for performance feedback, monthly Plan-Do-Study-Act surveys and pre-post surveys about office systems.

INTERVENTION

providers were trained at the start of the project on offering a strong recommendation for HPV vaccination. Practices implemented provider prompts and/or standing orders and/or reminder/recall if desired, and were provided monthly feedback on MOs to assess their progress.

ANALYSES

chi-square tests were used to assess changes in office practices, and logistic regression used to assess changes in MOs according to visit type and overall, as well as HPV vaccine initiation and completion.

RESULTS

MOs overall decreased (from 73% to 53% in community practices and 62% to 55% in continuity clinics; P < .01, and P = .03, respectively). HPV vaccine initiation increased for both genders in community practices (from 66% to 74% for female, 57% to 65% for male; P < .01), and for male patients in continuity clinics (from 68% to 75%; P = .05). Series completion increased overall in community practices (39% to 43%; P = .04) and for male patients in continuity clinics (from 36% to 44%; P = .03).

CONCLUSIONS

Office systems changes using a QI model and multicomponent interventions decreased rates of MO for HPV vaccination and increased initiation and completion rates among some gender subgroups. A learning collaborative model provides an effective forum for practices to improve HPV vaccine delivery.

摘要

目的

人乳头瘤病毒（HPV）疫苗接种率仍然较低，部分原因是错过了接种疫苗的机会（MOs）。我们使用学习合作质量改进（QI）模型来评估针对减少所有就诊类型 HPV 疫苗接种 MOs 的多组分干预措施的效果。

方法

研究设计：在 33 个社区实践和 14 个儿科连续性诊所中，使用 QI 干预措施，在 9 个月内进行 HPV 疫苗接种的 MOs 减少，以减少 HPV 疫苗接种的 MOs。

措施

结果措施包括 MOs 的基线和项目后测量（主要结果），以及 2）HPV 疫苗接种的启动和完成。过程措施包括每月对 HPV 疫苗接种的 MOs 进行图表审核，以提供绩效反馈，每月进行计划-执行-研究-行动调查以及关于办公室系统的预-后调查。

干预措施

在项目开始时，对提供者进行关于强烈推荐 HPV 疫苗接种的培训。实践实施提供者提示和/或常规医嘱和/或提醒/召回，如果需要，并每月提供 MOs 的反馈，以评估其进展。

分析

使用卡方检验评估办公室实践的变化，使用逻辑回归评估根据就诊类型和总体情况，以及 HPV 疫苗接种的启动和完成情况，MOs 的变化。

结果

总体而言，MOs 减少（社区实践从 73%降至 53%，连续性诊所从 62%降至 55%；P<.01，分别为 P=.03）。社区实践中，男女两性的 HPV 疫苗接种率均有所提高（女性从 66%增加到 74%，男性从 57%增加到 65%；P<.01），连续性诊所中男性患者的 HPV 疫苗接种率也有所提高（从 68%增加到 75%；P=.05）。社区实践中整体系列完成率增加（从 39%增加到 43%；P=.04），连续性诊所中男性患者的系列完成率也有所增加（从 36%增加到 44%；P=.03）。