Division of General Pediatrics, Department of Pediatrics, David Geffen School of Medicine and UCLA Mattel Children's Hospital (University of California, Los Angeles) (MD Shah, PJ Chung, R Valderrama, and PG Szilagyi), Los Angeles, Calif.
UCLA Kaiser Permanente Center for Health Equity (BA Glenn and LC Chang), Los Angeles, Calif; Jonsson Comprehensive Cancer Center at UCLA (BA Glenn and LC Chang), Los Angeles, Calif; Department of Health Policy and Management, UCLA Fielding School of Public Health (BA Glenn), Los Angeles, Calif.
Acad Pediatr. 2020 Nov-Dec;20(8):1124-1132. doi: 10.1016/j.acap.2020.04.002. Epub 2020 Apr 12.
Human papillomavirus (HPV) immunization rates among US adolescents are low. Missed opportunities (MOs) for HPV vaccination are common. School-based health centers (SBHCs) have potential to boost HPV vaccination, but their role in addressing MOs has not been examined.
We implemented a multicomponent intervention, consisting of 3 immunization process workflow modifications combined with provider performance feedback, in 2 Los Angeles area SBHCs and conducted a pre/post evaluation of MOs. Our primary outcome was SBHC-based MOs for HPV vaccination during all visits, including visits for confidential reproductive health care (ie, confidential visits). Secondary outcomes were MOs for meningococcal (MenACWY) and influenza vaccination during visits for nonconfidential care.
MOs for HPV vaccination decreased during all visit types from the baseline to the intervention period (82.3% to 46.1%; adjusted risk ratio [RR] = 0.558, P < .0001). The rate decrease appeared to be greater during physical examination visits than confidential visits (83.4% to 31.6% vs 98.7% to 70.4%, respectively). MOs for MenACWY (74.5% to 35.0%; adjusted RR = 0.47, P < .0001) and influenza (86.7% to 69.3%; adjusted RR = 0.792, P < .0001) vaccination also decreased during nonconfidential visits. Vaccine refusal was the most frequently documented reason for HPV vaccine MOs during both physical examination and confidential visits.
A pragmatic, multicomponent SBHC intervention reduced MOs for HPV vaccination during all visit types. MOs for MenACWY and influenza vaccination also decreased during nonconfidential visits. Findings suggest that practice-level improvements in SBHCs can improve delivery of HPV and other adolescent vaccines.
美国青少年的人乳头瘤病毒（HPV）疫苗接种率较低。HPV 疫苗接种的错失机会（MOs）很常见。校医院（SBHC）有潜力提高 HPV 疫苗接种率，但它们在解决 MOs 方面的作用尚未得到检验。
我们在洛杉矶地区的 2 所 SBHC 实施了一项多组分干预措施，该措施包括 3 项免疫接种流程修改，并结合了提供方绩效反馈，对 MOs 进行了干预前后评估。我们的主要结局是所有就诊时（包括为保密生殖健康护理就诊时，即保密就诊）SBHC 基于 HPV 疫苗接种的 MOs。次要结局是在非保密护理就诊时的脑膜炎球菌（MenACWY）和流感疫苗接种的 MOs。
与基线期相比，在所有就诊类型中，HPV 疫苗接种的 MOs 均有所减少（82.3%降至 46.1%；调整后的风险比[RR] = 0.558，P <.0001）。在体检就诊时，MOs 下降的幅度似乎大于在保密就诊时（分别为 83.4%降至 31.6%和 98.7%降至 70.4%）。在非保密就诊时，MenACWY（74.5%降至 35.0%；调整 RR = 0.47，P <.0001）和流感（86.7%降至 69.3%；调整 RR = 0.792，P <.0001）疫苗接种的 MOs 也有所减少。疫苗拒绝是在体检和保密就诊时记录 HPV 疫苗 MOs 最常见的原因。
一项实用的、多组分的 SBHC 干预措施减少了所有就诊类型 HPV 疫苗接种的 MOs。非保密就诊时，MenACWY 和流感疫苗接种的 MOs 也有所减少。这些发现表明，SBHC 实践水平的提高可以改善 HPV 和其他青少年疫苗的接种率。
