The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, United States of America.
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochetester, NY, United States of America.
Prev Med. 2020 Oct;139:106235. doi: 10.1016/j.ypmed.2020.106235. Epub 2020 Aug 12.
Human papillomavirus (HPV) vaccination rates are well below the Healthy People 2020 goal of 80%. Vaccinating in settings other than primary care, such as local health departments (LHDs), may help achieve higher HPV immunization rates. We tested the effect of a quality improvement (QI) collaborative to reduce missed opportunities (MOs) for HPV vaccine in LHDs. Between 2016 and 2019, we conducted four consecutive cohorts of a virtual QI collaborative at 24 LHDs across multiple states. Participants were trained on topics including how to provide an effective recommendation for HPV vaccine, strategies to reduce MOs, and motivational interviewing. Throughout the 6-month project implementation, LHDs tested strategies to reduce MOs through Plan-Do-Study-Act cycles, performed chart reviews to identify and characterize MOs, and received feedback reports to assess progress on MOs. HPV vaccination rates were assessed pre- and post-intervention. LHDs reduced MOs for HPV vaccine in all four cohorts with aggregated data showing a 25.3 percentage point reduction in MOs. Modified Poisson regression analysis found a 44% reduction in the relative risk of missing the opportunity for an HPV vaccine at a visit (RR = 0.56, 0.46-0.68, p < .001). This project shows that strategies effective in reducing MO for HPV vaccine in primary care settings are also effective in LHD settings. Training LHD staff on these strategies may help the U.S. approach national goals for HPV vaccine coverage.
人乳头瘤病毒 (HPV) 疫苗接种率远低于“健康人民 2020”目标的 80%。在初级保健以外的场所（如地方卫生部门）接种疫苗可能有助于提高 HPV 免疫接种率。我们测试了质量改进 (QI) 合作以减少地方卫生部门 HPV 疫苗接种机会错失 (MO) 的效果。在 2016 年至 2019 年期间，我们在 24 个来自多个州的地方卫生部门进行了四轮虚拟 QI 合作。参与者接受了关于如何为 HPV 疫苗提供有效建议、减少 MO 策略以及动机访谈等主题的培训。在整个 6 个月的项目实施过程中，地方卫生部门通过计划-执行-研究-行动周期测试了减少 MO 的策略，进行了图表审查以确定和描述 MO，并收到了反馈报告以评估 MO 进展情况。在干预前后评估了 HPV 疫苗接种率。所有四个队列的地方卫生部门都减少了 HPV 疫苗的 MO，汇总数据显示 MO 减少了 25.3 个百分点。修正泊松回归分析发现，错过 HPV 疫苗接种机会的相对风险降低了 44%（RR=0.56，0.46-0.68，p<0.001）。该项目表明，在初级保健环境中有效减少 HPV 疫苗 MO 的策略在地方卫生部门也同样有效。培训地方卫生部门工作人员了解这些策略可能有助于美国实现 HPV 疫苗接种覆盖率的国家目标。
