Dr. Drainoni: Research Professor, Boston University Schools of Medicine and Public Health, Boston, MA; Codirector, Evans Center for Implementation and Improvement Sciences, Boston, MA. Ms. Biancarelli: Consultant, Accenture, Boston, MA. Ms. Jansen: Senior Program Manager, Boston University School of Medicine, Boston, MA. Dr. Bernstein: Emeritus Professor, Boston University School of Public Health; Professor of Emergency Medicine, Boston University School of Medicine, Boston, MA. Dr. Joseph: Clinical Associate Professor of Adolescent Medicine and Pediatrics, Boston University School of Medicine, Boston, MA. Ms. Eun: PhD Student, Department of Sociology, Stanford University, Boston, MA. Dr. Fenton: Postdoctoral Fellow, Center for Outcomes Research & Evaluation, Maine Medical Center Research Institute, Boston, MA. Dr. Clark: Professor, Boston University School of Public Health, Boston, MA. Dr. Hanchate: Associate Professor, Boston University Schools of Medicine and Public Health; Health Economist, VA Boston Healthcare System, Boston, MA. Mr. Legler: Senior Healthcare Statistician, Boston VA Healthcare System, Boston, MA. Dr. Schuch: Chief Information Officer, Pediatrician at South Boston Community Health Center, Boston, MA. Dr. Leschly : Assistant Professor, Boston University School of Medicine; Medical Director, East Boston Neighborhood Health Center, Boston, MA. Dr. Perkins: Associate Professor, Boston University School of Medicine, Boston, MA.
J Contin Educ Health Prof. 2021 Jul 1;41(3):195-201. doi: 10.1097/CEH.0000000000000363.
Few studies have rigorously evaluated the drivers of successful implementation of interventions to improve human papillomavirus (HPV) vaccination rates. The aim of this study was to evaluate the implementation of Development of Systems and Education for HPV Vaccination (DOSE HPV), a performance improvement intervention.
Primary care providers (PCPs), nurses, and individuals with leadership roles from pediatric and family medicine practices who attended DOSE HPV intervention sessions participated in qualitative interviews immediately following intervention completion. The study team professionally transcribed interviews and performed qualitative coding using inductive methods. Final analysis employed the Promoting Action on Research implementation in Health Services (PARiHS) model.
Twenty-six individuals participated: 12 PCPs, 5 nurses, and 9 individuals with dual leadership and PCP roles. Participants described five factors that they felt contributed to program success: (1) evidence-based, goal-directed education; (2) personalized data feedback; (3) clinical leadership support; (4) collaborative facilitation; (5) repeated contacts/longitudinal structure of the intervention. Barriers to implementing the intervention included: (1) inability to standardize workflow across practices; (2) low pediatric volume, (3) competing priorities/lack of incentives, (4) ineffective involvement of nurses, (5) poor communication between clinical leadership and staff.
Although many HPV testing interventions have been implemented, findings have been mixed. It is clear that having an effective, evidence-based intervention by itself is not enough to get it into practice. Rather, it is crucial to consider implementation factors to ensure consistent implementation and sustainability. Key factors for the success of the DOSE HPV intervention appear to include a collaborative approach, provision of useful evidence to motivate behavior change, and repeated contacts to ensure accountability for implementing changes. Workflow issues, ineffective lines of communication, and competing priorities at both the visit and the patient and population management levels can hinder implementation.
很少有研究严格评估过提高人乳头瘤病毒 (HPV) 疫苗接种率干预措施成功实施的驱动因素。本研究旨在评估开发系统和 HPV 疫苗接种教育 (DOSE HPV) 的实施情况，这是一项绩效改进干预措施。
参加 DOSE HPV 干预课程的初级保健提供者 (PCP)、护士和儿科及家庭医学实践中的具有领导角色的个人在干预完成后立即参加了定性访谈。研究团队专业转录了访谈并使用归纳方法进行定性编码。最终分析采用了促进健康服务研究实施行动 (PARiHS) 模型。
共有 26 人参加：12 名 PCP、5 名护士和 9 名具有双重领导和 PCP 角色的个人。参与者描述了他们认为有助于项目成功的五个因素：(1) 基于证据、目标明确的教育；(2) 个性化数据反馈；(3) 临床领导支持；(4) 协作促进；(5) 干预的反复接触/纵向结构。实施干预措施的障碍包括：(1) 无法在整个实践中标准化工作流程；(2) 儿科量低；(3) 优先事项冲突/缺乏激励；(4) 护士参与度低；(5) 临床领导与员工之间沟通不畅。
尽管已经实施了许多 HPV 检测干预措施，但结果喜忧参半。显然，仅仅拥有一个有效、基于证据的干预措施本身是不够的，还必须考虑实施因素，以确保一致的实施和可持续性。DOSE HPV 干预成功的关键因素似乎包括协作方法、提供有用的证据来激励行为改变，以及反复接触以确保对实施变革负责。工作流程问题、沟通不畅以及在就诊和患者及人群管理层面的优先级冲突都会阻碍实施。
