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人乳头瘤病毒疫苗接种的绩效反馈：来自美国儿科学会办公室环境下儿科研究网络的一项随机试验

Performance Feedback for Human Papillomavirus Vaccination: A Randomized Trial From the American Academy of Pediatrics Pediatric Research in Office Settings Research Network.

作者信息

Fiks Alexander G, Stephens-Shields Alisa J, Kelly Mary Kate, Localio Russell, Hannan Chloe, Grundmeier Robert W, Shone Laura P, Steffes Jennifer, Wright Margaret, Breck Abigail, Rand Cynthia M, Albertin Christina, Humiston Sharon G, McFarland Greta, Abney Dianna E, Szilagyi Peter G

机构信息

Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (AG Fiks, MK Kelly, C Hannan, and RW Grundmeier), Philadelphia, Pa; Pediatric Research in Office Settings, American Academy of Pediatrics (AG Fiks, LP Shone, J Steffes, G McFarland, and DE Abney), Itasca, Ill.

Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania (AJ Stephens-Shields and R Localio), Philadelphia, Pa.

出版信息

Acad Pediatr. 2023 Jan-Feb;23(1):47-56. doi: 10.1016/j.acap.2022.07.006. Epub 2022 Jul 16.

DOI:10.1016/j.acap.2022.07.006

PMID:35853600

Abstract

OBJECTIVE

To test the hypothesis that a feedback-based intervention would reduce human papillomavirus (HPV) vaccine missed opportunities.

METHODS

In a longitudinal cluster randomized controlled trial of 48 pediatric primary care practices, we allocated half the practices to receive a sequential, multicomponent intervention phased over consecutive periods. In a prior trial (period 1), communication skills training reduced missed opportunities for the initial HPV vaccine dose at well visits but not at acute/chronic visits. The current trial (period 2) evaluated the added value of performance feedback to clinicians after communication training. Performance feedback consisted of an introductory training module, weekly electronic "Quick Tips," and 3 individualized performance feedback reports to clinicians. We fit logistic regression models for the primary outcome of HPV vaccination missed opportunities using generalized estimating equations with independence working correlation, accounting for clustering at the practice level.

RESULTS

Performance feedback resulted in a 3.4 (95% confidence interval [CI]: -6.8, 0.0) percentage point greater reduction in missed HPV vaccine opportunities for the intervention versus control group during acute/chronic visits for subsequent HPV vaccinations (dose 2 or 3). However, during well visits for HPV vaccination dose #1, intervention practices increased missed opportunities (worsened) by 4.2 (95% CI: 1.0, 7.4) percentage points more than control practices, reducing the prior period 1 improvements and blunting the overall effect of performance feedback. We did not observe differences for the other visit/dose categories.

CONCLUSIONS

Performance feedback improved HPV vaccination for one subset of visits (acute/chronic, subsequent HPV vaccinations due), but not for well visits.

摘要

目的

检验基于反馈的干预措施能否减少人乳头瘤病毒（HPV）疫苗接种机会错失的假设。

方法

在一项针对48家儿科初级保健机构的纵向整群随机对照试验中，我们将一半的机构分配为接受在连续阶段分阶段进行的多成分干预措施。在之前的试验（第1阶段）中，沟通技能培训减少了健康检查时首次HPV疫苗接种剂量的机会错失，但在急性/慢性疾病就诊时没有效果。当前试验（第2阶段）评估了沟通培训后向临床医生提供绩效反馈的附加价值。绩效反馈包括一个入门培训模块、每周的电子“快速提示”以及向临床医生提供的3份个性化绩效反馈报告。我们使用具有独立工作相关性的广义估计方程，针对HPV疫苗接种机会错失的主要结局拟合逻辑回归模型，同时考虑机构层面的聚类情况。

结果

在后续HPV疫苗接种（第2剂或第3剂）的急性/慢性疾病就诊期间，与对照组相比，干预组因绩效反馈导致HPV疫苗接种机会错失减少的幅度高出3.4个百分点（95%置信区间[CI]：-6.8，0.0）。然而，在第1剂HPV疫苗接种的健康检查期间，干预机构的机会错失增加（恶化）了4.2个百分点（95%CI：1.0，7.4），超过了对照机构，抵消了第1阶段的改善效果，并削弱了绩效反馈的总体效果。我们在其他就诊/剂量类别中未观察到差异。