Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
RAND Corporation, Santa Monica, California.
Pediatrics. 2022 Oct 1;150(4). doi: 10.1542/peds.2021-054186.
Nationally, 54.2% of youth are fully vaccinated for human papilloma virus (HPV) with persistent gender and racial/ethnic disparities. We used a quality improvement approach to improve completion of the HPV vaccine series by age 13 years. As a secondary aim, we examined racial/ethnic and gender differences in vaccine uptake.
The study setting included 2 pediatric, academic, primary care practices in Massachusetts. We designed a multilevel patient-, provider-, and systems-level intervention addressing parental hesitancy, provider communication, and clinical operations. Rates of HPV series completion by age 13 were monitored using a control p chart. Bivariate and multivariate analyses evaluated vaccine completion differences on the basis of clinic size, gender, and race/ethnicity.
Between July 1, 2014, and September 30, 2021, control p charts showed special cause variation with HPV vaccine initiation by age 9 years, increasing from 1% to 52%, and vaccine completion by 13 years, increasing from 37% to 77%. Compared with White and Black children, Hispanic children were more likely to initiate the HPV vaccine at age 9 (adjusted odds ratio [95% confidence interval] = (1.4-2.6)] and complete the series by age 13 (adjusted odds ratio [95% confidence interval] = 2.3 (1.7-3.0).
A multilevel intervention was associated with sustained HPV vaccine series completion by age 13 years. Hispanic children were more likely to be vaccinated. Qualitative family input was critical to intervention design. Provider communication training addressed vaccine hesitancy. Initiation of the vaccine at age 9 and clinicwide vaccine protocols were key to sustaining improvements.
全国范围内，有 54.2%的青少年完全接种了人乳头瘤病毒（HPV）疫苗，但仍存在持续性的性别和种族/民族差异。我们采用质量改进方法来提高青少年在 13 岁前完成 HPV 疫苗系列接种的比例。作为次要目标，我们研究了疫苗接种率在种族/民族和性别方面的差异。
研究地点包括马萨诸塞州的两家儿科学术型初级保健机构。我们设计了一个多层次的患者、提供者和系统层面的干预措施，以解决家长的犹豫、提供者的沟通和临床操作问题。使用控制 p 图监测 HPV 系列接种在 13 岁前的完成率。使用 bivariate 和 multivariate 分析，根据诊所规模、性别和种族/民族评估疫苗接种完成率的差异。
2014 年 7 月 1 日至 2021 年 9 月 30 日，HPV 疫苗接种在 9 岁时的起始率从 1%上升到 52%，13 岁时的完成率从 37%上升到 77%，控制 p 图显示 HPV 疫苗接种的特殊原因发生了变化。与白人及黑人儿童相比，西班牙裔儿童在 9 岁时更有可能开始接种 HPV 疫苗（调整后的优势比[95%置信区间]=(1.4-2.6)]，并在 13 岁时完成整个系列（调整后的优势比[95%置信区间]=(2.3(1.7-3.0]）。
多层次的干预措施与 13 岁前 HPV 疫苗系列接种的持续完成有关。西班牙裔儿童更有可能接种疫苗。家庭的定性反馈对于干预措施的设计至关重要。提供者的沟通培训解决了疫苗犹豫的问题。9 岁时开始接种疫苗和全诊所的疫苗接种方案是维持改进的关键。
