Division of Epidemiology, Mayo Clinic, Rochester, Minnesota.
Division of Health Care Delivery Research and Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
JAMA Pediatr. 2024 Jan 1;178(1):29-36. doi: 10.1001/jamapediatrics.2023.4932.
Despite availability of a safe and effective vaccine, an estimated 36 500 new cancers in the US result from human papillomavirus (HPV) annually. HPV vaccine uptake falls short of national public health goals and lags other adolescent vaccines.
To evaluate the individual and combined impact of 2 evidence-based interventions on HPV vaccination rates among 11- and 12-year-old children.
DESIGN, SETTING, AND PARTICIPANTS: The study team conducted a cluster randomized clinical trial with a stepped-wedge factorial design at 6 primary care practices affiliated with Mayo Clinic in southeastern Minnesota. Using block randomization to ensure balance of patient volumes across interventions, each practice was allocated to a sequence of four 12-month steps with the initial baseline step followed by 2 intermediate steps (none, 1, or both interventions) and a final step wherein all practices implemented both interventions. Each month, all eligible children who turned 11 or 12 years in the 2 months prior were identified and followed until the end of the step. Data were analyzed from April 2018 through March 2019. Participants included children who turned 11 or 12 years old and were due for a dose of the HPV vaccine.
Parents of eligible patients were mailed reminder/recalls following their child's birthdays. Health care professionals received confidential audit/feedback on their personal in-office success with HPV vaccine uptake via intra-campus mail. These 2 interventions were assessed separately and in combination.
Eligible patients' receipt of any valid dose of HPV vaccine during the study step.
The cohort was comprised of 9242 11-year-olds (5165 [55.9%]) and 12-year-olds (4077 [44.1%]), and slightly more males (4848 [52.5%]). Parent reminder/recall resulted in 34.6% receiving a dose of HPV vaccine, health care professional audit/feedback, 30.4%, both interventions together resulted in 39.7%-all contrasted to usual care, 21.9%. Compared with usual care, the odds of HPV vaccination were higher for parent reminder/recall (odds ratio [OR], 1.56; 95% CI, 1.23-1.97) and for the combination of parent reminder/recall and health care professional audit/feedback (OR, 2.03; 95% CI, 1.44-2.85). Health care professional audit/feedback alone did not differ significantly from usual care (OR, 1.19; 95% CI, 0.94-1.51).
In this cluster randomized trial, the combination of parent reminder/recall and health care professional audit/feedback increased the odds of HPV vaccination compared with usual care. These findings underscore the value of simultaneous implementation of evidence-based strategies to improve HPV vaccination.
尽管有安全有效的疫苗，但估计每年仍有 36500 例新的美国癌症由人乳头瘤病毒（HPV）引起。HPV 疫苗接种率未达到国家公共卫生目标，且滞后于其他青少年疫苗。
评估 2 种基于证据的干预措施对 11 至 12 岁儿童 HPV 疫苗接种率的单独和联合影响。
设计、设置和参与者：研究小组在明尼苏达州东南部梅奥诊所附属的 6 个初级保健机构进行了一项具有分步楔形因子设计的集群随机临床试验。使用块随机化确保干预措施之间的患者量平衡，每个实践都被分配到四个 12 个月步骤的序列中，初始基线步骤后跟两个中间步骤（无、1 个或两者都有），最后一个步骤是所有实践都实施了这两个干预措施。每个月，所有符合条件的在过去 2 个月中年满 11 或 12 岁的合格儿童都会被识别出来，并一直跟踪到步骤结束。数据分析于 2018 年 4 月至 2019 年 3 月进行。参与者包括年满 11 或 12 岁且需要接种 HPV 疫苗的儿童。
在孩子生日后，向符合条件的患者的父母邮寄提醒/召回。医疗保健专业人员通过校园内邮件收到有关他们个人在办公室中 HPV 疫苗接种成功率的机密审核/反馈。单独评估和组合评估了这 2 种干预措施。
在研究步骤中，符合条件的患者接受任何有效剂量的 HPV 疫苗的情况。
队列包括 9242 名 11 岁儿童（5165[55.9%]）和 12 岁儿童（4077[44.1%]），男性略多（4848[52.5%]）。父母提醒/召回导致 34.6%的人接种了 HPV 疫苗，医疗保健专业人员审核/反馈为 30.4%，两者结合为 39.7%-均与常规护理相比，为 21.9%。与常规护理相比，父母提醒/召回（优势比[OR]，1.56；95%置信区间，1.23-1.97）和父母提醒/召回和医疗保健专业人员审核/反馈的组合（OR，2.03；95%置信区间，1.44-2.85）的 HPV 疫苗接种几率更高。医疗保健专业人员审核/反馈本身与常规护理无显著差异（OR，1.19；95%置信区间，0.94-1.51）。
在这项集群随机试验中，与常规护理相比，父母提醒/召回和医疗保健专业人员审核/反馈的组合增加了 HPV 疫苗接种的几率。这些发现强调了同时实施基于证据的策略来改善 HPV 疫苗接种的重要性。
