Szilagyi Peter G, Fiks Alexander G, Rand Cynthia M, Kate Kelly Mary, Russell Localio A, Albertin Christina S, Humiston Sharon G, Grundmeier Robert W, Steffes Jennifer, Davis Kristin, Shone Laura P, McFarland Greta, Abney Dianna E, Stephens-Shields Alisa J
Department of Pediatrics, University of California Los Angeles Mattel Children's Hospital, Los Angeles, California.
Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Pediatrics. 2025 Feb 1;155(2). doi: 10.1542/peds.2024-068145.
Human papillomavirus (HPV) vaccination rates are suboptimal, and missed vaccination opportunities are common. We hypothesized that a bundled intervention improves missed HPV vaccination opportunities.
We used a pre-post design to assess differences in HPV vaccine missed opportunities (visits when vaccine-eligible adolescents are not vaccinated). We compared rates for a 12-month period before vs those for a 6-month period (February 23, 2022, to August 9, 2022) during a bundled intervention. We implemented the bundled intervention in 24 primary care pediatric practices that had been usual care controls for a prior randomized trial. The bundled intervention involved 3 components: online clinician training on HPV vaccine communication, performance feedback on missed HPV vaccination opportunities, and clinician prompts for HPV vaccination. As a secondary analysis, we compared missed opportunities for these 24 practices vs 48 contemporaneous comparison group practices identified retrospectively.
For well-child care (WCC) visits, missed HPV vaccination opportunities were improved during vs before the intervention by 4.8 percentage points (95% CI, -7.2% to -2.4%) for initial HPV vaccine doses and a modest 2.2 percentage points (95% CI, -4.4% to -0.0%) for subsequent doses. For other visit types, findings ruled out changes beyond minimal improvements. Missed vaccination opportunity rates for initial HPV vaccination at WCC visits were similar for the 24 intervention practices vs the 48 comparison practices for a 4.5-year period before the intervention, but they improved for intervention practices and worsened for comparison practices during the intervention period (difference, -6.6%; 95% CI, -9.3% to -3.8%).
This bundled intervention appeared to improve HPV vaccination during WCC visits.
人乳头瘤病毒（HPV）疫苗接种率未达最佳水平，错过疫苗接种机会的情况很常见。我们推测，综合干预措施可改善错过HPV疫苗接种的情况。
我们采用前后对照设计，评估HPV疫苗接种错过机会（符合疫苗接种条件的青少年未接种疫苗的就诊情况）的差异。我们比较了综合干预期间6个月（2022年2月23日至2022年8月9日）与之前12个月期间的比率。我们在24家初级保健儿科诊所实施了综合干预，这些诊所在之前的一项随机试验中为常规护理对照组。综合干预包括三个部分：针对HPV疫苗沟通的在线临床医生培训、关于错过HPV疫苗接种机会的绩效反馈以及临床医生对HPV疫苗接种的提示。作为次要分析，我们比较了这24家诊所与48家同期回顾性确定的对照组诊所的错过机会情况。
对于健康儿童保健（WCC）就诊，干预期间与干预前相比，首剂HPV疫苗错过接种机会改善了4.8个百分点（95%CI，-7.2%至-2.4%），后续剂次改善了适度的2.2个百分点（95%CI，-4.4%至-0.0%）。对于其他就诊类型，研究结果排除了超出微小改善的变化。在干预前的4.5年期间，24家干预诊所与48家对照诊所在WCC就诊时首剂HPV疫苗接种错过机会率相似，但在干预期间，干预诊所的该比率有所改善，对照诊所的该比率则恶化（差异为-6.6%；95%CI，-9.3%至-3.8%）。
这种综合干预措施似乎改善了WCC就诊期间的HPV疫苗接种情况。
