Effectiveness of decision support for families, clinicians, or both on HPV vaccine receipt

Abstract

Objective: To improve human papillomavirus (HPV) vaccination rates, we studied the effectiveness of targeting automated decision support to families, clinicians, or both.

Methods: Twenty-two primary care practices were cluster-randomized to receive a 3-part clinician-focused intervention (education, electronic health record-based alerts, and audit and feedback) or none. Overall, 22, 486 girls aged 11 to 17 years due for HPV vaccine dose 1, 2, or 3 were randomly assigned within each practice to receive family-focused decision support with educational telephone calls. Randomization established 4 groups: family-focused, clinician-focused, combined, and no intervention. We measured decision support effectiveness by final vaccination rates and time to vaccine receipt, standardized for covariates and limited to those having received the previous dose for HPV #2 and 3. The 1-year study began in May 2010.

Results: Final vaccination rates for HPV #1, 2, and 3 were 16%, 65%, and 63% among controls. The combined intervention increased vaccination rates by 9, 8, and 13 percentage points, respectively. The control group achieved 15% vaccination for HPV #1 and 50% vaccination for HPV #2 and 3 after 318, 178, and 215 days. The combined intervention significantly accelerated vaccination by 151, 68, and 93 days. The clinician-focused intervention was more effective than the family-focused intervention for HPV #1, but less effective for HPV #2 and 3.

Conclusions: A clinician-focused intervention was most effective for initiating the HPV vaccination series, whereas a family-focused intervention promoted completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt.

Keywords: decision support systems; electronic records; immunizations.

Figures

FIGURE 1

Randomization of study subjects. Girls were randomly assigned as they became eligible during the study period. Adolescents vaccinated at family planning visits were excluded to protect confidentiality.

FIGURE 2

Kaplan-Meier curves of time to vaccine receipt. A, HPV #1. B, HPV #2. C, HPV #3. Horizontal reference lines report cumulative incidence thresholds for comparing the number of days to receipt of vaccination for the 4 different interventions.