Human Papillomavirus vaccination clinical decision support for young adults in an upper midwestern healthcare system: a clinic cluster-randomized control trial

Melissa L Harry, Stephen E Asche, Laura A Freitag, JoAnn M Sperl-Hillen, Daniel M Saman, Heidi L Ekstrom, Ella A Chrenka, Anjali R Truitt, Clayton I Allen, Patrick J O'Connor, Steven P Dehmer, Joseph A Bianco, Thomas E Elliott, Melissa L Harry, Stephen E Asche, Laura A Freitag, JoAnn M Sperl-Hillen, Daniel M Saman, Heidi L Ekstrom, Ella A Chrenka, Anjali R Truitt, Clayton I Allen, Patrick J O'Connor, Steven P Dehmer, Joseph A Bianco, Thomas E Elliott

Abstract

Introduction: Human papillomavirus (HPV) vaccination rates are low in young adults. Clinical decision support (CDS) in primary care may increase HPV vaccination. We tested the treatment effect of algorithm-driven, web-based, and electronic health record-linked CDS with or without shared decision-making tools (SDMT) on HPV vaccination rates compared to usual care (UC).

Methods: In a clinic cluster-randomized control trial conducted in a healthcare system serving a largely rural population, we randomized 34 primary care clinic clusters (with three clinics sharing clinicians randomized together) to: CDS; CDS+SDMT; UC. The sample included young adults aged 18-26 due for HPV vaccination with a study index visit from 08/01/2018-03/15/2019 in a study clinic. Generalized linear mixed models tested differences in HPV vaccination status 12 months after index visits by study arm.

Results: Among 10,253 patients, 6,876 (65.2%) were due for HPV vaccination, and 5,054 met study eligibility criteria. In adjusted analyses, the HPV vaccination series was completed by 12 months in 2.3% (95% CI: 1.6%-3.2%) of CDS, 1.6% (95% CI: 1.1%-2.3%) of CDS+SDMT, and 2.2% (95% CI: 1.6%-3.0%) of UC patients, and at least one HPV vaccine was received by 12 months in 13.1% (95% CI: 10.6%-16.1%) of CDS, 9.2% (95% CI: 7.3%-11.6%) of CDS+SDMT, and 11.2% (95% CI: 9.1%-13.7%) of UC patients. Differences were not significant between arms. Females, those with prior HPV vaccinations, and those seen at urban clinics had significantly higher odds of HPV vaccination in adjusted models.

Discussion: CDS may require optimization for young adults to significantly impact HPV vaccination.

Trial registration: clinicaltrials.gov NCT02986230, 12/6/2016.

Keywords: Clinical decision support; cluster randomized control trial; human papillomavirus vaccination; primary cancer prevention; primary care; shared decision making; young adults.

Conflict of interest statement

No potential competing interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Study CONSORT diagram.

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