Increasing HPV Vaccination in Community-Based Pediatric Practices

Background:

The human papillomavirus (HPV) vaccine offers the unprecedented opportunity to prevent nearly
all cervical and anal cancers and a high proportion of vaginal, oropharyngeal, vulvar and
penile cancers, where HPV is the etiologic agent. HPV vaccination is recommended for all
children ages 11-12, with catch up for females to age 26 and males to age 21. However,
despite clear and indisputable value in cancer prevention, uptake and completion of the HPV
vaccine series has lagged far behind the goal of 80%. Provider recommendation is the
strongest determinant of HPV vaccination, but slow translation of guidelines for preventive
services, such as immunizations, into practice is a known challenge. Practice Facilitation
(PF), also called quality improvement coaching, is a multicomponent quality improvement
intervention approach that has well-established efficacy, in which external support and
resources are provided to build the internal capacity of practices to improve quality of care
and patient outcomes.

Objectives:

The central goal of the study is to identify the optimal approach to implementing an
evidence-based intervention for the uptake and completion of HPV vaccine among adolescents
receiving care in the community, guided by implementation science theory.

AIM 1: Determine the clinical effectiveness and cost-effectiveness of two modalities for
delivering a multi-component PF intervention to increase HPV vaccination initiation and
completion in community-based pediatric practices.

The investigators will compare the traditional In-person Coaching modality to a
lower-resource Web-Based Coaching modality. The primary patient outcome is HPV vaccination.
The investigators will also examine and compare the sustainability of practice changes on
vaccination rates and the effects over time for each intervention modality.

H1: Both interventions will result in significant increases in HPV vaccination from baseline
over time.

H2: Increases in the rate of HPV vaccination will be higher and sustained for a longer period
of time in the In-person Coaching PF Arm as compared with the Web-Based Coaching Arm.

H3: The Web-Based Coaching Arm will be more cost-effective than the In-person Coaching Arm.

AIM 2. Understand mechanisms of why the PF intervention may work better for some pediatric
practices than others for HPV vaccination.

The investigators will examine theory-based determinants at the organizational, provider, and
patient levels that may mediate (explain) or moderate (change) the effects of the PF
intervention on vaccination outcomes.

H4: Adoption of changes (process variables) and patient factors will mediate effects of the
intervention on HPV vaccination outcomes.

H5: Organizational factors, provider attitudes, and intervention characteristics will
moderate intervention effects on HPV vaccination outcomes.

Implications:

The findings will inform organizations about which PF modality to use among their constituent
practices to improve HPV vaccination rates, with potential for future national dissemination.

Inclusion Criteria:

- All providers and staff at each practice

Exclusion Criteria: