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Article ; Online: Text vs Patient Portal Messaging to Improve Influenza Vaccination Coverage: A Health System-Wide Randomized Clinical Trial.

Szilagyi, Peter G / Duru, O Kenrik / Casillas, Alejandra / Ong, Michael K / Vangala, Sitaram / Tseng, Chi-Hong / Albertin, Christina / Humiston, Sharon G / Clark, Emma / Ross, Mindy K / Evans, Sharon A / Sloyan, Michael / Fox, Craig R / Lerner, Carlos

JAMA internal medicine

2024 Volume 184, Issue 5, Page(s) 519–527

Abstract: Importance: Increasing influenza vaccination rates is a public health priority. One method recommended by the US Centers for Disease Control and Prevention and others is for health systems to send reminders nudging patients to be vaccinated.: ... ...

Abstract	Importance: Increasing influenza vaccination rates is a public health priority. One method recommended by the US Centers for Disease Control and Prevention and others is for health systems to send reminders nudging patients to be vaccinated. Objective: To evaluate and compare the effect of electronic health record (EHR)-based patient portal reminders vs text message reminders on influenza vaccination rates across a health system. Design, setting, and participants: This 3-arm randomized clinical trial was conducted from September 7, 2022, to April 30, 2023, among primary care patients within the University of California, Los Angeles (UCLA) health system. Interventions: Arm 1 received standard of care. The health system sent monthly reminder messages to patients due for an influenza vaccine by portal (arm 2) or text (arm 3). Arm 2 had a 2 × 2 nested design, with fixed vs responsive monthly reminders and preappointment vs no preappointment reminders. Arm 3 had 1 × 2 design, with preappointment vs no preappointment reminders. Preappointment reminders for eligible patients were sent 24 and 48 hours before scheduled primary care visits. Fixed reminders (in October, November, and December) involved identical messages via portal or text. Responsive portal reminders involved a September message asking patients about their plans for vaccination, with a follow-up reminder if the response was affirmative but the patient was not yet vaccinated. Main outcomes and measures: The primary outcome was influenza vaccination by April 30, 2023, obtained from the UCLA EHR, including vaccination from pharmacies and other sources. Results: A total of 262 085 patients (mean [SD] age, 45.1 [20.7] years; 237 404 [90.6%] adults; 24 681 [9.4%] children; 149 349 [57.0%] women) in 79 primary care practices were included (87 257 in arm 1, 87 478 in arm 2, and 87 350 in arm 3). At the entire primary care population level, none of the interventions improved influenza vaccination rates. All groups had rates of approximately 47%. There was no statistical or clinically significant improvement following portal vs text, preappointment reminders vs no preappointment reminders (portal and text reminders combined), or responsive vs fixed monthly portal reminders. Conclusions and relevance: At the population level, neither portal nor text reminders for influenza vaccination were effective. Given that vaccine hesitancy may be a major reason for the lack of impact of portal or text reminders, more intensive interventions by health systems are needed to raise influenza vaccination coverage levels. Trial registration: ClinicalTrials.gov Identifier: NCT05525494.
MeSH term(s)	Humans ; Text Messaging ; Reminder Systems ; Male ; Patient Portals ; Female ; Influenza, Human/prevention & control ; Influenza Vaccines/administration & dosage ; Middle Aged ; Vaccination Coverage/statistics & numerical data ; Adult ; Aged ; Electronic Health Records ; Vaccination/methods ; Vaccination/statistics & numerical data
Chemical Substances	Influenza Vaccines
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2024.0001
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Article ; Online: Perspectives on Maternal Vaccination from Obstetrical Clinicians: A Qualitative Multi-site Study.

Humiston, Sharon G / Szilagyi, Peter G / Bender, Robin G / Breck, Abigail / Albertin, Christina S / Clark, Devin / Rand, Cynthia M

Maternal and child health journal

2022

Abstract: Objectives: Despite the seriousness of influenza and pertussis, availability of safe and effective vaccines against them, and long-standing maternal vaccination recommendations, US maternal influenza and Tdap vaccination rates have been low. To increase ...

Abstract	Objectives: Despite the seriousness of influenza and pertussis, availability of safe and effective vaccines against them, and long-standing maternal vaccination recommendations, US maternal influenza and Tdap vaccination rates have been low. To increase vaccination rates in obstetric offices, it is important to understand clinician perspectives and office processes. We conducted in-depth interviews with nurses and providers on these topics. Methods: Interviewees worked in obstetric offices in one-of-four participating health systems in NY and CA. We audio-recorded and transcribed 20-30-min interviews. We used predetermined categories to code interviews with Dedoose, then iteratively refined codes and identified themes. Results: We conducted 20 interviews between 4/2020 and 9/2020: 13 providers (physician or nurse midwife) (5 NY, 8 CA); 7 office nurses (6 NY, 1 CA). In almost all offices, patient refusal of influenza vaccine was considered the major vaccination barrier; Tdap was often deferred by patients until post-delivery. Nurse-only visits for either vaccine were rare. Vaccination outside the office was uncommon; few offices systematically documented vaccines given elsewhere in a retrievable manner. Participants emphasized patient education as key to prenatal care, but the number of topics left little time for immunizations. Few interviewees could identify an office "immunization champion," knew their office vaccination rates, or had participated in vaccination quality improvement. Several interviewees indicated that they or another provider were good at persuading hesitant patients, but their method had not been shared with other clinicians. Conclusions for practice: Multiple practical barriers and maternal vaccine hesitancy limit maternal vaccination. Quality improvement strategies are needed.
Language	English
Publishing date	2022-10-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	1339905-6
ISSN	1573-6628 ; 1092-7875
ISSN (online)	1573-6628
ISSN	1092-7875
DOI	10.1007/s10995-022-03535-x
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Article ; Online: A validated modification of the vaccine hesitancy scale for childhood, influenza and HPV vaccines.

Helmkamp, Laura J / Szilagyi, Peter G / Zimet, Gregory / Saville, Alison W / Gurfinkel, Dennis / Albertin, Christina / Breck, Abigail / Vangala, Sitaram / Kempe, Allison

Vaccine

2021 Volume 39, Issue 13, Page(s) 1831–1839

Abstract: Introduction: Vaccine hesitancy contributes to outbreaks of preventable disease worldwide. The Vaccine Hesitancy Scale (VHS), developed by the international WHO SAGE Working Group, has been validated previously for measuring hesitancy towards childhood ... ...

Abstract	Introduction: Vaccine hesitancy contributes to outbreaks of preventable disease worldwide. The Vaccine Hesitancy Scale (VHS), developed by the international WHO SAGE Working Group, has been validated previously for measuring hesitancy towards childhood vaccines; some psychometric properties were suboptimal. Methods: We collected data using large, nationally-representative samples of parents in the U.S. We adapted the VHS items, and additional hesitancy items, to assess hesitancy towards influenza and HPV vaccines in addition to routine childhood vaccines. We then used exploratory and confirmatory factor analysis to identify latent constructs and create modified scales for childhood (VHS-child), influenza (VHS-flu) and HPV (VHS-HPV) vaccines with improved psychometric properties. Finally, we compared hesitancy scores on the VHS-child, VHS-flu, and VHS-HPV, to self-reported receipt of each vaccine category, and compared subscale scores to assess whether drivers of hesitancy differed by vaccine category. Results: 2052 parents of children <18 years old completed the VHS-child and VHS-flu while 2020 parents of adolescents completed the VHS-HPV. A two-factor structure of 'risks' and a 'lack of confidence' was found for each vaccine category. Slight modifications to the VHS improved psychometric properties. Hesitancy was strongly associated with vaccine receipt: e.g., 76% of parents not hesitant towards influenza vaccine had vaccinated their child the past season, versus 9% of hesitant parents (p < 0.0001). Subscale scores also differed significantly between vaccines: lack of confidence was greater towards influenza (Median (IQR): 2.0 (1.2, 3.3)) and HPV (2.0 (1.3, 3.0)) vaccines than childhood (1.2 (1.0, 1.8), p < 0.0001 for both) vaccines; perceived risks of HPV vaccines (2.7 (1.7, 3.7)) were greater than for childhood vaccines (2.0 (1.3, 3.0), p < 0.0001). Conclusions: Our modified VHS scales perform well psychometrically and allow for consistent measurement of the extent and reasons for hesitancy between vaccine categories. We suggest that future work use these scales to examine hesitancy towards other vaccines and to monitor hesitancy over time.
MeSH term(s)	Adolescent ; Child ; Health Knowledge, Attitudes, Practice ; Humans ; Influenza Vaccines ; Influenza, Human/prevention & control ; Papillomavirus Vaccines ; Parents ; Patient Acceptance of Health Care ; Vaccination
Chemical Substances	Influenza Vaccines ; Papillomavirus Vaccines
Language	English
Publishing date	2021-03-04
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2021.02.039
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Zs.A 1930: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: A validated modification of the vaccine hesitancy scale for childhood, influenza and HPV vaccines

Helmkamp, Laura J / Szilagyi, Peter G / Zimet, Gregory / Saville, Alison W / Gurfinkel, Dennis / Albertin, Christina / Breck, Abigail / Vangala, Sitaram / Kempe, Allison

Vaccine. 2021 Mar. 26, v. 39, no. 13

2021

Abstract: Vaccine hesitancy contributes to outbreaks of preventable disease worldwide. The Vaccine Hesitancy Scale (VHS), developed by the international WHO SAGE Working Group, has been validated previously for measuring hesitancy towards childhood vaccines; some ... ...

Abstract	Vaccine hesitancy contributes to outbreaks of preventable disease worldwide. The Vaccine Hesitancy Scale (VHS), developed by the international WHO SAGE Working Group, has been validated previously for measuring hesitancy towards childhood vaccines; some psychometric properties were suboptimal.We collected data using large, nationally-representative samples of parents in the U.S. We adapted the VHS items, and additional hesitancy items, to assess hesitancy towards influenza and HPV vaccines in addition to routine childhood vaccines. We then used exploratory and confirmatory factor analysis to identify latent constructs and create modified scales for childhood (VHS-child), influenza (VHS-flu) and HPV (VHS-HPV) vaccines with improved psychometric properties. Finally, we compared hesitancy scores on the VHS-child, VHS-flu, and VHS-HPV, to self-reported receipt of each vaccine category, and compared subscale scores to assess whether drivers of hesitancy differed by vaccine category.2052 parents of children <18 years old completed the VHS-child and VHS-flu while 2020 parents of adolescents completed the VHS-HPV. A two-factor structure of ‘risks’ and a ‘lack of confidence’ was found for each vaccine category. Slight modifications to the VHS improved psychometric properties. Hesitancy was strongly associated with vaccine receipt: e.g., 76% of parents not hesitant towards influenza vaccine had vaccinated their child the past season, versus 9% of hesitant parents (p < 0.0001). Subscale scores also differed significantly between vaccines: lack of confidence was greater towards influenza (Median (IQR): 2.0 (1.2, 3.3)) and HPV (2.0 (1.3, 3.0)) vaccines than childhood (1.2 (1.0, 1.8), p < 0.0001 for both) vaccines; perceived risks of HPV vaccines (2.7 (1.7, 3.7)) were greater than for childhood vaccines (2.0 (1.3, 3.0), p < 0.0001).Our modified VHS scales perform well psychometrically and allow for consistent measurement of the extent and reasons for hesitancy between vaccine categories. We suggest that future work use these scales to examine hesitancy towards other vaccines and to monitor hesitancy over time.
Keywords	childhood ; children ; factor analysis ; influenza ; influenza vaccines
Language	English
Dates of publication	2021-0326
Size	p. 1831-1839.
Publishing place	Elsevier Ltd
Document type	Article
Note	NAL-light
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2021.02.039
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Article ; Online: Missed Opportunities for Adolescent Immunizations at Well-Care Visits During the COVID-19 Pandemic.

Kelly, Mary Kate / Stephens-Shields, Alisa J / Hannan, Chloe / Rand, Cynthia M / Localio, Russell / Shone, Laura P / Steffes, Jennifer / Davis, Kristin / Grundmeier, Robert W / Humiston, Sharon G / Albertin, Christina / McFarland, Greta / Abney, Dianna E / Szilagyi, Peter G / Fiks, Alexander G

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

2023 Volume 73, Issue 3, Page(s) 595–598

Abstract: Purpose: The Coronavirus Disease 2019 pandemic disrupted healthcare, but the impact on vaccination missed opportunities (MOs, vaccine-eligible visits without vaccination) is unknown. We evaluated pandemic-related trends in MOs at adolescent well-care ... ...

Abstract	Purpose: The Coronavirus Disease 2019 pandemic disrupted healthcare, but the impact on vaccination missed opportunities (MOs, vaccine-eligible visits without vaccination) is unknown. We evaluated pandemic-related trends in MOs at adolescent well-care visits for three vaccines: human papillomavirus; quadrivalent meningococcal conjugate; and tetanus, diphtheria, and acellular pertussis (Tdap). Methods: We analyzed electronic health record data from 24 pediatric primary care practices in 13 states from 1/1/2018 to 12/31/2021. Segmented logistic regression estimated risk differences for MOs during the pandemic relative to prepandemic trends. Results: Among 106,605 well-care visits, we observed decreases in MOs prepandemic followed by an increase in MOs during the pandemic for all three vaccines. Relative to prepandemic, MOs increased for human papillomavirus (+15.9%, 95% confidence interval [CI]: 11.7%, 20.1%), meningococcal conjugate (+9.4%, 95% CI: 5.2%, 13.7%), and tetanus, diphtheria, and acellular pertussis (Tdap) (+ 8.2%, 95% CI: 4.3%, 12.1%). Discussion: Increases in vaccine MOs during the pandemic equaled or exceeded pre-pandemic decreases. Reducing MOs in adolescent well-care could raise vaccine coverage.
MeSH term(s)	Humans ; Adolescent ; Child ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Pandemics/prevention & control ; Tetanus/prevention & control ; Diphtheria/prevention & control ; Whooping Cough ; Immunization Schedule ; COVID-19/prevention & control ; Vaccination ; Neisseria meningitidis ; Meningococcal Vaccines ; Papillomavirus Vaccines
Chemical Substances	Diphtheria-Tetanus-acellular Pertussis Vaccines ; Meningococcal Vaccines ; Papillomavirus Vaccines
Language	English
Publishing date	2023-06-29
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S. ; Research Support, Non-U.S. Gov't
ZDB-ID	1063374-1
ISSN	1879-1972 ; 1054-139X
ISSN (online)	1879-1972
ISSN	1054-139X
DOI	10.1016/j.jadohealth.2023.05.008
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Article ; Online: Clinician Prompts for Human Papillomavirus Vaccination: A Cluster Randomized Trial.

Rand, Cynthia M / Stephens-Shields, Alisa J / Kelly, Mary K / Localio, Russell / Hannan, Chloe / Grundmeier, Robert W / Shone, Laura P / Steffes, Jennifer / Davis, Kristin / Albertin, Christina / Humiston, Sharon G / McFarland, Greta / Abney, Dianna E / Szilagyi, Peter G / Fiks, Alexander G

Academic pediatrics

2023 Volume 24, Issue 4, Page(s) 579–586

Abstract: Objective: We assessed the impact of an online intervention using clinician prompts for human papillomavirus (HPV) vaccination with a cluster randomized controlled trial.: Methods: The randomized trial occurred July 2021-January 2022 in 48 primary ... ...

Abstract	Objective: We assessed the impact of an online intervention using clinician prompts for human papillomavirus (HPV) vaccination with a cluster randomized controlled trial. Methods: The randomized trial occurred July 2021-January 2022 in 48 primary care pediatric practices (24 intervention, 24 control) across the US. We trained clinicians via two online learning modules, plus weekly ''quick tips'' delivered via text or email. The training taught practices to implement a staff prompt to the clinician (e.g., printed reminders placed on the keyboard) plus electronic health record (EHR) prompts (if not already done) at well and acute/chronic visits for initial and subsequent HPV vaccination. We assessed missed opportunities for HPV vaccination using logistic regression models accounting for clustering by practice on an intent to treat basis. Surveys assessed facilitators and barriers to using prompts. Results: During the 6-month intervention, missed opportunities for HPV vaccination increased (worsened) in both intervention and control groups. However, at well child care visits, missed opportunities for the initial HPV vaccine increased by 4.5 (95% CI: -9.0%, -0.1%) percentage points less in intervention versus control practices. Change in missed opportunities for subsequent doses at well child care and non-well child care visits did not differ between trial groups. An end-of trial survey found understaffing as a common challenge. Conclusions: Clinician prompts reduced missed opportunities for HPV vaccination at well child care visits. Understaffing related to the COVID-19 pandemic may have led to worsening missed opportunities for both groups and likely impeded practices in fully implementing changes.
MeSH term(s)	Humans ; Papillomavirus Vaccines/administration & dosage ; Papillomavirus Vaccines/therapeutic use ; Papillomavirus Infections/prevention & control ; Female ; Reminder Systems ; Male ; Child ; Vaccination ; Adolescent ; COVID-19/prevention & control ; Primary Health Care/methods ; Electronic Health Records ; United States ; Human Papillomavirus Viruses
Chemical Substances	Papillomavirus Vaccines
Language	English
Publishing date	2023-11-02
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2483385-X
ISSN	1876-2867 ; 1876-2859
ISSN (online)	1876-2867
ISSN	1876-2859
DOI	10.1016/j.acap.2023.10.011
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Article ; Online: Evaluation of behavioral economic strategies to raise influenza vaccination rates across a health system: Results from a randomized clinical trial.

Szilagyi, Peter G / Casillas, Alejandra / Duru, O Kenrik / Ong, Michael K / Vangala, Sitaram / Tseng, Chi-Hong / Albertin, Christina / Humiston, Sharon G / Ross, Mindy K / Friedman, Sarah R / Evans, Sharon / Sloyan, Michael / Bogard, Jonathan E / Fox, Craig R / Lerner, Carlos

Preventive medicine

2023 Volume 170, Page(s) 107474

Abstract: Influenza vaccination rates are low. Working with a large US health system, we evaluated three health system-wide interventions using the electronic health record's patient portal to improve influenza vaccination rates. We performed a two-arm RCT with a ... ...

Abstract	Influenza vaccination rates are low. Working with a large US health system, we evaluated three health system-wide interventions using the electronic health record's patient portal to improve influenza vaccination rates. We performed a two-arm RCT with a nested factorial design within the treatment arm, randomizing patients to usual-care control (no portal interventions) or to one or more portal interventions. We included all patients within this health system during the 2020-2021 influenza vaccination season, which overlapped with the COVID-19 pandemic. Through the patient portal, we simultaneously tested: pre-commitment messages (sent September 2020, asking patients to commit to a vaccination); monthly portal reminders (October - December 2020), direct appointment scheduling (patients could self-schedule influenza vaccination at multiple sites); and pre-appointment reminder messages (sent before scheduled primary care appointments, reminding patients about influenza vaccination). The main outcome measure was receipt of influenza vaccine (10/01/2020-03/31/2021). We randomized 213,773 patients (196,070 adults ≥18 years, 17,703 children). Influenza vaccination rates overall were low (39.0%). Vaccination rates for study arms did not differ: Control (38.9%), pre-commitment vs no pre-commitment (39.2%/38.9%), direct appointment scheduling yes/no (39.1%/39.1%), pre-appointment reminders yes/no (39.1%/39.1%); p > 0.017 for all comparisons (p value cut-off adjusted for multiple comparisons). After adjusting for age, gender, insurance, race, ethnicity, and prior influenza vaccination, none of the interventions increased vaccination rates. We conclude that patient portal interventions to remind patients to receive influenza vaccine during the COVID-19 pandemic did not raise influenza immunization rates. More intensive or tailored interventions are needed beyond portal innovations to increase influenza vaccination.
MeSH term(s)	Adult ; Child ; Humans ; Influenza Vaccines ; Influenza, Human/prevention & control ; Economics, Behavioral ; Pandemics ; Reminder Systems ; COVID-19/prevention & control ; Vaccination
Chemical Substances	Influenza Vaccines
Language	English
Publishing date	2023-03-02
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	184600-0
ISSN	1096-0260 ; 0091-7435
ISSN (online)	1096-0260
ISSN	0091-7435
DOI	10.1016/j.ypmed.2023.107474
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Article: Supporting and sustaining centralized reminder/recall for immunizations: Qualitative insights from stakeholders

Fisher, Michael P / Albertin, Christina / Breck, Abigail / Gurfinkel, Dennis / Kempe, Allison / Saville, Alison / Szilagyi, Peter G / Valderrama, Rebecca

Vaccine. 2019 Oct. 16, v. 37, no. 44

2019

Abstract: Centralized reminder/recall (C-R/R) is an evidence-based strategy for increasing vaccination rates that uses a population-level database such as a state immunization information system (IIS) to send notifications across large geographic areas. IISs are ... ...

Abstract	Centralized reminder/recall (C-R/R) is an evidence-based strategy for increasing vaccination rates that uses a population-level database such as a state immunization information system (IIS) to send notifications across large geographic areas. IISs are usually based in state public health departments, which could initiate C-R/R. While C-R/R is a promising strategy, the factors influencing its initiation and sustainment are not clear. Utilizing qualitative content analysis methodology and interviews with key stakeholders involved in or knowledgeable about C-R/R, we examined the characteristics of these initiatives and factors influencing their success. We identified and spoke with managers and senior leaders across IISs, health plans, health systems, pharmaceutical companies, and advocacy organizations and focused especially on C-R/R activities within IISs. Several considerations were determined important to C-R/R success: decision-making, stakeholder buy-in, partnerships, funding, data and technology, evaluation, and message content. Salient barriers were costs and lack of funding, poor contact data quality (i.e. telephone number, home address), and messaging that is either overly broad or too specific. Pertinent facilitators of C-R/R included notifying health providers in advance of an initiative, conducting a rigorous post-reminder/recall evaluation, and engaging a range of partners. Partnerships were important to stakeholders for multiple reasons including technical assistance, resource sharing, and sharing of best practices. Overall, our results illustrate the many opportunities to advance C-R/R through further collaboration within and across public health departments and potentially via public-private partnerships.
Keywords	advocacy ; data quality ; databases ; decision making ; funding ; information systems ; interviews ; managers ; pharmaceutical industry ; public health ; public-private partnerships ; stakeholders ; vaccination ; vaccines
Language	English
Dates of publication	2019-1016
Size	p. 6601-6608.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2019.09.055
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Article ; Online: Obstetric Provider Attitudes and Office Practices for Maternal Influenza and Tdap Vaccination.

Rand, Cynthia M / Bender, Robin / Humiston, Sharon G / Albertin, Christina / Olson-Chen, Courtney / Chen, Judy / Hsu, Yung-Shee J / Vangala, Sitaram / Szilagyi, Peter G

Journal of women's health (2002)

2022 Volume 31, Issue 9, Page(s) 1246–1254

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Cross-Sectional Studies ; Diphtheria Toxoid ; Diphtheria-Tetanus-acellular Pertussis Vaccines/therapeutic use ; Female ; Humans ; Infant ; Infant, Newborn ; Influenza Vaccines/therapeutic use ; Influenza, Human/prevention & control ; Pregnancy ; Toxoids ; Vaccination ; Whooping Cough/prevention & control
Chemical Substances	Diphtheria Toxoid ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Influenza Vaccines ; Toxoids
Language	English
Publishing date	2022-07-28
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1139774-3
ISSN	1931-843X ; 1059-7115 ; 1540-9996
ISSN (online)	1931-843X
ISSN	1059-7115 ; 1540-9996
DOI	10.1089/jwh.2022.0030
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Article ; Online: Identifying Strategies to Reduce Missed Opportunities for HPV Vaccination in Primary Care: A Qualitative Study of Positive Deviants.

Rand, Cynthia M / Concannon, Cathleen / Wallace-Brodeur, Rachel / Davis, Wendy / Albertin, Christina S / Humiston, Sharon G / Szilagyi, Peter G

Clinical pediatrics

2020 Volume 59, Issue 12, Page(s) 1058–1068

Abstract: The objectives of this study were to assess the contextual factors, practice strategies, and sustainability of interventions implemented during a national quality improvement (QI) project to raise human papillomavirus (HPV) vaccination rates. We ... ...

Abstract	The objectives of this study were to assess the contextual factors, practice strategies, and sustainability of interventions implemented during a national quality improvement (QI) project to raise human papillomavirus (HPV) vaccination rates. We conducted semistructured interviews with positive deviant practices that successfully reduced missed opportunities by ≥20% for HPV vaccination in the prior year. We assessed leadership support, motivators, interventions used, and sustainability. Key themes related to QI teams included strong leadership support, multidisciplinary teams, having a practice champion, and a collaborative environment. Themes related to the interventions included using a presumptive bundled recommendation for all appropriate vaccines at age 11, previsit planning, and reminders for preventive visits, which were sustainable for most practices 1-year postintervention. Both internal practice-level factors (multidisciplinary teams, collaboration, and previsit planning) and organizational factors (institutional support and health system-level reminders for preventive visits) were key to a successful QI intervention to improve HPV vaccination.
MeSH term(s)	Adolescent ; Child ; Female ; Humans ; Male ; Papillomavirus Infections/prevention & control ; Papillomavirus Infections/psychology ; Papillomavirus Vaccines/administration & dosage ; Physician-Patient Relations ; Preventive Health Services/methods ; Primary Health Care/organization & administration ; Professional-Family Relations ; Qualitative Research ; Quality Improvement/organization & administration ; Vaccination/statistics & numerical data
Chemical Substances	Papillomavirus Vaccines
Language	English
Publishing date	2020-06-29
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	207678-0
ISSN	1938-2707 ; 0009-9228
ISSN (online)	1938-2707
ISSN	0009-9228
DOI	10.1177/0009922820930357
Database	MEDical Literature Analysis and Retrieval System OnLINE

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