Objective

To evaluate the effectiveness of a multilevel intervention using national partnerships on human papillomavirus (HPV) vaccination rates.

Methods

The American Cancer Society's Vaccinate Adolescents against Cancer program is a multilevel intervention focusing on systems and providers. The 2017 cohort introduced national partnerships to deliver intervention elements and Maintenance of Certification and continuing medical education credits for physicians. Eleven federally qualified health center (FQHC) systems completed interventions in 2017. Interventions included provider training and ≥1 other evidence-based systems improvement. We compared adolescent vaccination rates in the preintervention period (2016) and intervention period (2017) among adolescents who turned 13 during the calendar year. Intervention effectiveness was assessed using repeated measures paired t tests and Cohen's d effect size for vaccination rate change.

Results

All FQHC systems implemented provider training plus an average of 2.3 additional systems improvements. Series initiation increased by an average of 23.6 percentage points (47.2%–70.8%). HPV completion rates increased by an average of 22.7 percentage points (24.6%–46.3%). Meningococcal and Tdap vaccination rates increased by 23.3 and 25.9 percentage points respectively (47.9%–71.2% and 48.8%–74.7%). All changes were statistically significant (all P < .05) and indicated large effect sizes (Cohen's d³ 1.15). Among clinicians completing postintervention surveys, 90% reported making changes to their health care system or direct patient care based on what they had learned.

Conclusions

Multilevel interventions focusing on provider training and systems changes can substantially improve on-time adolescent vaccination coverage and can be successfully performed using national partnerships and a train-the-trainer model.

中文翻译：

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使用国家伙伴关系的多层次质量改进干预对人乳头瘤病毒疫苗接种率的影响

客观的

使用国家合作伙伴关系评估多层次干预对人乳头瘤病毒 (HPV) 疫苗接种率的有效性。

方法

美国癌症协会的青少年癌症疫苗接种计划是一项多层次干预，重点关注系统和提供者。2017 年队列引入了国家合作伙伴关系，为医生提供干预要素和认证维护以及继续医学教育学分。11 个联邦合格的健康中心 (FQHC) 系统在 2017 年完成了干预。干预包括提供者培训和≥1 项其他循证系统改进。我们比较了日历年年满 13 岁的青少年在干预前（2016 年）和干预期（2017 年）的青少年疫苗接种率。使用重复测量配对t检验和 Cohen d对疫苗接种率变化的影响大小来评估干预有效性。

结果

所有 FQHC 系统都实施了供应商培训以及平均 2.3 项额外系统改进。系列启动平均增加了 23.6 个百分点（47.2%–70.8%）。HPV 完成率平均提高了 22.7 个百分点（24.6%–46.3%）。脑膜炎球菌和 Tdap 疫苗接种率分别增加了 23.3 和 25.9 个百分点（47.9%–71.2% 和 48.8%–74.7%）。所有变化都具有统计学意义（所有P < .05）并表明效应量大（Cohen's d ³ 1.15）。在完成干预后调查的临床医生中，90% 的人报告说根据他们所学到的知识改变了他们的医疗保健系统或直接对患者进行护理。

结论

侧重于提供者培训和系统变革的多层次干预可以显着提高准时的青少年疫苗接种覆盖率，并且可以使用国家伙伴关系和培训师培训模式成功实施。