BACKGROUND AND OBJECTIVES US health departments routinely conduct in-person quality improvement (QI) coaching to strengthen primary care clinics' vaccine delivery systems, but this intervention achieves only small, inconsistent improvements in human papillomavirus (HPV) vaccination. Thus, we sought to evaluate the effectiveness of combining QI coaching with remote provider communication training to improve impact. METHODS With health departments in 3 states, we conducted a pragmatic 4-arm cluster randomized clinical trial with 267 primary care clinics (76% pediatrics). Clinics received in-person QI coaching, remote provider communication training, both interventions combined, or control. Using data from states' immunization information systems, we assessed HPV vaccination among 176 189 patients, ages 11 to 17, who were unvaccinated at baseline. Our primary outcome was the proportion of those, ages 11 to 12, who had initiated HPV vaccination at 12-month follow-up. RESULTS HPV vaccine initiation was 1.5% points higher in the QI coaching arm and 3.8% points higher in the combined intervention arm than in the control arm, among patients ages 11 to 12, at 12-month follow-up (both P < .001). Improvements persisted at 18-month follow-up. The combined intervention also achieved improvements for other age groups (ages 13-17) and vaccination outcomes (series completion). Remote communication training alone did not outperform the control on any outcome. CONCLUSIONS Combining QI coaching with remote provider communication training yielded more consistent improvements in HPV vaccination uptake than QI coaching alone. Health departments and other organizations that seek to support HPV vaccine delivery may benefit from a higher intensity, multilevel intervention approach.

中文翻译：

---

HPV 疫苗接种辅导和沟通培训：整群随机试验。


背景和目标 美国卫生部门定期进行面对面的质量改进 (QI) 辅导，以加强初级保健诊所的疫苗接种系统，但这种干预措施在人乳头瘤病毒 (HPV) 疫苗接种方面仅取得了微小且不一致的改善。因此，我们试图评估将 QI 辅导与远程提供商沟通培训相结合以提高影响力的有效性。方法 我们与 3 个州的卫生部门合作，对 267 个初级保健诊所（76% 是儿科诊所）进行了一项实用的 4 臂整群随机临床试验。诊所接受了面对面的 QI 辅导、远程提供者沟通培训、两种干预措施的结合或控制。利用各州免疫信息系统的数据，我们评估了 176 189 名 11 至 17 岁、基线时未接种疫苗的患者的 HPV 疫苗接种情况。我们的主要结果是在 12 个月的随访中开始接种 HPV 疫苗的 11 至 12 岁人群的比例。结果 在 12 个月的随访中，11 岁至 12 岁的患者中，HPV 疫苗的起始接种率比对照组高 1.5%，联合干预组高 3.8%（P < . 001）。 18 个月的随访后，情况持续改善。联合干预措施还改善了其他年龄组（13-17 岁）和疫苗接种结果（系列完成）。单独的远程通信培训在任何结果上都没有优于控制。结论 与单独的 QI 辅导相比，将 QI 辅导与远程提供者沟通培训相结合可以更一致地提高 HPV 疫苗接种率。寻求支持 HPV 疫苗接种的卫生部门和其他组织可能会受益于更高强度、多层次的干预方法。