Quality Improvement Strategies to Increase Human Papillomavirus (HPV) Vaccination
Quality Improvement Strategies to Increase Human Papillomavirus (HPV) Vaccination
HPV vaccination is at lower levels than the national goals. This study will evaluate the
 effectiveness of quality improvement strategies for increasing HPV vaccination coverage among
 adolescents in primary care clinics.
The University of North Carolina will test the effectiveness of the Center for Disease
 Control and Prevention's AFIX model, physician-to-physician engagement, and both strategies
 in combination, for increasing HPV vaccination coverage among adolescents in primary care
 clinics. AFIX (Assessment, Feedback, Incentives and eXchange) consists of brief quality
 improvement consultations that immunization specialists from state health departments deliver
 to vaccine providers in primary care settings. Using immunization registry data, the
 specialist evaluates the clinic's vaccination coverage and delivers education on best
 practices to improve coverage. Physician-to-physician (P2P) engagement consists of physician
 educators providing feedback about clinics' current HPV vaccination coverage and in-depth
 training about how to make strong and effective HPV vaccination recommendations to primary
 care providers via remote webinar consultations. Physician educators will also use
 immunization registry data to provide feedback on clinics' vaccine coverage. The
 investigators will compare changes in HPV vaccination coverage before and after intervention
 for high-volume primary care clinics in four study conditions: AFIX consultations delivered
 in-person by state health department immunization specialists (AFIX group),
 physician-to-physician consultations delivered remotely by trained physician educators (P2P
 group), both AFIX and P2P consultations in combination (AFIX + P2P group), or no HPV quality
 improvement intervention (control group). In each state, 30 clinics will be randomly assigned
 to each study arm, for a total of 120 clinics per state, or 360 clinics overall. As a
 secondary endpoint, we proposed to evaluate the impact of intervention "booster" visits
 delivered at 12-months post-intervention. However, the CDC has recently changed the AFIX
 program so that the desired comparison is no longer possible. Therefore, we have eliminated
 booster visits. This change does not affect our primary endpoint. The primary objective of
 this study is to compare the change in coverage for HPV vaccine initiation among 11-12 year
 old patients, from baseline to 12-month follow-up. Secondarily, the study will compare the
 change in coverage for other vaccines, age groups and time periods.
Inclusion Criteria:

 -  Pediatric or family medicine clinics or practices in New York, Wisconsin, or Arizona
 with at least 200 active records for patients, ages 11-17, in their states'
 immunization information systems.

 Exclusion Criteria:

 -  Less than 200 active records for patients between 11-17