Increasing HPV Vaccination in Community-Based Pediatric Practices
Increasing HPV Vaccination in Community-Based Pediatric Practices
The central goal of this study is to identify the optimal approach to implementing an
 evidence-based practice facilitation (PF) 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 PF modality to a lower-resource Web-Based Coaching PF
 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.

 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.
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:

 -  None