Epidemiological and survey research to characterize multi-level factors associated with HPV vaccination rates

Transcription

1 Epidemiological and survey research to characterize multi-level factors associated with HPV vaccination rates Finney Rutten LJ, Radecki Breitkopf C, Jacobson RM Mayo Clinic, Rochester, MN 20Reminder/Recall7 MFMER slide-1

2 History of Vaccine Resistance 20Reminder/Recall7 MFMER slide-2

3 Vaccine Resistance Has Persisted 20Reminder/Recall7 MFMER slide-3

4 Uptake and Completion of HPV Vaccination 20Reminder/Recall7 MFMER slide-4

5 Overview Our team has conducted several studies to better understand HPV vaccination in our local population. I will briefly describe two of these studies and introduce a pragmatic trial that builds on this work. 20Reminder/Recall7 MFMER slide-5

6 Study 1: Examined socioeconomic and geographic variation in HPV vaccination Medical Records Data Vaccination Demographics Address Integration Area-Level Data Annual household income Proportion of population: <high school degree unemployed Medicaid Below poverty level Non-White Population density 20Reminder/Recall7 MFMER slide-6

7 Rochester Epidemiology Project Medical records linkage system Includes several health systems in SE MN 27 counties Focus: starred counties 90% Coverage 20Reminder/Recall7 MFMER slide-7

8 Methods Fixed cohort (n=15,003) Adolescents ages 9-14 years Linked vaccination data to American Community Survey socioeconomic data Individual and area level factors 20Reminder/Recall7 MFMER slide-8

9 Results Vaccine Series Vaccine Series Initiation Completion Variable (reference level) Adjusted OR Adjusted OR Age Sex (Male) Female Race/ethnicity (White) Black Asian Hispanic Other/Unknown Low Socioeconomic Area Rural Area OR=Odds Ratio; OR in Bold=Significant 20Reminder/Recall7 MFMER slide-9

10 Results: Geographic variation 20Reminder/Recall7 MFMER slide-10

11 Study 2: Examined association of clinician knowledge, attitudes, and behavior with HPV vaccination rates Clinician Survey HPV-Related Knowledge Attitudes Behavior Integration Medical Records Data 20Reminder/Recall7 MFMER slide-11

12 Methods Mailed and Web Survey 27-county region Oct Jan primary care clinicians 51 clinical sites Survey Research Center Mayo Clinic st Street SW Rochester, MN Reminder/Recall7 MFMER slide-12

13 Methods: Linked survey and clinical data Survey Data HPV-related knowledge Perceived barriers Recommendations Clinical Data Vaccination rates 20Reminder/Recall7 MFMER slide-13

14 Results of First Analysis Site-level characteristics Vaccine Series Initiation IRR Vaccine Series Completion IRR Clinician Knowledge Clinician Barriers Perceived Parental Barriers IRR=Incident Rate Ratio; Bold IRR=Significant Adjusted for percent white, percent female, percent ages 9 13 and percent with government insurance or self-pay at each site. 20Reminder/Recall7 MFMER slide-14

15 Results of Second Analysis Site-level characteristics Often recommend for Males Aged Years Often recommend for Females Aged Years Strongly Recommend for Males Aged Years Strongly Recommend for Females Aged Years Vaccine Series Initiation Vaccine Series Completion IRR IRR IRR=Incident Rate Ratio; Bold IRR=Significant Adjusted for percent white, percent female, percent ages 9 13 and percent with government insurance or self-pay at each site. 20Reminder/Recall7 MFMER slide-15

16 FOA: Linking the Provider Recommendation to Adolescent HPV (R01) Vaccine Uptake encourages research on how the healthcare delivery system enhances or inhibits effectiveness of a provider s recommendation of the adolescent human papillomavirus (HPV) vaccine. 20Reminder/Recall7 MFMER slide-16

17 Multi-Level Intervention Practice Clinician Patient/ Parent 20Reminder/Recall7 MFMER slide-17

18 Pragmatic Trial with Process Evaluation 20Reminder/Recall7 MFMER slide-18

19 Stepped Wedge Cluster Randomized Trial Factorial Design Evaluate the independent and combined impact of two evidencebased implementation strategies on HPV vaccination rates. Step Practice A B C D E F Current care Current care Reminder/Recall Current care Reminder/Recall Reminder/Recall Audit & Feedback Current care Audit & Feedback Audit & Feedback Current care Current care Audit & Feedback Current care Reminder/Recall Reminder/Recall Current care Audit & Feedback Reminder/Recall Audit & Feedback Reminder/Recall Audit & Feedback Reminder/Recall Audit & Feedback Reminder/Recall Audit & Feedback Reminder/Recall Audit & Feedback Reminder/Recall Audit & Feedback Current care Audit & Feedback 20Reminder/Recall7 MFMER slide-19

20 Potential Impact Rigorously tested, population-level interventions, such as the one we are evaluating in our pragmatic trial, are essential if we are to reach the Healthy People 2020 goal for HPV vaccination. 20Reminder/Recall7 MFMER slide-20