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
History of Vaccine Resistance 20Reminder/Recall7 MFMER slide-2
Vaccine Resistance Has Persisted 20Reminder/Recall7 MFMER slide-3
Uptake and Completion of HPV Vaccination 20Reminder/Recall7 MFMER slide-4
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
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
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
Methods Fixed cohort (n=15,003) Adolescents ages 9-14 years 2010-2015 Linked vaccination data to American Community Survey socioeconomic data Individual and area level factors 20Reminder/Recall7 MFMER slide-8
Results Vaccine Series Vaccine Series Initiation Completion Variable (reference level) Adjusted OR Adjusted OR Age 1.90 2.00 Sex (Male) Female 1.41 1.62 Race/ethnicity (White) Black 1.03 0.71 Asian 0.94 1.03 Hispanic 0.99 0.90 Other/Unknown 0.77 0.64 Low Socioeconomic Area 0.91 0.85 Rural Area 0.94 1.14 OR=Odds Ratio; OR in Bold=Significant 20Reminder/Recall7 MFMER slide-9
Results: Geographic variation 20Reminder/Recall7 MFMER slide-10
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
Methods Mailed and Web Survey 27-county region Oct. 2015 - Jan. 2016 280 primary care clinicians 51 clinical sites Survey Research Center Mayo Clinic 200 1 st Street SW Rochester, MN 55905 20Reminder/Recall7 MFMER slide-12
Methods: Linked survey and clinical data Survey Data HPV-related knowledge Perceived barriers Recommendations Clinical Data Vaccination rates 20Reminder/Recall7 MFMER slide-13
Results of First Analysis Site-level characteristics Vaccine Series Initiation IRR Vaccine Series Completion IRR Clinician Knowledge 1.05 1.28 Clinician Barriers 0.99 0.97 Perceived Parental Barriers 0.94 0.90 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
Results of Second Analysis Site-level characteristics Often recommend for Males Aged 11-12 Years Often recommend for Females Aged 11-12 Years Strongly Recommend for Males Aged 11-12 Years Strongly Recommend for Females Aged 11-12 Years Vaccine Series Initiation Vaccine Series Completion IRR IRR 1.00 1.04 1.05 1.08 1.05 1.05 1.03 1.04 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
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
Multi-Level Intervention Practice Clinician Patient/ Parent 20Reminder/Recall7 MFMER slide-17
Pragmatic Trial with Process Evaluation 20Reminder/Recall7 MFMER slide-18
Stepped Wedge Cluster Randomized Trial Factorial Design Evaluate the independent and combined impact of two evidencebased implementation strategies on HPV vaccination rates. Step Practice 1 2 3 4 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
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