Clinician Prompts for Human Papillomavirus Vaccination: A Cluster Randomized Trial

Cynthia M Rand; Alisa J Stephens-Shields; Mary K Kelly; Russell Localio; Chloe Hannan; Robert W Grundmeier; Laura P Shone; Jennifer Steffes; Kristin Davis; Christina Albertin; Sharon G Humiston; Greta McFarland; Dianna E Abney; Peter G Szilagyi; Alexander G Fiks

doi:10.1016/j.acap.2023.10.011

Clinician Prompts for Human Papillomavirus Vaccination: A Cluster Randomized Trial

Acad Pediatr. 2024 May-Jun;24(4):579-586. doi: 10.1016/j.acap.2023.10.011. Epub 2023 Nov 2.

Authors

Affiliations

¹ Department of Pediatrics (CM Rand), University of Rochester School of Medicine and Dentistry, Rochester, NY. Electronic address: cynthia_rand@urmc.rochester.edu.
² Department of Biostatistics (AJ Stephens-Shields, R Localio, C Hannan, and RW Grundmeier), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
³ Clinical Futures (MK Kelly and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa.
⁴ Department of Biostatistics (AJ Stephens-Shields, R Localio, C Hannan, and RW Grundmeier), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Biomedical and Health Informatics (RW Grundmeier and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa.
⁵ Shone Sciences (LP Shone), DBA, Lowville, NY.
⁶ Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill; Primary Care Research (J Steffes and K Davis), American Academy of Pediatrics, Itasca, Ill.
⁷ Department of Pediatrics (C Albertin), University of California at Los Angeles, Mattel Children's Hospital, Los Angeles, Calif.
⁸ Department of Pediatrics, Mattel Children's Hospital, UCLA, Los Angeles, CA, USA.
⁹ Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill.
¹⁰ Clinical Futures (MK Kelly and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Biomedical and Health Informatics (RW Grundmeier and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa; Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill.

PMID: 37925070
PMCID: PMC11056302 (available on 2025-05-01)
DOI: 10.1016/j.acap.2023.10.011

Abstract

Objective: We assessed the impact of an online intervention using clinician prompts for human papillomavirus (HPV) vaccination with a cluster randomized controlled trial.

Methods: The randomized trial occurred July 2021-January 2022 in 48 primary care pediatric practices (24 intervention, 24 control) across the US. We trained clinicians via two online learning modules, plus weekly ''quick tips'' delivered via text or email. The training taught practices to implement a staff prompt to the clinician (e.g., printed reminders placed on the keyboard) plus electronic health record (EHR) prompts (if not already done) at well and acute/chronic visits for initial and subsequent HPV vaccination. We assessed missed opportunities for HPV vaccination using logistic regression models accounting for clustering by practice on an intent to treat basis. Surveys assessed facilitators and barriers to using prompts.

Results: During the 6-month intervention, missed opportunities for HPV vaccination increased (worsened) in both intervention and control groups. However, at well child care visits, missed opportunities for the initial HPV vaccine increased by 4.5 (95% CI: -9.0%, -0.1%) percentage points less in intervention versus control practices. Change in missed opportunities for subsequent doses at well child care and non-well child care visits did not differ between trial groups. An end-of trial survey found understaffing as a common challenge.

Conclusions: Clinician prompts reduced missed opportunities for HPV vaccination at well child care visits. Understaffing related to the COVID-19 pandemic may have led to worsening missed opportunities for both groups and likely impeded practices in fully implementing changes.

Keywords: adolescent vaccination; human papillomavirus vaccine; primary care pediatrics; provider reminder.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
COVID-19 / prevention & control
Child
Electronic Health Records
Female
Human Papillomavirus Viruses
Humans
Male
Papillomavirus Infections* / prevention & control
Papillomavirus Vaccines* / administration & dosage
Papillomavirus Vaccines* / therapeutic use
Primary Health Care / methods
Reminder Systems*
United States
Vaccination

Substances

Papillomavirus Vaccines

Grants and funding

R01 CA202261/CA/NCI NIH HHS/United States