Implementation of QI coaching versus physician communication training for improving HPV vaccination in primary care: A randomized implementation trial
Principal Investigator(s): View help for Principal Investigator(s) Noel Brewer, UNC Gillings School of Global Public Health, Department of Health Behavior; UNC Lineberger Comprehensive Cancer Center; Melissa Gilkey, UNC Gillings School of Global Public Health, Department of Health Behavior; UNC Lineberger Comprehensive Cancer Center
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Project Citation:
Brewer, Noel, and Gilkey, Melissa. Implementation of QI coaching versus physician communication training for improving HPV vaccination in primary care: A randomized implementation trial. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2020-09-24. https://doi.org/10.3886/E122722V1
Project Description
Summary:
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Background
Health departments are at the forefront of efforts to
improve HPV vaccine uptake in the US. Most notably, health department staff
routinely conduct in-person quality improvement coaching to help primary care
clinics improve their vaccine delivery systems and communication. Some health
departments additionally engage outside experts to conduct remote physician communication
training. Such training is a more focused intervention to improve the way
physicians and other vaccine prescribers recommend HPV vaccination. To understand the relative strengths and challenges of implementing quality
improvement coaching and physician communication training, we compared
the interventions on key implementation outcomes, including adoption, reach,
and cost.
Methods As part of a cluster randomized trial, we allocated 855 primary care clinics in three geographically-diverse US states to receive: 1) quality improvement coaching via the national Assessment, Feedback, Incentives, and eXchange (AFIX) program; 2) physician communication training via Announcement Approach Training (AAT); or 3) both interventions (AFIX+AAT). In each arm, we assessed adoption (or the proportion of clinics receiving the allocated intervention out of those invited), contacts per clinic (mean number of contacts needed to successfully schedule one clinic), reach (median number of total staff and prescriber participants per clinic), and delivery cost.
Results A higher proportion of clinics adopted AFIX than AAT or AFIX+AAT (63% vs 16% and 12%, both p<.05). Recruiting clinics into AFIX sessions required fewer contacts than AAT or AFIX+AAT (mean = 4.7 vs 29.0 and 40.4, both p<.05). In contrast, AAT and AFIX+AAT reached more total staff per clinic than AFIX (median= 5 and 5 vs 2, both p<.05), including more prescribers per clinic (2 and 2 vs 0, both p<.05). AFIX cost $439 per clinic on average, including costs incurred from follow up ($129/clinic), session preparation ($73/clinic), and travel ($69/clinic). AAT cost $1,287 per clinic, with most cost incurred from clinic recruitment ($653/clinic).
Conclusions In-person quality improvement coaching was lower cost and had higher adoption, but remote communication training achieved higher reach, including to highly influential vaccine prescribers. Thus, AAT is a promising intervention for improving HPV vaccine delivery, although care will be needed to overcome substantial challenges to clinic recruitment.
Methods As part of a cluster randomized trial, we allocated 855 primary care clinics in three geographically-diverse US states to receive: 1) quality improvement coaching via the national Assessment, Feedback, Incentives, and eXchange (AFIX) program; 2) physician communication training via Announcement Approach Training (AAT); or 3) both interventions (AFIX+AAT). In each arm, we assessed adoption (or the proportion of clinics receiving the allocated intervention out of those invited), contacts per clinic (mean number of contacts needed to successfully schedule one clinic), reach (median number of total staff and prescriber participants per clinic), and delivery cost.
Results A higher proportion of clinics adopted AFIX than AAT or AFIX+AAT (63% vs 16% and 12%, both p<.05). Recruiting clinics into AFIX sessions required fewer contacts than AAT or AFIX+AAT (mean = 4.7 vs 29.0 and 40.4, both p<.05). In contrast, AAT and AFIX+AAT reached more total staff per clinic than AFIX (median= 5 and 5 vs 2, both p<.05), including more prescribers per clinic (2 and 2 vs 0, both p<.05). AFIX cost $439 per clinic on average, including costs incurred from follow up ($129/clinic), session preparation ($73/clinic), and travel ($69/clinic). AAT cost $1,287 per clinic, with most cost incurred from clinic recruitment ($653/clinic).
Conclusions In-person quality improvement coaching was lower cost and had higher adoption, but remote communication training achieved higher reach, including to highly influential vaccine prescribers. Thus, AAT is a promising intervention for improving HPV vaccine delivery, although care will be needed to overcome substantial challenges to clinic recruitment.
Funding Sources:
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UNC Department of Health Behavior, Gillings School of Global Public Health and US Centers for Disease Control and Prevention (Cooperative Agreement U01IP001073-02);
UNC Lineberger Comprehensive Cancer Center (T32CA057726-28)
Scope of Project
Subject Terms:
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human papillomavirus vaccines;
cancer prevention;
implementation science;
quality improvement;
IQIP;
physician communication
Geographic Coverage:
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Three US states
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