title: Effectiveness of decision support for families, clinicians, or both on HPV vaccine receipt.
abstract: OBJECTIVE
  To improve human papillomavirus (HPV) vaccination rates, we studied the effectiveness of targeting automated decision support to families, clinicians, or both.
  
  
  METHODS
  Twenty-two primary care practices were cluster-randomized to receive a 3-part clinician-focused intervention (education, electronic health record-based alerts, and audit and feedback) or none. Overall, 22, 486 girls aged 11 to 17 years due for HPV vaccine dose 1, 2, or 3 were randomly assigned within each practice to receive family-focused decision support with educational telephone calls. Randomization established 4 groups: family-focused, clinician-focused, combined, and no intervention. We measured decision support effectiveness by final vaccination rates and time to vaccine receipt, standardized for covariates and limited to those having received the previous dose for HPV #2 and 3. The 1-year study began in May 2010.
  
  
  RESULTS
  Final vaccination rates for HPV #1, 2, and 3 were 16%, 65%, and 63% among controls. The combined intervention increased vaccination rates by 9, 8, and 13 percentage points, respectively. The control group achieved 15% vaccination for HPV #1 and 50% vaccination for HPV #2 and 3 after 318, 178, and 215 days. The combined intervention significantly accelerated vaccination by 151, 68, and 93 days. The clinician-focused intervention was more effective than the family-focused intervention for HPV #1, but less effective for HPV #2 and 3.
  
  
  CONCLUSIONS
  A clinician-focused intervention was most effective for initiating the HPV vaccination series, whereas a family-focused intervention promoted completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt.
authors: The Pediatric Research Consortium, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. fiks@email.chop.edu
authors: Alexander G
authors: AG
authors: Fiks
authors: Robert W
authors: RW
authors: Grundmeier
authors: Stephanie
authors: S
authors: Mayne
authors: Lihai
authors: L
authors: Song
authors: Kristen
authors: K
authors: Feemster
authors: Dean
authors: D
authors: Karavite
authors: Cayce C
authors: CC
authors: Hughes
authors: James
authors: J
authors: Massey
authors: Ron
authors: R
authors: Keren
authors: Louis M
authors: LM
authors: Bell
authors: Richard
authors: R
authors: Wasserman
authors: A Russell
authors: AR
authors: Localio
mesh_terms: D000293:Adolescent; D002648:Child; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005190:Family; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010820:Physicians; D058007:Physicians, Primary Care
chemical_list: D053918:Papillomavirus Vaccines
keywords: decision support systems; electronic records; immunizations
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