title: Effect of decision support on missed opportunities for human papillomavirus vaccination.
abstract: BACKGROUND
  Missed opportunities for human papilloma virus (HPV) vaccination are common, presenting a barrier to achieving widespread vaccine coverage and preventing infection.
  
  
  OBJECTIVE
  To compare the impact of clinician- versus family-focused decision support, none, or both on captured opportunities for HPV vaccination.
  
  
  METHODS
  Twelve-month cluster randomized controlled trial conducted in 2010-2011.
  
  
  METHODS
  Adolescent girls aged 11-17 years due for HPV Dose 1, 2, or 3 receiving care at primary care practices.
  
  
  METHODS
  Twenty-two primary care practices were cluster randomized to receive a three-part clinician-focused intervention (educational sessions, electronic health record-based alerts, and performance feedback) or none. Within each practice, girls were randomized at the patient level to receive family-focused, automated, educational phone calls or none. Randomization resulted in four groups: clinician-focused, family-focused, combined, or no intervention.
  
  
  METHODS
  Standardized proportions of captured opportunities (due vaccine received at clinician visit) were calculated among girls in each study arm. Analyses were conducted in 2013.
  
  
  RESULTS
  Among 17,016 adolescent girls and their 32,472 visits (14,247 preventive, 18,225 acute), more HPV opportunities were captured at preventive than acute visits (36% vs 4%, p<0.001). At preventive visits, the clinician intervention increased captured opportunities by 9 percentage points for HPV-1 and 6 percentage points for HPV-3 (p≤0.01), but not HPV-2. At acute visits, the clinician and combined interventions significantly improved captured opportunities for all three doses (p≤0.01). The family intervention was similar to none. Results differed by practice setting; at preventive visits, the clinician intervention was more effective for HPV-1 in suburban than urban settings, whereas at acute visits, the clinician intervention was more effective for all doses at urban practices.
  
  
  CONCLUSIONS
  Clinician-focused decision support is a more effective strategy than family-focused to prevent missed HPV vaccination opportunities. Given the persistence of missed opportunities even in intervention groups, complementary strategies are needed. This study is registered at clinicaltrials.gov NCT01159093.
authors.affiliation: Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Mayne
authors.affiliation: Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Nathalie E
authors.initials: NE
authors.lastname: duRivage
authors.affiliation: Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute for Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Feemster
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.affiliation: Pediatric Research Consortium (PeRC), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Biomedical Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Grundmeier
authors.affiliation: Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatric Research Consortium (PeRC), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Biomedical Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: fiks@email.chop.edu.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Fiks
mesh_terms: D000293:Adolescent; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D050316:Medical Order Entry Systems; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000379:methods*; D011320:Primary Health Care / Q000379:methods; D011368:Professional-Family Relations; D013192:Staff Development / Q000458:organization & administration*; D014481:United States; D014611:Vaccination / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines