WP 14 Can Automated Physician Reminders Increase 2nd and 3rd Dose Administration of HPV Vaccine?

Wednesday, September 21, 2016
Galleria Exhibit Hall
Gregory Zimet, PhD1, Brian Dixon, MPA, PhD, FHIMSS2, Shan Xiao, MS3, Wanzhu Tu, PhD4, Brianna Lindsey, PhD5, Meena Sheley, MS3, Stephen Downs, MD, MS6, Tammy Dugan, MS3 and Abby Church, BS7, 1Section of Adolescent Medicine, Department of Pediatrics & Center for HPV Research, Indiana University School of Medicine, Indianapolis, IN, 2Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, 3Children's Health Services Research, IU School of Medicine, 4Department of Biostatistics, Indiana University School of Medicine, 5Merck Corporation, 6Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 7Regenstrief Institute

Background: HPV vaccination rates in the U.S. are lower than desired. The goal of this study was to evaluate the effect of computerized decision-support system (CDSS) reminders on administration of the 2nd and 3rd doses of HPV vaccine.

Methods: In 2015-2016, 27 pediatric health care providers (HCP) serving 5 community clinics in Indianapolis were randomized to either usual care or reminder prompts. Prompts reminded HCPs that a patient was due for a 2nd or 3rd dose of HPV vaccine. Receipt of vaccines was confirmed by the state’s immunization registry. Prompts were delivered via an existing CDSS, called "CHICA", integrated with the clinics’ Electronic Health Record system for any 11-17 year old patient who had received 1 or 2 doses of HPV vaccine.  Data were analyzed via logistic regression with generalized estimating equations to account for clustering of patients within physician.

Results: 12 HCPs in the control arm saw 516 patients and 15 in the prompt arm saw 494 patients. Patients were 44% female; 56% male. At enrollment 56% of patients had received 1 dose and 44% had 2 doses of vaccine. These proportions did not differ by intervention group. During the clinic appointment, 72% of patients received their 2nd or 3rd dose of vaccine. 78% of the prompt group received a subsequent dose of HPV vaccine compared with 66% of the control group. This difference, however, was not statistically significant after accounting for clustering (OR=1.54; 95%CI=0.87-2.70; p=.13).

Conclusions: Although the effects of the prompt appeared to move subsequent vaccination rates in the positive direction, the results were not statistically significant when accounting for clustering effects. It may be possible to achieve more substantial results with enhancements that increase the salience of the prompts to HCPs.