ASPO Abstracts
Implementation of QI coaching versus physician communication training for improving HPV vaccination in primary care: A randomized implementation trial
Category: Behavioral Science & Health Communication
Conference Year: 2021
Abstract Body:
Purpose of study:
Health departments (HDs) are at the forefront of efforts to improve HPV vaccine uptake in the US. Most
notably, HD staff routinely conduct in-person quality improvement (QI) coaching to help primary care clinics
improve their vaccine delivery systems. Some HDs also engage outside experts to conduct remote physician
communication training to help vaccine prescribers recommend HPV vaccine more effectively. To guide future
HD programming, we sought to understand the implementation strengths and challenges of QI coaching and
physician communication training.
Methods:
In a cluster randomized trial, we allocated 855 primary care clinics in 3 geographically-diverse US states to
receive: 1) QI coaching; 2) physician communication training; or 3) both interventions combined. In each arm,
we assessed adoption (or the % 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:
More clinics adopted QI coaching than communication training or the combined intervention (63% vs 16% and
12%, both p<.05). Recruiting clinics into QI coaching sessions required fewer contacts than communication
training or the combined intervention (mean = 4.7 vs 29.0 and 40.4, both p<.05). In contrast, communication
training and the combined intervention reached more total staff per clinic than QI coaching (median= 5 and 5
vs 2, both p<.05), including more prescribers per clinic (2 and 2 vs 0, both p<.05). QI coaching cost $439 per
clinic on average, including costs incurred from follow up ($129/clinic), session preparation ($73/clinic), and
travel ($69/clinic). Communication training cost $1,287 per clinic, with most cost incurred from clinic
recruitment ($653/clinic).
Conclusions:
QI coaching was lower cost and had higher adoption, but remote communication training achieved higher
reach, including to highly influential vaccine prescribers. Thus, communication training is a promising
intervention for improving HPV vaccine delivery, although care will be needed to overcome substantial
challenges to clinic recruitment.
Keywords: human papillomavirus vaccines, cancer prevention, implementation science, quality improvement, physician communication