The Give Teens Vaccines Study

While historically much attention has been focused on the immunization of infants and young children, recent licensing of new vaccines for adolescents has broadened the population requiring timely vaccination. However, effectively delivering adolescent vaccines, especially the quadrivalent human papillomavirus (HPV) vaccine, has been challenging. According to a recent National Immunization Survey, rates of HPV vaccination are the lowest of all adolescent vaccines.

The Children's Hospital of Philadelphia (CHOP) Pediatric Research Consortium (PeRC) has evaluated the impact of clinician-focused and patient/family-focused health information interventions on HPV vaccination rates among adolescents. The PeRC network serves as an integrated pediatric care delivery system, with shared administrative structure and a shared state-of-the-art electronic health record (EHR). This study compared the effectiveness of targeting immunization decision support at families versus clinicians by conducting two parallel trials: a cluster-randomized trial aimed at clinicians, and a family-level randomized trial. The intervention employed multiple evidence-based strategies to influence HPV vaccine delivery and receipt in primary care. For clinicians, these included education, clinical decision support, and audit and feedback on vaccination success measured as the proportion of eligible patients seen by a clinician and given the vaccine during each month of the study. Family-focused decision support reminded parents and their adolescent child that the vaccine is due through phone calls that offered links to educational information on a Web site designed for this project that linked to content available through the CHOP Vaccine Education Center. 

The project objectives were to:

• Conduct a qualitative study to better understand decisionmaking at the point of care and generate hypotheses to inform interventions to increase vaccine receipt.
• Test the benefit of clinician-directed versus family-directed decision support, delivered using the EHR, on receipt of HPV (primary outcome) and other vaccines for adolescent girls.
• Assess the acceptability of this intervention among parents and its effect on HPV vaccine communication and decisionmaking.

For HPV doses 1, 2, and 3, the combined family and clinician decision support intervention was the most effective, shortening time to receipt of each dose by 151, 68, and 93 days, and increasing vaccination rates by 9 percent, 8 percent, and 13 percent, respectively, compared to no intervention. The clinician-focused intervention was superior to the family-focused group for HPV dose 1, but inferior for doses 2 and 3. The intervention had little effect on Tdap (tetanus, diphtheria, and acellular pertussis vaccine) and MCV (meningococcal vaccine).

The evaluation of these two distinct approaches provides information on the impact of these alternate strategies, alone or in combination, on HPV vaccination rates. The findings from this study help to advance understanding of how to use health information technology to engage adolescents and families with clinicians in health decisions, and inform future interventions aimed at improving health for children and adolescents.