state immunization information systems to improve hpv vaccination rates

Conditions: Vaccine; Human Papiloma Virus Vaccine; HPV Vaccine; Immunization; Health Registry; Adolescent Health; Reproductive Health; Preventive Health Services

Summary: the overarching goal of this study is to evaluate the effectiveness, cost-effectiveness and sustainability of utilizing statewide immunization information systems (iis) to conduct centralized reminder/recall (r/r) to improve human papiloma virus (hpv) vaccination rates among adolescents ages 11-17 (with a more focused look at the new two dose series for 11-14 year olds).

the overarching goal of this study is to evaluate the effectiveness, cost-effectiveness and sustainability of utilizing statewide immunization information systems (iis) to conduct centralized reminder/recall (r/r) to improve hpv vaccination rates among adolescents ages 11-17, and additionally look at the 11-14 year old subset for whom a new 2 dose series has recently been recommended. the investigators will extend previous research on effectiveness of centralized r/r to a new population--adolescents due for hpv vaccine-- and test the use of centralized r/r as a cancer-prevention strategy. investigators will assess the effect of centralized r/r in two states--one with and one without mandated reporting of vaccinations to iiss, and disseminate iis r/r to other states. investigators will implement, evaluate (using the re-aim framework 31-36), and disseminate a collaborative, iis-based centralized hpv vaccine r/r model in which partnerships of public health systems and primary care practices in two states (ny, co) collaborate to remind parents about hpv vaccination. specific aims and hypotheses: aim #1: adapt iis messages and delivery systems (e.g., algorithms) previously developed for centralized r/r for other vaccines to fit hpv vaccine iis r/r. aim #2: assess the impact and cost-effectiveness of centralized iis-based (iis-c) autodialer (phone) r/r in increasing vaccine rates \[initial dose (hpv#1) and a complete series (hpv#2 or #3)\] among teens. conduct a pragmatic trial, to assess the impact and cost effectiveness of centralized iis-based (iis-c) autodialer (phone) r/r in increasing initiation and completion rates for the hpv vaccine series in adolescents ages 11-17 years. the investigators will use a within-practice design, randomizing patients within randomly selected primary care practices to iis-c r/r (1, 2, or 3 reminders per dose) compared to usual care (0 reminders from this study). the investigators will apply the re-aim framework to evaluate the reach, effectiveness/cost effectiveness, adoption, and implementation of iis-c r/r. hypothesis 2a: iis-c r/r will result in higher hpv vaccination rates than usual care. hypothesis 2b: iis-c r/r will result in higher hpv vaccination rates than usual care in key subgroups (males and females, younger and older teens, urban//rural teens). hypothesis 2c: iis-c r/r will be more cost-effective (cost/vaccine received) than usual care. aim #3: assess the impact and cost-effectiveness of centralized iis-based (iis-c) r/r using autodialer (phone) or mail in increasing vaccine rates \[initial dose (hpv#1) and a complete series (hpv#2)\] and decreasing time to completion among teens 11-14. conduct a pragmatic trial, to assess the impact and cost effectiveness of centralized iis-based (iis-c) r/r using either autodialer (phone) or postcard (mail) in increasing initiation and completion rates for the newly implemented hpv vaccine 2 dose series in adolescents ages 11-14 years. we will use a within-practice design, randomizing patients within randomly selected primary care practices to iis-c r/r using either an autodailer or postcards (up to 2 reminders per dose needed) compared to usual care (0 reminders from this study). we will apply the re-aim framework to evaluate the reach, effectiveness/cost effectiveness, adoption, and implementation of iis-c r/r. hypothesis 3a: iis-c r/r (either modality) will result in higher hpv vaccination rates than usual care. hypothesis 3b: iis-c r/r (either modality) will result in higher hpv vaccination rates than usual care in key subgroups (males and females, younger and older teens, urban//rural teens). hypothesis 3c: iis-c r/r will be more cost-effective (cost/vaccine received) than usual care. iis-c r/r using autodialer will be more cost effective than iis-c r/r using postcards. aim #4: disseminate iis-c r/r across ny and co and pilot in four iiss: (a) develop an iis-c hpv r/r toolkit, (b) use a technical advisory group, (c) initiate iis-c r/r in four other iiss \[yr. 4\]. by the end of the study investigators will have a feasible, sustainable, cost-effective model for hpv vaccine reminders that can be used nationally to prevent cervical cancer and other hpv-related cancers.

Eligibility criteria:
inclusion criteria: * 11 through 17 years of age (trial 1) * 11 through 14 years of age (trial 2) * defaulted to our selected clinics within ciis * is either due for an hpv dose at baseline according to advisory committee on immunization practices (acip) guidelines, or * has initiated but not yet completed the hpv series at baseline exclusion criteria: * has completed the hpv vaccine series according to advisory committee on immunization practices (acip) guidelines * any child whose parents have requested removal from the immunization registry