Adolescent Vaccination in the Medical Home: Established and Innovative Strategies
Condition: Immunization Rate
Study type: Interventional

Summary: 
      In this project, the investigators will develop, implement, and evaluate an adolescent
      vaccination quality improvement program, with the program designed to encourage adolescents
      to visit their usual primary care provider to receive vaccinations and other recommended
      preventive health services. This study will be conducted in different types of primary care
      settings, such as public, private, and managed care clinics serving adolescent patients of
      diverse backgrounds, and will provide important information to help guide future public
      health efforts to achieve high rates of immunization in adolescents.
    

Detailed description: 
      Specific Aim 1: Within different types of primary care practices (pediatric practices in
      public, private, and managed care settings) serving adolescent patients of diverse
      socioeconomic and racial/ethnic backgrounds, to assess provider and staff attitudes regarding
      the desirability, feasibility, and potential sustainability of evidence-based and innovative
      strategies to promote adolescent vaccination in primary care practices.

      Specific Aim 2: Among parents of adolescents (and/or adolescent patients) seen at primary
      care practices, to assess knowledge of existing national and state programs to promote
      vaccination, and to assess attitudes regarding, perceived barriers to, and acceptability of
      various practice-based strategies to promote adolescent vaccination.

      Specific Aim 3: To implement and evaluate the effectiveness of a multi-faceted quality
      improvement program to promote adolescent vaccination within the medical home.

        1. Based upon findings from Specific Aims 1 and 2, develop a quality improvement program
           containing two or more interventions to promote adolescent vaccination.

        2. Select intervention patients to receive a multi-faceted vaccination quality improvement
           program and usual care patients which will continue receiving usual care.

        3. Compare the following primary outcome measure between intervention and usual care
           patients, overall and stratified by the type of practice setting: 1)percent of
           adolescents who received ≥ 1 or more needed vaccines or well-care visits

        4. Compare the following secondary outcome measures between intervention and usual care
           patients, overall and stratified by practice setting: 1) percent of adolescent patients
           with ≥ 1 Tdap vaccine; 2) percent of adolescent patients with ≥ 1 meningococcal (MCV4)
           vaccine; 3) percent of adolescent patients with ≥ 1 HPV vaccine; 4) percent of
           adolescent patients with ≥ 3 HPV vaccines; 5) percent of adolescent patients receiving ≥
           1 influenza vaccine during the preceding influenza season; 6) percent of adolescent
           patients with either a documented history of varicella disease or ≥ 2 varicella
           vaccines; 7) percent of adolescent patients with ≥ 2 MMR vaccines; 8) percent of
           adolescent patients with ≥ 3 hepatitis B vaccines; 9) percent of adolescent patients
           with ≥ 3 poliovirus vaccines; and 10) percent of adolescent patients with ≥ 1 missed
           vaccination opportunity, defined as having a patient visit to a primary care practice,
           being eligible for vaccination, and not receiving needed vaccines.

      Specific Aim 3 (Kaiser Only): Design, implement and evaluate an HPV reminder/recall
      intervention based on obtaining the parents' and adolescents' preferences for reminder method
      and recipient at the time of the first dose of HPV.

        1. Compare 2nd and 3rd dose HPV vaccination rates among adolescents age 11-17 between
           intervention and usual care patients.

        2. Assess process measures related to feasibility and fidelity of implementation

      Specific Aim 4: Evaluate the effect of a multi-faceted vaccination quality improvement
      program on the receipt of non-vaccination clinical preventive services recommended for
      adolescents.

      a) Compare the following outcome measures between intervention and usual care patients,
      overall and stratified by the type of practice setting: 1) receipt of ≥ 1 health maintenance
      visits within a 12 month interval; 2) receipt of blood pressure screening; and 3) growth
      assessment, as documented by the measurement of weight and height and calculation of body
      mass index at a clinic visit.

      Specific Aim 5: Assess the cost to participating practices of implementing a multi-faceted
      vaccination quality improvement program designed to promote adolescent vaccination.

      Specific Aim 6: After conducting a multi-faceted quality improvement program to promote
      adolescent vaccination, to assess provider and staff attitudes about the program, in
      particular the perceived benefits of the program and factors which may facilitate or hamper
      the sustainability of the program within study practices.
    

Intervention name(s): Text Message Reminder/Recall; Parent Preference
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Adolescents will be randomly selected from the participating private practices and safety net organization clinics. Parents of selected adolescents will receive a text message to alert them that their child is due for a vaccine or well-care visit. The text message will provide response instructions. The responses can be one of three options: 1) the parent will call the clinic to schedule a visit, 2) the parent would like the clinic to call them to schedule a visit, or 3) the parent would like to stop any future text message reminders. Parents who would like the clinic to call them to schedule an appointment will be contacted by their child's provider to set up a visit. Parents may receive up to 3 text message reminders, unless they chose to stop any future messages.; Parents of adolescents being seen within the managed care organization's intervention clinics will be asked about their reminder method preference at their child's 1st HPV immunization. The preference options include phone call, text message, or email. The preference for contact method will be recorded and utilized for the 2nd and 3rd dose reminders. The clinics' usual method of reminder will be used for all other parents.
Other intervention name(s): Text Messaging
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research
Keywords: Vaccination; Medical Home; Adolescents