(provided by the applicant): This K08 application supports the faculty development of Cynthia Rand, MS, MD, MPH, an academic general pediatrician who combines health services research with inner-city pediatric practice. The project will evaluate the effectiveness of a health information technology (HIT) intervention in improving HPV vaccination delivery to female adolescents in inner-city primary care practices in Rochester, NY. The award will provide Dr. Rand with a rigorous didactic and mentored training program in clinical research, the use of HIT to improve quality of care, immunization delivery, and health services research. The didactic program includes coursework in medical informatics, quality improvement, statistical analysis, and qualitative research methodology. HPV is the most common sexually transmitted infection in the U.S., and the cause of cervical cancer. The HPV vaccine is recommended for females 11-12 years and those 13-26 years who are unvaccinated. Multiple barriers impede vaccine receipt, including infrequent use of healthcare by teens, competing healthcare priorities, and missed opportunities for vaccination during healthcare visits. HPV vaccination rates are low. This study will focus on the translation of evidence-based practices of immunization delivery to the delivery of HPV vaccine to teens. Under guidance of an experienced team, Dr. Rand will develop and implement an HIT intervention in inner-city clinics to improve delivery of HPV vaccine to underserved teens. The project aims are to (1) measure baseline rates of missed opportunities for HPV vaccination, vaccination intervals, overall HPV vaccination rates, and rates of health maintenance visits in 4 urban practices, (2a) implement provider prompting based on HIT in all practices and measure the before and after impact on missed opportunities, (2b) develop and implement, using a RCT (randomizing practices), an HIT-based intervention (patient electronic reminders, via text messaging, e-mail or social networking sites) in inner-city practices to decrease intervals between HPV vaccination doses and increase overall HPV vaccination rates, (3) measure post-intervention rates and the impact of the intervention on missed opportunities, vaccination intervals, overall HPV vaccination rates, and health maintenance visits. Results will guide development of an R01 (Aim 4) to test the intervention widely. This award will prepare Dr. Rand to perform independent HIT-based health services research to improve preventive health care delivery to adolescents. This project supports several of AHRQ's missions: This work focuses on an AHRQ priority population of inner-city, mostly minority, adolescent females. It uses HIT to support both health care decision making and patient-centered care. The project also represents the essence of translational research: taking a recently developed vaccine, and understanding how to improve its delivery to the targeted population. This work aims to improve timely completion of the HPV vaccination series for low income, minority adolescents. Delivering HPV vaccine to all young women will ultimately reduce their risk for cervical cancer and genital warts, and decrease their lifetime healthcare costs. Using electronic means to reach adolescents can improve their receipt of preventive services, and overall health outcomes.

Public Health Relevance

Delivering HPV vaccine to all young women will ultimately reduce their risk for cervical cancer and genital warts, and decrease their lifetime healthcare costs. Using electronic means to reach adolescents can improve their receipt of preventive services, and overall health outcomes.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HS017951-05
Application #
8531152
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Anderson, Kay
Project Start
2009-09-30
Project End
2014-09-29
Budget Start
2013-09-30
Budget End
2014-09-29
Support Year
5
Fiscal Year
2013
Total Cost
Indirect Cost
Name
University of Rochester
Department
Pediatrics
Type
Schools of Dentistry
DUNS #
041294109
City
Rochester
State
NY
Country
United States
Zip Code
14627
Rand, Cynthia M; Blumkin, Aaron; Szilagyi, Peter G (2014) Electronic health record use and preventive counseling for US children and adolescents. J Am Med Inform Assoc 21:e152-6