428 - Provider Prompts for HPV Vaccination: A Cluster Randomized Trial

Low HPV vaccination rates leave many adolescents susceptible to HPV disease. HPV missed opportunities (MOs) are visits at which a patient is eligible for HPV vaccine but does not receive it (lower MOs is better). Some MOs may be prevented via either EHR or nurse prompts (reminders) for providers (physicians and advanced practice providers), referred to as provider prompts.

Objective: This cluster RCT (randomized by practice) assessed the impact of provider prompts on MOs for HPV vaccination in 48 pediatric practices across the US. Intervention group practices had previously received communication training and feedback on vaccination rates; we now assessed the added impact of provider prompts. We hypothesized that provider prompts would be more effective for subsequent than for initial HPV vaccine doses.

Design/Methods: The STOP-HPV trial involved 48 pediatric practices in 19 states recruited from the AAP Pediatric Research in Office Settings (PROS) network. The prompts intervention (July 2021 – January 2022) trained providers via two online learning modules and weekly text or email ‘quick tips.’  The training recommended both a staff prompt to the provider (e.g., a Vaccine Information Statement printout placed on the keyboard) and EHR prompts at all visits for any HPV vaccination dose. The primary outcome measure was the rate of MOs for HPV vaccination by dose (initial vs. subsequent) and visit type (well child vs. acute/chronic) for all 11-17 year olds. Analyses were intent-to-treat accounting for clustering by practice.

Results: Enrolled practices included 366 clinicians (179 intervention, 187 control) serving 100,752 adolescents with 76,593 visits in the 12-month baseline period. During the intervention, MOs increased (worsened) at all visit types and for any HPV vaccine dose, but less so at intervention practices for the initial dose at well visits (intervention 54.4% to 55.6%, control 55.1% to 60.9% = -4.5 percentage points, CI= -9.0%, -0.1%) (Table). Prompts had no impact on MOs for subsequent HPV vaccine doses.

Conclusion(s): In this broad US sample of pediatric practices, MOs for HPV vaccination increased at all visit types, but provider prompts for the initial dose at well visits resulted in a smaller increase in MOs. Prompts were less successful at other visit types. Even at a time of short staffing and growing vaccine hesitancy, provider prompts resulted in a meaningful reduction in MOs relative to usual care.