This CPRIT dissemination project resubmission is proposed to develop and evaluate the web-based Adolescent Vaccination Program Implementation Tool (AVP-IT), designed to support the adoption, implementation, and maintenance of a suite of evidence-based HPV vaccination strategies into Texas pediatric clinics. A robust evidence base exists for strategies that increase HPV vaccination including assessment and feedback, electronic decision reminders, health care provider (HCP) cues, HCP training on message bundling and patient interaction, and direct education for patients. Despite this, adoption of these strategies in clinical networks has been piecemeal. Lacking is a readily adoptable multi-lev...
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This CPRIT dissemination project resubmission is proposed to develop and evaluate the web-based Adolescent Vaccination Program Implementation Tool (AVP-IT), designed to support the adoption, implementation, and maintenance of a suite of evidence-based HPV vaccination strategies into Texas pediatric clinics. A robust evidence base exists for strategies that increase HPV vaccination including assessment and feedback, electronic decision reminders, health care provider (HCP) cues, HCP training on message bundling and patient interaction, and direct education for patients. Despite this, adoption of these strategies in clinical networks has been piecemeal. Lacking is a readily adoptable multi-level approach that enables clinics to adopt multiple HPV vaccination strategies within their organization (a systems level approach). Many clinical networks lack the expertise and resources to adopt, implement, and maintain a systems approach to HPV vaccination that enables implementation of evidence-based strategies. The proposed project builds on a successful CPRIT-funded prevention collaborative project between UTHealth, Baylor College of Medicine, and Texas Children’s Pediatric Practice Network in Houston to develop and implement the AVP, a systems-based intervention encompassing a bundled suite of evidence-based strategies previously demonstrated effective in enhancing HPV vaccination rates. The AVP comprises: 1) clinic-based vaccination champions, 2) assessment and feedback reports for HCPs, 3) HCP training on message bundling and navigating patient resistance, 4) real time EHR cues to HCPs, 5) tailored patient reminders, and 6) an App, HPVCancerFree, providing self-tailored parent education. Rollout of the AVP in a large urban pediatric clinical network was associated with an increase in vaccination initiation rates from 53.9% in 2015 to 76.9% in 2017. Proposed is the development of a platform responsive web-based implementation tool to enable clinical networks throughout Texas to adopt, implement, and maintain the AVP. The AVP-IT will be designed to provide access to the six existing evidence-based AVP strategies (above) and provide user-friendly and tailored guidance to enable roll out of each strategy regardless of the size and type of pediatric clinic or clinic network. If successful, the AVP-IT promises a means to translate evidence-based HPV vaccination strategies into clinical practice. Goals for the project are to: 1: Design an online implementation tool (AVP-IT) to assist health care providers to implement the Adolescent Vaccination Program (AVP) to access the existing suite of bundled evidence-based HPV vaccination strategies (described above) and protocols to implement them (Mo.1-7). 2: Develop the platform responsive web-based AVP-IT prototype, test its usability, and make informed enhancements to complete the tool (Mo. 8-14). 3: Pilot the delivery of the AVP-IT in a sample of 6 heterogeneous Texas clinics to evaluate its feasibility, acceptability, and impact on adoption and implementation of all six AVP evidence-based strategies within the clinics (Mo. 15-24). This resubmission is responsive to reviewers’ comments from our initial submission. Reviewers expressed concern that the application is premature for a dissemination mechanism given that the tool doesn’t yet exist. The proposed tool is a delivery platform for previously developed and successfully tested AVP assets (described above). This helps address concerns because development is focused on a delivery platform and not on the development of each strategy from scratch. Related concerns included aggressive timeline and low development budget. This has been addressed by 1) leveraging existing AVP assets for inclusion in the AVP-IT; 2) increased budget dedicated to the subcontractors (Radiant LLC) for AVP-IT development; 3) increased time to develop (year 1) and test (year 2) the AVP-IT; 4) increased percent time for the PI (Shegog) to invest in design of the AVP-IT; and 5) a reduced number of clinic sites for a more manageable dissemination design. This project is significant because it may make the adoption, implementation, and maintenance of a suite of evidence based HPV vaccination strategies more accessible to clinics throughout Texas, thus enabling expanded reach to those underserved. This project is innovative because it informs how to use a web-based implementation tool to empower Texas clinics and clinic networks to implement a systems-based approach to HPV vaccination.
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