Electronic Health Record Alerts for Early Human Papillomavirus Vaccination
Menée aux États-Unis dans 21 centres de soins primaires ambulatoires auprès de 15 743 enfants âgés de 9 à 14 ans, cette étude analyse l'effet, sur l'initiation de la vaccination contre le papillomavirus humain entre 9 et 10 ans, d'alertes du dossier médical électronique avec ou sans formation des professionnels de santé
Despite recommendations to begin human papillomavirus (HPV) vaccination as early as 9 years of age, uptake remains low.To compare early HPV vaccine initiation between 2 interventions, compare vaccine completion rates between youths initiating HPV vaccination at 9 to 10 vs 11 to 14 years of age, and identify factors associated with early HPV vaccination initiation and series completion.This retrospective quality improvement study was conducted from January 1, 2019, to December 31, 2023. The study analyzed a quality improvement project using descriptive statistics and survival analyses. Youths aged 9 to 14 years with no prior HPV vaccination, who had at least 1 in-person visit, and who had complete electronic health record (EHR) data were included. The study took place at 21 US outpatient primary care sites within a large health system. Site assignments were based on patient volume and geographic location (urban and rural).An EHR best practice alert (BPA) recommending HPV vaccination beginning at 9 years of age implemented with or without an added clinician education component.The primary outcome was HPV vaccine initiation at 9 to 10 years of age. Secondary outcomes included vaccine series completion within 2 years after initiation and factors associated with early initiation and completion. Outcomes were measured using EHR-recorded vaccination status and timing.A total of 15 743 eligible patients (mean [IQR] age, 9.9 [9.0-11.0] years; 7946 [50.5%] male; 1260 [8.0%] Asian, 5082 [32.3%] Black or African American, 7621 [48.4%] White, 420 [2.7%] unknown race, and 1360 [8.6%] other race, including American Indian or Alaska Native, Guamanian or Chamorro, and Native Hawaiian or Other Pacific Islander) participated in the study. Overall, 10 102 (64.2%) initiated and 5198 (33.0%) completed the vaccine series. In the group aged 9 to 10 years, the BPA plus education arm had a significantly higher likelihood of initiating vaccination than the BPA-only arm (adjusted hazard ratio, 1.39; 95% CI, 1.17-1.65; P < .001) compared with the group aged 11 to 14 years. Completion increased from 16 (2.2%) to 464 (19.6%) among youths aged 9 to 10 years and from 183 (13.9%) to 323 (66.6%) among youths age 11 to 14 years. By year 3, the group aged 9 to 10 years had a higher cumulative completion rate than the group aged 11 to 14 years (3899 [33.9%] vs 1299 [30.7%], P < .001). Black or African American race and public insurance were associated with HPV vaccine initiation and completion.In this quality improvement study of early HPV vaccine initiation, an EHR BPA combined with education was associated with a higher likelihood of early HPV vaccination. Delayed but meaningful improvements in series completion were observed among early initiators.
JAMA Network Open , article en libre accès, 2026