Financial Incentives + Communication Training for HPV Vaccine Uptake
Recruiting in Palo Alto (17 mi)
Age: < 18
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: UNC Lineberger Comprehensive Cancer Center
Disqualifiers: Non-pediatric clinics, Others
No Placebo Group
Trial Summary
What is the purpose of this trial?This trial will look at the impact of clinic-level financial incentives to improve provider communication and increase HPV vaccine uptake. Some clinics will receive communication training. Other clinics will receive the same training and a clinic-level financial incentive program with a monthly data feedback report to increase HPV vaccine uptake.
Will I have to stop taking my current medications?
The trial does not specify whether participants need to stop taking their current medications. However, since the trial involves clinics and their staff rather than individual patients, it is unlikely that personal medication changes are required.
What data supports the effectiveness of the treatment involving communication training and financial incentives for HPV vaccine uptake?
Research shows that communication skills training can improve patient satisfaction and compliance with treatment, which suggests it might help increase HPV vaccine uptake. Additionally, effective communication has been linked to better treatment outcomes, indicating that training healthcare providers in communication could positively impact vaccine acceptance.
12345Is communication training and financial incentives for HPV vaccine uptake safe for humans?
The research does not provide specific safety data for communication training or financial incentives related to HPV vaccine uptake, but these interventions generally focus on improving communication and motivation, which are typically safe for humans.
678910How does the treatment of financial incentives and communication training for HPV vaccine uptake differ from other treatments?
This treatment is unique because it combines financial incentives with communication training to encourage HPV vaccine uptake, focusing on motivating both healthcare providers and patients through economic rewards and improved communication skills, rather than relying solely on medical or pharmaceutical interventions.
69111213Eligibility Criteria
This trial is for pediatric or family medicine clinics in North Carolina with less than a 72% HPV vaccine initiation rate and at least 50 patients aged 9-12. Clinics must have at least two providers offering the HPV vaccine and no recent financial incentives or communication training aimed at increasing vaccination rates.Inclusion Criteria
Clinics eligible if they are a pediatric or family medicine clinic in North Carolina
My clinic has seen 50 or more patients aged 9-12 last year.
My clinic offers the HPV vaccine from 2 or more providers.
+5 more
Exclusion Criteria
Clinics had an HPV initiation rate greater than 72%
My clinic does not offer HPV vaccines to children aged 9-12.
Clinics with a specialty other than pediatrics or family medicine
+6 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Training and Intervention
Clinics receive communication training and some receive a financial incentive program with monthly data feedback
24 months
Follow-up
Participants are monitored for changes in HPV vaccination rates
24 months
Participant Groups
The study is testing if giving clinics financial rewards, along with communication training, increases the number of kids getting the HPV vaccine. Some clinics will just get training, while others will also receive money based on their performance plus monthly progress reports.
2Treatment groups
Experimental Treatment
Group I: HPV vaccine communication training.Experimental Treatment1 Intervention
Staff in clinics randomized to this arm will receive an intervention called Announcement Approach Training (AAT). This training is designed to improve communication about HPV vaccination.
Group II: HPV vaccine communication training and clinic-level financial incentive programExperimental Treatment2 Interventions
Staff in clinics randomized to this arm will receive the Announcement Approach Training and a clinic-level financial incentive program with a monthly data feedback report to increase HPV vaccine uptake.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of North Carolina at Chapel HillChapel Hill, NC
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Who Is Running the Clinical Trial?
UNC Lineberger Comprehensive Cancer CenterLead Sponsor
National Cancer Institute (NCI)Collaborator
References
Promoting patient participation in healthcare interactions through communication skills training: A systematic review. [2018]To present literature on training patients in the use of effective communication skills.
Improving patient care and reducing risk through effective communication. [2007]Effective communication with patients results in better treatment outcomes, and may be the best tool in managing risk. Providers must appreciate the barriers to effective communication, identify what and how information is to be communicated, and develop the necessary skills.
Teaching communication skills: a skills-based approach. [2022]The purpose of this project was to design structured training activities to emphasize key points about patient-physician communication. Effective communication has been shown to enhance patient satisfaction, compliance with treatment, and medical decisions and outcomes. Basic communication skills and behavioral-change interview skills are taught.
Developing and implementing an advanced communication training program in oncology at a comprehensive cancer center. [2022]Cancer patients report significant levels of unmet needs in the realm of communication. Communication skills training programs have been shown to improve clinical communication. However, advanced communication skills training programs in oncology have lacked institutional integration, and thus have not attended to institutional norms and cultures that may counteract explicit communication skills training. We developed and implemented an advanced communication skills training program made up of nine teaching modules for faculty, fellows, and residents. Training included didactic and experiential small group work. Self-efficacy and behavior change were assessed for individual participants. Since 2006, 515 clinicians have participated in this training program. Participants have shown significant gains in self-efficacy regarding communicating with patients in various contexts. Our initial work in this area demonstrates the implementation of such a program at a major cancer center to be feasible, to be acceptable, and to have a significant impact on participants' self-efficacy.
The effects of patient communication skills training on compliance. [2022]To examine the relationship between communication skills training for patients and their compliance with recommended treatment.
Increasing the adoption of evidence-based communication practices for HPV vaccination in primary care clinics: The HPV ECHO study protocol for a cluster randomized controlled trial. [2023]The safe, highly-effective human papillomavirus (HPV) vaccine remains underused in the US. The Announcement Approach Training (AAT) has been shown to effectively increase HPV vaccine uptake by training providers to make strong vaccine recommendations and answer parents' common questions. Systems communications, like recall notices, can further improve HPV vaccination by reducing missed clinical opportunities for vaccination. Never tested in supporting HPV vaccination, the ECHO (Extension for Community Healthcare Outcomes) model is a proven implementation strategy to increase best practices among healthcare providers. This trial uses a hybrid effectiveness-implementation design (type II) to evaluate two ECHO-delivered interventions intended to increase HPV vaccination rates.
A pilot intervention combining assessment and feedback with communication training and behavioral nudges to increase HPV vaccine uptake. [2022]Human papillomavirus (HPV) causes >40,000 cancer diagnoses each year, yet vaccination rates remain low because widespread implementation of strategies to increase vaccinations has not occurred. Behavioral nudges have demonstrated efficacy in improving uptake of desired behaviors in health care settings but have not been tested for increasing HPV vaccinations. We assessed the impact of an intervention combining behavioral nudges with other proven strategies (i.e., assessment and feedback, provider communication training) on HPV vaccination rates and parental satisfaction in four Midwestern pediatric, outpatient practices. Practices were randomly assigned to receive either assessment and feedback or assessment and feedback combined with vaccine communication training and behavioral nudges in the form of vaccine commitment posters. Providers (n = 16) completed surveys regarding vaccine policies and parents (n = 215) reported on their child's vaccine history and satisfaction with the consultation. Three practices increased HPV vaccination rates (1-10%); however, there was no statistically significant difference by study arm. Most parents (M age 41.3; SD 8.1; 85% female, 68% White) indicated their child had previously initiated the HPV vaccine series (61%) and 72% indicated receipt of an HPV vaccine during the study visit. Concerns among HPV vaccine-hesitant parents (28%) included vaccine safety and believing the vaccine is unnecessary (40%). Most parents were satisfied with their consultation. Practices in both intervention groups increased vaccination rates. While some parents continue to harbor concerns about vaccine safety and necessity, parents welcomed discussions about HPV and were satisfied with their provider's communication regardless of their vaccine decisions.
Success of an EMR-Driven Postpartum Intervention to Improve HPV Vaccination Rates. [2021]Human papillomavirus vaccination (HPV) remains low in the United States. The inpatient postpartum setting provides an innovative opportunity to vaccinate eligible patients. This study evaluated two different interventions to improve HPV vaccination rates in hospitalized postpartum patients: a nurse based protocol and an electronic medical record (EMR) postpartum order prompt. This was a comparative intervention study performed in a prospective cohort of postpartum patients at two affiliated County Hospitals. The intervention was conducted over a 6-month period aimed at increasing HPV vaccination rates through a nurse based protocol at one hospital (H-NBP) and an EMR postpartum order prompt at the second hospital (H-EMR). Outcomes measures included vaccine administration, patient refusal, and vaccine wastage. A multiple logistic regression model was used to compare outcomes. At H-NBP, 143 vaccine-eligible patients (74%) were identified of which 44 (32%) received the HPV vaccine, 66 (46%) refused, and 33 (21%) had missed opportunities. At H-EMR, 169 patients (87%) were identified as vaccine-eligible of which 111 (66%) received the HPV4 vaccine, 24 (14%) refused and 34 (20%) had missed opportunities. After adjusting for sociodemographic variables, patients at H-EMR were nearly 6 times more likely than patients at H-NBP to undergo postpartum HPV vaccination (OR 5.865, CI 3.358-10.245, p value
Insurance reimbursements for human papillomavirus vaccination in the private sector, 2007-2014. [2020]This study aims to assess payments to private providers for HPV vaccination. We used the 2007-2014 MarketScan Commercial Claims and Encounters Database and included 3,456,180 HPV vaccination visits made by adolescents aged 11-17 years and enrolled in a non-capitated insurance plan in 37 states. We examined insurance reimbursements and its time trend for vaccine purchase and vaccine administration. Using the vaccine purchase price published by the Centers for Disease Control and Prevention (CDC) and the vaccination payment recommended by the American Academy of Pediatrics (AAP), we evaluated the financial concerns of administering HPV vaccines among private providers. In 2007-2014, the mean vaccine purchase reimbursement was $159.17 and the mean vaccine administration reimbursement was $23.91. During the study period, vaccine purchase reimbursements did not significantly change, but vaccine administration reimbursements increased. On average, 89.9% of the HPV claims received vaccine purchase reimbursements greater than the CDC-published price and 14.1% of HPV claims received vaccine purchase reimbursements above the AAP-recommended payment. Our results suggest that private providers are likely to receive sufficient reimbursements to cover the costs of administering HPV vaccines. However, the profit margin is likely to be small.
Provider communication and HPV vaccine uptake: A meta-analysis and systematic review. [2022]Provider communication can be critically important to families as they consider HPV vaccination. We sought to characterize the association of provider communication and HPV vaccine uptake, and when communication better motivates vaccination. We searched four databases for studies published between 2006 and 2019. Eligible studies examined health care provider communication (defined as recommendation or discussion) and HPV vaccine uptake (defined as initiation, completion, or follow-through) in the US. Two coders independently identified eligible studies and coded effect sizes and study characteristics. We pooled effect sizes using random-effects meta-analysis. We identified 59 eligible studies of 265,083 patients. Receiving a provider recommendation was associated with higher HPV vaccine initiation (pooled OR = 10.1, 95% CI: 7.6-13.4). HPV vaccine initiation was 24% for patients without and 60% for patients with a provider recommendation. The pooled effect size for provider recommendation and initiation was smaller for probability samples, clinical records, and NIS-Teen (all p
The influence of free quadrivalent human papillomavirus vaccine (HPV4) on the timely completion of the three dose series. [2019]Economic incentives can positively influence social determinants to improve the health care of the uninsured and underserved populations. The aim of this study was to determine if free HPV4 vaccine would lead to on-time series completion in our safety net health care system in the US Midwest.
Optimising HPV vaccination communication to adolescents: A discrete choice experiment. [2021]Human Papillomavirus (HPV) vaccine coverage in France is below 30%, despite proven effectiveness against HPV infections and (pre-)cancerous cervical lesions. To optimise vaccine promotion among adolescents, we used a discrete choice experiment (DCE) to identify optimal statements regarding a vaccination programme, including vaccine characteristics.
Provider Payments And The Receipt Of Human Papillomavirus Vaccine Among Privately Insured Adolescents. [2019]Financial concerns such as high vaccine purchase costs and inadequate insurance reimbursement are cited as a key barrier to human papillomavirus (HPV) vaccination of adolescents who are covered by private health insurance. Statistical evidence on the relationship between payments to providers for HPV vaccination and HPV vaccine uptake is limited. This study used data for 2008-14 from the MarketScan Commercial Claims and Encounters database and included adolescents ages 11-17 who had been continuously enrolled in the same noncapitated private insurance plan. Our estimates showed that a $1 increase in median provider payments in a state was associated with a 0.48-percentage-point increase in the probability of initiating the HPV vaccine series and a 0.25-percentage-point increase in the probability of receiving two or more doses. These numbers translated to an average increase of 49,435 adolescents initiating the series and 25,314 adolescents receiving two or more doses. The association between provider payments and HPV vaccine uptake was stronger among adolescents ages 11-12 than among older adolescents, and among adolescents who lived in a Metropolitan Statistical Area than those who did not.