Impact of brief quality improvement coaching on adolescent HPV vaccination coverage: A pragmatic cluster randomized trial


 Background: Health departments in the United States routinely conduct quality improvement (QI) coaching to help primary care providers optimize vaccine delivery. In a prior trial focusing on multiple adolescent vaccines, this light-touch intervention yielded only short-term improvements in HPV vaccination. We sought to evaluate the impact of an enhanced, HPV vaccine-specific QI coaching intervention when delivered in person or virtually. Methods: We partnered with health departments in 3 states to conduct a pragmatic cluster randomized trial in 2015-2016. We randomized 224 primary care clinics to receive no intervention (control), in-person coaching, or virtual coaching. Health department staff delivered the brief (45-60 minute) coaching interventions, including HPV vaccine-specific training with assessment and feedback on clinics’ vaccination coverage (i.e., proportion of patients vaccinated). States’ immunization information systems provided data to assess coverage change for HPV vaccine initiation (≥1 doses) at 12-month follow-up, among patients ages 11-12 (primary outcome) and 13-17 (secondary outcome) at baseline. Results: Clinics served 312,227 patients ages 11-17. For ages 11-12, coverage change for HPV vaccine initiation was higher in the in-person and virtual coaching arms than in the control arm at 12-month follow-up (1.2% and 0.7% point difference, both p<0.05). For ages 13-17, coverage change was higher for virtual coaching than control (1.4% point difference, p<0.001), but in-person coaching did not yield an intervention effect. Conclusions: Our brief QI coaching intervention produced small long-term improvements in HPV vaccination. Impact: Health departments may benefit from targeting QI coaching to specific vaccines, like HPV vaccine, that need them most.