Implementation of QI coaching versus physician communication training for improving HPV vaccination in primary care: A randomized implementation trial

Background Health departments are at the forefront of efforts to improve HPV vaccine uptake in the US. Most notably, health department staff routinely conduct in-person quality improvement coaching to help primary care clinics improve their vaccine delivery systems and communication. Some health departments additionally engage outside experts to conduct remote physician communication training. Such training is a more focused intervention to improve the way physicians and other vaccine prescribers recommend HPV vaccination. To understand the relative strengths and challenges of implementing quality improvement coaching and physician communication training, we compared the interventions on key implementation outcomes, including adoption, reach, and cost. <br> Methods As part of a cluster randomized trial, we allocated 855 primary care clinics in three geographically-diverse US states to receive: 1) quality improvement coaching via the national Assessment, Feedback, Incentives, and eXchange (AFIX) program; 2) physician communication training via Announcement Approach Training (AAT); or 3) both interventions (AFIX+AAT). In each arm, we assessed adoption (or the proportion of clinics receiving the allocated intervention out of those invited), contacts per clinic (mean number of contacts needed to successfully schedule one clinic), reach (median number of total staff and prescriber participants per clinic), and delivery cost. <br> Results A higher proportion of clinics adopted AFIX than AAT or AFIX+AAT (63% vs 16% and 12%, both pConclusions In-person quality improvement coaching was lower cost and had higher adoption, but remote communication training achieved higher reach, including to highly influential vaccine prescribers. Thus, AAT is a promising intervention for improving HPV vaccine delivery, although care will be needed to overcome substantial challenges to clinic recruitment.