How can people use the results?Health systems can include data on social risks to improve how well measures assess quality of care.

Objectives Given poor compliance by providers with adolescent health risk assessment (HRA) in primary care, we describe the development and feasibility of using a health information technology (HIT)-enhanced HRA to improve the frequency of HRAs in diverse clinical settings, asking adolescents' recall of quality of care as a primary outcome. Methods We conducted focus groups and surveys with key stakeholders (Phase I) , including adolescents, clinic staff and providers to design and implement an intervention in a practice-based research network delivering private, comprehensive HRAs via tablet (Phase II). Providers and adolescents received geo-coded community resources according to individualized risks. Following the point-of-care implementation , we collected patient-reported outcomes using post-visit quality surveys (Phase III). Patient-reported outcomes from intervention and comparison clinics were analyzed using a mixed-model, fitted separately for each survey domain. Results Stakeholders agreed upon an HIT-enhanced HRA (Phase I). Twenty-two academic and community practices in north-central Florida then recruited 609 diverse adolescents (14-18 years) during primary care visits over 6 months; (mean patients enrolled = 28; median = 20; range 1-116; Phase II). Adolescents receiving the intervention later reported higher receipt of confidential/private care and counseling related to emotions and relationships (adjusted scores 0.42 vs 0.08 out of 1.0, p < .01; 0.85 vs 0.57, p < .001, respectively, Phase III) than those receiving usual care. Both are important quality indicators for adolescent well-child visits. Conclusions Stakeholder input was critical to the acceptability of the HIT-enhanced HRA. Patient recruitment data indicate that the intervention was feasible in a variety of clinical settings and the pilot evaluation data indicate that the intervention may improve adolescents' perceptions of high quality care.

Journal of Adolescent and Young Adult OncologyVol. 3, No. 1 PerspectiveQuality of Life Tools and Young Adult Survivors of Pediatric Cancer: A Commentary on the Need to Examine Perceptions of Romantic RelationshipsGwendolyn P. Quinn, Devin Murphy, Michelle A. Fortier, Ivana Sehovic, Katie Z. Eddleton, and I-Chan HuangGwendolyn P. QuinnHealth Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida.Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida.Search for more papers by this author, Devin MurphyJonathan Jaques Children's Cancer Center, Miller Children's Hospital, Long Beach, California.Search for more papers by this author, Michelle A. FortierDepartment of Anesthesiology and Perioperative Care, UCI Center on Stress & Health, UC Irvine School of Medicine, Orange, California.Search for more papers by this author, Ivana SehovicHealth Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida.Search for more papers by this author, Katie Z. EddletonDepartments of Health Outcomes and Policy, and the Institute for Child Health Policy, University of Florida, Gainesville, Florida.Search for more papers by this author, and I-Chan HuangDepartments of Health Outcomes and Policy, and the Institute for Child Health Policy, University of Florida, Gainesville, Florida.Search for more papers by this authorPublished Online:12 Mar 2014https://doi.org/10.1089/jayao.2013.0020AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byContraception: the Need for Expansion of Counsel in Adolescent and Young Adult (AYA) Cancer Care15 February 2016 | Journal of Cancer Education, Vol. 32, No. 4Exploring gender and identity issues among female adolescent and young adults who connect in an anonymous platform30 September 2015 | Journal of Health Psychology, Vol. 22, No. 5A Qualitative Study of the Impact of Cancer on Romantic Relationships, Sexual Relationships, and Fertility: Perspectives of Canadian Adolescents and Parents During and After Treatment Jennifer N. Stinson, Lindsay A. Jibb, Mark Greenberg, Maru Barrera, Stephanie Luca, Meghan E. White, and Abha Gupta17 June 2015 | Journal of Adolescent and Young Adult Oncology, Vol. 4, No. 2 Volume 3Issue 1Mar 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Gwendolyn P. Quinn, Devin Murphy, Michelle A. Fortier, Ivana Sehovic, Katie Z. Eddleton, and I-Chan Huang.Quality of Life Tools and Young Adult Survivors of Pediatric Cancer: A Commentary on the Need to Examine Perceptions of Romantic Relationships.Journal of Adolescent and Young Adult Oncology.Mar 2014.47-49.http://doi.org/10.1089/jayao.2013.0020Published in Volume: 3 Issue 1: March 12, 2014Keywordssurvivorsrelationshipsquality of lifeperceptionPDF download

Purpose: Adolescence is an important time for the detection of health risk behaviors and factors with subsequent counseling and intervention. Limited research has examined adolescent perceptions of comprehensive health risk assessments (HRAs) and counseling with an assessment of gender differences.Methods: Participants were identified using Florida's Medicaid and State Children's Health Insurance Program databases. A total of 35 low-income, racially/ethnically diverse adolescents (ages 14-18 years) participated in eight focus groups stratified by gender. Adolescents completed an internet-based, tablet-administered, comprehensive HRA and then participated in a semi-structured interview. Discussions were recorded, transcribed, and analyzed using a multi-step, team-based approach applying grounded theory to determine major themes.Results: Male adolescents desired less parental involvement, had less understanding of the protections of clinical confidentiality and the need for comprehensive HRA, and placed greater emphasis on the importance of professional appearance. In contrast, more females valued face-to-face interactions and stressed the importance of concern from the health risk assessor. Overall, adolescents placed importance on their relationship with the health risk assessor, and on valuing trust, confidentiality, and nonjudgmental care. Adolescents preferred to complete HRAs in clinical, private, and professional settings, and reported that tablet technology supported their confidentially in completing the HRA. Furthermore, they stressed the importance of autonomy and learning about the health risk outcomes for risk reduction.Conclusions: Gender differences exist in adolescent perceptions of comprehensive HRAs. Adolescent perceptions of HRAs support their use in confidential primary care settings using modalities that emphasize nonjudgmental, private care, and the use of communication techniques that respect adolescents' autonomy to change health risks. (C) 2014 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.

BACKGROUND: Many women who develop cervical cancer are eligible for or are participants of Medicaid. Providing human papillomavirus (HPV) vaccination to girls enrolled in Medicaid may reduce cervical cancer disparities in low-income and minority women. This study evaluated provider characteristics associated with HPV vaccination among 9- to 17-year-old female Medicaid enrollees. METHODS: A random sample of 800 providers from the Florida Medicaid Master Provider File was mailed a survey in October 2009 that evaluated demographic and practice characteristics, HPV information and knowledge, barriers to HPV vaccination, vaccine practices, and vaccine recommendation practices. To measure HPV vaccination, Medicaid claims data were used to calculate the proportion of eligible patients who received at least 1 dose of the vaccine from participating providers within the study period. Provider factors associated with vaccination at the bivariate level were evaluated in a multiple linear regression model. RESULTS: The response rate was 68.3% (N = 485). After excluding ineligible respondents, the current analysis included 433 providers. HPV vaccination prevalence ranged from 0% to 61.9% (M = 20.4, standard deviation = 14.5). HPV vaccination rates were higher among providers who were pediatricians, had a private practice, practiced in a single specialty setting, were providers under the Vaccines for Children program, saw primarily non-Hispanic white patients, used 2 or more strategies for vaccine series completion, and did not refer out for HPV vaccination. CONCLUSIONS: Despite financial coverage for Medicaid-eligible girls, HPV vaccination rates are low. Study findings can be used to target health services interventions to providers least likely to administer HPV vaccine to female Medicaid enrollees. Cancer 2013. (C) 2012 American Cancer Society.

Few studies examine the relevance of health-related quality of life (HRQOL) instruments for young adult survivors of childhood cancer (YASCC). This study compared the psychometric properties of two survivor-specific instruments, the Quality of Life–Cancer Survivor (QOL-CS) and Quality of Life in Adult Cancer Survivor (QLACS).

Abstract Background: Low-income and minority women bear a disproportionate burden of cervical cancer. Many women who develop cervical cancer are eligible for or are participants of Medicaid. Providing human papillomavirus (HPV) vaccination to girls in Medicaid may help reduce subsequent cervical disparities observed in low-income and minority women. Provider recommendation is a critical factor associated with HPV vaccination. Purpose: The primary aim of this study was to evaluate provider characteristics associated with HPV vaccination among 9–17 year old female Medicaid enrollees. Methods: A sample of 800 providers was randomly selected from the Florida Medicaid Master Provider File. The sampling frame was restricted to providers who had: a physical address in Florida, billed claims or an assigned panel that included 25 or more 9–17 year old girls in the past year, and a specialty of Pediatrics, Obstetrics and Gynecology, or Family Medicine that included internal medicine, general practice, or preventive medicine. Physicians were mailed a survey in October 2009 that evaluated key factors related to HPV vaccination, including: 1) demographic and practice characteristics, 2) HPV information and knowledge, 3) barriers to HPV vaccination, 4) vaccine practices, and 5) vaccine recommendation practices. To measure HPV vaccination, Medicaid claims data were used to calculate the proportion of eligible patients who received at least one dose of the vaccine from sampled providers within the study period. Provider factors (e.g., provider specialty) associated with HPV vaccination at the bivariate level were evaluated simultaneously in a multiple linear regression model with HPV vaccination as the outcome variable. Results: The response rate was 68.3% (n = 485). After excluding respondents who identified themselves as unlikely to be involved in vaccination (e.g., hospice, emergency care providers; n = 23) or reported a specialty other than what was requested or no specialty (n = 23), the current analysis included 439 providers. The prevalence of HPV vaccination ranged from 0% to 61.9% (mean = 19.9, SD = 14.4). About 33% of the variance in HPV vaccine administration was attributable to the independent variables, F(14, 382) = 13.2, p < .0001, adjusted R2 = 0.3. Provider factors significantly associated with HPV vaccination included provider specialty, private vs. other practice, daily patient load, VFC provider status, patient race, and referring out for HPV vaccination. Private vs. other practice (e.g., ambulatory care clinic of hospital or medical center, urgent care clinic, community health center) was the strongest predictor of HPV vaccination (beta = −0.3, p < .0001). Conclusions: HPV vaccination has the potential to reduce cervical cancer disparities among low-income and minority women. Despite the financial coverage of the HPV vaccine for Medicaid-eligible girls, the average vaccination rates are low. Results of the current study can be used to target health services interventions to those providers least likely to administer HPV vaccine to female Medicaid enrollees. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B106.

Background: Assessing barriers to human papillomavirus (HPV) vaccination among a sample of physicians seeing Medicaid patients is an important step in understanding the diffusion of HPV vaccination to medically underserved populations. Purpose: The primary aim of this study was to assess physician barriers to immunizing Florida Medicaid patients against HPV. Methods: A sample of 800 providers was randomly selected from the Florida Medicaid Master Provider File. The sampling frame was restricted to providers who had a physical address in Florida, had billed claims or had an assigned panel that included 25 or more 9- to 17-year-old girls in the past year, and had a specialty of Pediatrics (Peds), Obstetrics and Gynecology (OBGYN), or Family Medicine (FM) that included internal medicine, general practice, and preventive medicine. In October 2009, physicians were mailed a survey that evaluated key areas related to HPV vaccination, including: 1) demographic and practice characteristics, 2) HPV information and knowledge, 3) barriers to HPV vaccination, 4) vaccine practices, and 5) vaccine recommendation practices. Physician barriers to immunizing patients were assessed using a 13 item scale. Physicians were asked to rate their level of agreement with a series of barriers to HPV immunization for their Medicaid patients (1 = strongly disagree, 5 = strongly agree). Items were summed and averaged to create a mean barrier score (range: 1 −5). Differences in mean barrier scores by physician specialty were assessed using a one-way ANOVA. Additionally, frequencies were obtained for each item on the barrier scale. Results: After removing physicians who were ineligible (n = 43), undeliverable surveys (n = 65), and duplicate surveys (n = 4), the response rate was 67.44% (n = 464). Among physicians who answered all barrier items (n = 458), the overall mean barrier score was 2.70 (SD = 0.72). Stratified by specialty, the mean barrier score was 2.65 (SD = 0.72) for Peds, 3.01 (SD = 0.66) for FM physicians, and 2.60 (SD = 0.64) for OBGYNs. FM physicians had a significantly higher mean barrier score than both Peds and OBYGNs, F(2,436) = 7.30, p = 0.0008. The three most common barriers to HPV vaccination where physicians reported they “strongly agree” were lack of adequate reimbursement (21.56%, n = 94), concerns about vaccine safety (19.18%, n = 84), and lack of timely reimbursement (17.66%, n = 77). Conclusions: Results indicate relatively low overall barriers to immunizing Medicaid patients against HPV. Physician reimbursement issues appear to be top barriers to immunizing Medicaid patients. Additionally, specialty appears to impact perceived barriers to HPV vaccination, with FM physicians indicating greater barriers than Peds or OBGYNs. These findings suggest that improvement in reimbursement procedures may increase HPV vaccination among medically underserved groups. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B115.