Electronic Health Record Clinical Decision Support to Close the Human Papillomavirus Vaccination Gender Disparity in Children Aged 9 and 10 Years
Bibliographic record
Abstract
We performed a quality improvement project (31 clinics; July 2021 to October 2023) to increase human papillomavirus vaccination initiation frequency and decrease gender disparity in children aged 9 and 10 years. The 11 process changes included electronic health record clinical decision support (CDS) tools for providers, staff, and parents and medical assistant participation. In phase 1 (preparation), initiation frequency was lower in boys (250 of 1688 visits, 15%) than girls (289 of 1549 visits, 19%; P = .003). In phase 2 (CDS alerts; recommended initiation age lowered from 11 to 9 years), initiation frequency was increased and similar between boys (906 of 1847 visits, 49%) and girls (867 of 1740 visits, 50%; P = .64). In phase 3 (patient portal outreach), initiation frequency was increased further for boys and girls. The multifaceted intervention, including CDS tools and lowering the initiation age, was associated with increased initiation frequency and decreased gender disparity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.026 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".