Problem and Purpose:
Each year, 33,700 men and women in the United States are diagnosed with a cancer caused by infection from the human papillomavirus (HPV), 90% of which could have been prevented through vaccination. Despite the proven safety and effectiveness of this vaccine, rates of uptake are low nationwide, a mere 53.7% for females and 48.7% for males. The purpose of this quality improvement (QI) project was to implement and evaluate interventions guided by the 4 Pillars™ for Practice Transformation Program, an evidence-based tool-kit shown to increase HPV vaccination rates across settings, including in primary care. Methods: A bundle of interventions was implemented using the 4 Pillars Program. Pillar 1 Convenience and Easy Access: all patient encounters of those aged 11-18 were used as an opportunity to vaccinate (not just well visits). Pillar 2 Patient Communication: providers issued a “strong recommendation” for the HPV vaccine using the Same-Way Same-Day strategy from the Centers for Disease Control and Prevention (CDC). Pillar 3 Enhanced Vaccination Systems: Immunization status was assessed as part of vital signs and Vaccine Information Statements (VIS) were given to all eligible patients’ parents. Pillar 4 Motivation: progress toward improving HPV vaccination rates was tracked and posted in staff break room. Results:
Implementation of this tool-kit resulted in an increase in the HPV vaccination rate from 68% to 76.6%, an 8.6% increase (p<0.01). 100% of patients presenting for 11-year-old well child checks were vaccinated (n=32). 100% of eligible patients were given VIS and immunization status was assessed as part of vital signs for 100% of patient encounters. There was no real gender difference discovered in the final HPV vaccination rate. Among males (n=521), there was a 78% final rate and 76% for females (n=574), echoing the closing of the gender gap nationwide. 15 patients who previously refused, consented and were vaccinated. Conclusion:
This QI project demonstrated this vaccination tool-kit is an effective way to increase HPV vaccination among adolescents in primary care.