P0647 - HPV Vaccine Improvement QI Project

Background: HPV infects one-fourth of people in the USA. The HPV vaccine protects against 9 oncogenic strains of HPV, including HPV-16 & 18, which cause 70% of cervical cancers. It is the only available vaccine that prevents cancer, including cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers. The American Cancer Society recommends the vaccine for boys and girls ages 9-45, yet less than 50% are vaccinated. This resident-led quality improvement project aimed to increase the vaccine initiation and completion rate of eligible patients in our clinic.

Methodology: We aimed to “Increase HPV vaccination in patient’s ages 11-18 by 20% in 3 months utilizing a notification letter, education leaflet, and follow-up telephone call intervention.” A fishbone diagram and a clinic process flowchart helped identify causes of low HPV vaccine rates in clinic. Initial data was extracted from our EMR and screened for initiation or completion of the vaccine. Completed meant initiation < 15 yo with two doses, or started >15 yo with three doses. We accessed our EMR to identify eligible patients to start or complete the series.

A notification letter encouraging the vaccine and educational leaflets were mailed to the identified patients. Clinic staff tracked all those who presented after letters were sent, and called those who had not responded. Vaccination data was collected monthly.

Discussion: At the start, 60.8% of females and 61.1% of males who were eligible had initiated HPV vaccination. Of females aged 11-14, 59.5% had initiated and of 15-17 yo, 62.5% had. Males aged 11-14, 57.5% had initiated and of 15-17 yo, 64.2% had. In 6 months, 72.9% of females (12.1% increase) and 68% of males (6.9% increase) had initiated the series. The greatest increase was seen in females aged 11-14 with a 12.2% increase. By the end of the project females and males ages 11-17 had initiation rates greater than 70%. Our intervention methods were successful in raising the vaccination rate.

Limitations include who may have been included who do not utilize our clinic for primary care. We did not take into account vaccinations not recorded in the EMR or performed at other locations. Strengths include a large adolescent population, ancillary staff involvement, and an easy and effective intervention that can be easily reproduced.

Our simple method of sending letters and follow up phone calls was effective in increasing HPV vaccination in adolescent male and female patients.