P0313 - Improving Human Papillomavirus (HPV) Vaccination at an Academic Center through Provider Education and Utilization of Electronic Health Record Tools

Introduction: Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. Completion of the HPV vaccine series is important in the primary prevention of cervical cancer. HPV vaccination rates remain significantly lower than those for other vaccines recommended for children ages 11–12 years. In 2016, only 43.4% of adolescents in the United States were up to date with the HPV vaccination series, whereas the rates for the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) and the meningococcal conjugate vaccine were in the 80-90% range.1 Our study aims to evaluate multi-component interventions focusing on provider and patient education and electronic health record (EHR) reminders to increase HPV vaccination rates at well child checks.

Method: A retrospective chart review was performed on 1860 Well Child Checks (WCC) for children ages 9–18 years. Patient encounters were reviewed and those where the patient was eligible for an HPV vaccine during pre and post-intervention period were included for final analysis; patients up to date or not indicated for vaccination were excluded. Interventions included provider education through interactive presentations, immunization cards with initiation of HPV vaccination at 9 years of age, and workshops on techniques for discussing HPV vaccination for residents and clinic staff. Technical support interventions were implemented by creating EHR reminders, including a Best Practice Alert, an HPV status column on physician schedules, and order sets that link follow-up nurse visit orders for subsequent doses. Differences by time period were assessed using two-sample t-tests and chi-square tests. A multivariable logistic regression analysis was performed to assess the impact of the intervention on vaccination rates while controlling for sociodemographic variables.
Result:
A total of 1,190 patients for those ages ≥ 9 were included for analysis, 68.5% (n=815) from the pre-intervention period of January 2017-October 2017 and 31.5% (n=375) from the post-intervention period of October 2018-April 2019. The first HPV vaccine was received more often in the post-intervention period (57.9%) compared to the pre-intervention period (43.9%) (adjusted OR = 1.75, 95% CI: 1.30-2.34, p<0.001). Among those who received HPV vaccine #1, the mean age was younger in the post-intervention period (11.4±2.0 years) compared to pre-intervention (12.1±1.8 years) (p<0.001). There was significant improvement in HPV vaccination rate in pediatric resident clinic compared to attendings clinics. The reasons for not having received HPV vaccine in the post-intervention period was more likely due to parental refusal than lack of provider recommendation. HPV vaccine rates lag behind Meningococcal and Tdap in both periods but the gap was significantly reduced in post-intervention period by 12%.

Discussion:
HPV vaccination rates remain lower than other age appropriate vaccinations. Provider education and EHR reminders can improve the rate of HPV vaccination.