P0134 - Improving HPV vaccination rates in Pennsyvlania-a Chapter quality improvement project

The Pennsylvania Chapter of the American Academy of Pediatrics (PA AAP) applied for and received a grant to support two quality improvement projects to improve HPV vaccination rates. The first project recruited thirty-three practices across the state to improve initiation and completion of the vaccine series. The second project, approximately one year later, focused on the sustainability of improvement techniques with ten practices from the original group of thirty. Through interactive webinars, we used an all-teach, all-learn approach to quality improvement. Practices improved their rates of initiation of vaccine by 26% and of completion of the series by 33%. Clinicians helped each other problem solve issues of vaccine hesitancy and employed evidence based strategies to boost rates of vaccine administration. The practices found a message of HPV vaccine as cancer prevention was a very effective message. This approach integrated HPV vaccination with other routine anticipatory guidance by primary care pediatricians (sunscreen, tobacco avoidance). The focus on cancer prevention rather than sexuality diminished parents’ HPV vaccine refusal. In addition, practices found that a standard approach to offering the vaccine at both sick and well appointments was effective; i.e. including HPV vaccine in the middle of the menu of recommended vaccines (“at this visit, we administer Tdap, HPV and meningococcal vaccines”). This standard “sandwich” approach diminished the emotional focus on HPV vaccine and maintained the tone that HPV is not special and different from all the other vaccines offered by pediatricians to keep children healthy. Another aim of the project was to initiate the HPV series at age 9-10. This earlier administration further unlinked the vaccine from sexuality for parents. We encouraged clinicians to stress the greater immune response and the opportunity for fewer injections by giving the vaccine at the earlier age range. In addition, younger children generally have higher rates of adherence to recommended preventive medicine visits than teens, enabling greater success for our practices in achieving aims. Finally, practices taught each other the importance of culture change within the practice, involvement of all staff (front desk, medical assistants) as well as reminders in the electronic record and outreach to families for completion of the series. We worked with a subset of practices on sustainability of QI efforts, demonstrating how to make change stick. Through the use of the AAP’s Quality Improvement Data Aggregator (QIDA), practices were able to view their run charts and do Plan Do Study Act cycles of iterative improvement. These projects enabled physicians to earn maintenance of certification part 4 (QI) credit which was an additional incentive for participation. The PA AAP collaborated with the PA Immunization Coalition (PAIC) which made suggestions for improvement interventions and was kept abreast of the project.