185 - Quality Improvement Project to Increase the HPV Vaccination Rates of 13 year old Patients at a Pediatric Clinic

Poster Number: 185
Publication Number: 185.142

Steven Soo, New York University Long Island School of Medicine, Portland, OR, United States; Arsenia Asuncion, NYU Langone Hospital - Long Island, Fresh Meadows +, NY, United States; Peter O'Keefe, The Children’s Medical Center at NYU Winthrop Hospital, Garden City, NY, United States

Background: The 9-valent human papilloma virus (HPV) vaccine targets HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. The Advisory Committee on Immunization Practices recommends HPV vaccination at age 11 or 12 years. The percentage of adolescents (aged 13-17 years) up to date with HPV vaccination was 58.6% in 2020 per the National Immunization Survey-Teen.

Objective: The objective was to increase the HPV vaccination rate in 13 yo (year old) patients from a baseline rate of 46.6% to 50.0% from Oct 2020 to Oct 2021.

Design/Methods: This quality improvement (QI) project was at a university based ambulatory pediatric practice setting with 13 yo patients as the target population. An interprofessional team was created to formulate interventions and ensure compliance. The key drivers were patient-family engagement and physician compliance. The following PDSA (Plan-Do-Study-Act) cycles were implemented in summative, three month intervals: 1) adding HPV vaccination refusal code to the electronic medical record, 2) physician education, 3) medical assistant education, 4) distribution of HPV vaccine informational brochures, 5) individual physician performance report of vaccination rate. The process measure was the # of HPV vaccinated 13 yo per month divided by the # of 13 yo seen at clinic that month. The outcome measure was the # of HPV vaccinated 13 yo divided by the total # of 13 yo at the clinic. The balancing measure was patient output.

Results: The clinic’s baseline HPV vaccination rate was 46.6%. The average monthly sample size was 32, the average sample size of the three low points on Figure 1 was 16. Despite having months where the rate fell below baseline, the average for each PDSA cycle was above baseline (Figure 2). The average and median HPV vaccination rate since implementing PDSA cycles was 53.4% and 55.1%, respectively.

The range of individual physician vaccination rates was 21.3% to 84.7% (Figure 3), group average and median rates were 54.6% and 50.8%, respectively. The range of patients being missed (i.e. where HPV vaccine was not ordered and refusal code not documented) was 11.1% to 56.3%, average and median missed were 35.0% and 38.6%, respectively.Conclusion(s): HPV vaccination rates at a pediatric clinic can be increased by implementing PDSA cycles targeting patient-family engagement and physician compliance. Tracking individual physician results appears to be the most effective at increasing vaccination rates. Future interventions being discussed to further improve the clinic’s HPV vaccination rate include pay-for-performance.
HPV Vaccination Rate by Month and PDSA Cycle
Run Chart of Average HPV Vaccination Rate by PDSA Cycle