Abstract
Purpose
The human papillomavirus (HPV) causes genitourinary and oropharyngeal cancers. The
HPV vaccine is safe and effective in preventing those diseases; however, vaccine series
completion rates remain low in the United States. Our quality improvement (QI) project
aimed to increase HPV-vaccination series completion rates to 70% from 2017 to 2020
for the 13-year patient population in an extensive academic pediatric primary care
network that serves predominantly minority and Medicaid-insured children in Columbus,
OH.
Methods
The outcome measure was the percentage of 13-years Nationwide Children's Hospital
Primary Care Network patients who completed the two-dose vaccine series by their 13th
birthday. Four QI implemented interventions were utilized. Electronic medical records
alert informed providers when the HPV vaccines are due. We studied monthly data for
the network and for individual clinics using statistical process control, displaying
data on a control chart. We followed two process measures, captured opportunity rate,
and the number of HPV vaccines given.
Results
We substantially increased HPV-vaccination series completion rates overall in the
13-year teen population from 27% to 65%, and three clinics reached the 70% goal for
at least one quarter. Latino children had the highest completion rate of 80% and White
children had the lowest completion rate at 64%.
Discussion
Our QI project used four measures to improve HPV-vaccination series completion rates
in the 13-year patient population that serves minority and low-income teens predominantly.
Further QI studies are needed to improve HPV vaccine completion rates in teens.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Adolescent HealthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancers associated with human papillomavirus, United States—2013–2017. USCS data brief: United States cancer statistics.in: CDC, Atlanta, Georgia2020
- Review of HPV-related diseases and cancers.New Microbiol. 2017; 40: 80-85
- HPV and HPV-associated diseases.Infect Dis Clin North Am. 2013; 27: 765-778
- National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 Years - United States, 2017.MMWR Morb Mortal Wkly Rep. 2018; 67: 909-917
- National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 Years - United States, 2018.MMWR Morb Mortal Wkly Rep. 2019; 68: 718-723
- National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 Years - United States, 2019.MMWR Morb Mortal Wkly Rep. 2020; 69: 1109-1116
- Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US.Vaccine. 2020; 38: 6027-6037
- Vaccine hesitancy: An overview on parents' opinions about vaccination and possible reasons of vaccine refusal.J Public Health Res. 2019; 8: 1436
- Barriers to human papillomavirus vaccination among US adolescents: A systematic review of the literature.JAMA Pediatr. 2014; 168: 76-82
- Association between mother-child sexual communication and HPV vaccine uptake.Prev Med. 2015; 74: 63-66
- Long-term persistence of systemic and mucosal immune response to HPV-16/18 AS04-adjuvanted vaccine in preteen/adolescent girls and young women.Int J Cancer. 2011; 129: 2147-2157
- Fall in human papillomavirus prevalence following a national vaccination program.J Infect Dis. 2012; 206: 1645-1651
- Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: Updated systematic review and meta-analysis.Lancet. 2019; 394: 497-509
- HPV vaccine schedule and dosing.CDC, Atlanta, Georgia2019
- Immunogenicity of the 9-valent HPV vaccine using 2-dose regimens in girls and boys vs a 3-dose regimen in women.JAMA. 2016; 316: 2411-2421
- Comparison of different human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV-related disease in females and males.Cochrane Database Syst Rev. 2019; 2019: CD013479
- What are the factors that contribute to parental vaccine-hesitancy and what can we do about it?.Hum Vaccin Immunother. 2014; 10: 2584-2596
- Levels of parental HPV vaccine hesitancy and their reasons for not intending to vaccinate: Insights from the 2019 National Immunization Survey-Teen.J Adolesc Health. 2022; 71: 39-46
- Youth risk behavior surveillance data summary & trends report: 2009-2019.CDC, Atlanta, Georgia2019
- 2019 high school YRBS sexual behaviors report.Ohio Department of Health, Columbus, OH2020
- Provider communication and HPV vaccination: The impact of recommendation quality.Vaccine. 2016; 34: 1187-1192
- SQUIRE 2.0 (standardsfor quality improvement reporting excellence): Revised publication guidelines from a detailed consensus process.BMJ Qual Saf. 2016; 25: 986-992
- Quality improvement initiative to improve human papillomavirus vaccine initiation at 9 Years of age.Acad Pediatr. 2018; 18: 769-775
- American society for quality.(Available at:)https://asq.org/quality-resources/control-chartDate accessed: March 20, 2022
- Parental attitudes toward human papillomavirus vaccination: Evaluation of an educational intervention, 2008.J Health Commun. 2011; 16: 300-313
- Human papillomavirus vaccine interventions in the U.S.: A systematic review and meta-analysis.Am J Prev Med. 2019; 56: 591-602
- Electronic reminder's role in promoting human papillomavirus vaccine use.Am J Manag Care. 2017; 23: e353-e359
Article info
Publication history
Published online: March 14, 2023
Accepted:
January 9,
2023
Received:
June 18,
2022
Footnotes
Conflicts of interest: The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2023 Society for Adolescent Health and Medicine. All rights reserved.
