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this month's e-newsletter offers interventions to help boost hpv vaccination rates in delaware and shares successes

ImagePack Vaccine Did you know that according to CDC data, Delaware still has 13.49/100,000 cases of HPV cancers annually despite the launch of the Human Papillomavirus (HPV) vaccine in 2006? Even with Delaware surpassing the nation in HPV vaccination and series completion, we still have opportunities to achieve the Healthy People 2020  HPV vaccination goals of 80%. These goals look to increase the percentage of female and male adolescents receiving the ACIP-recommended number of appropriately spaced doses of HPV vaccine based on their age at initiation of HPV vaccination. 

In this month's e-newsletter, we are highlighting not only evidence-based interventions, but also success stories of Delaware healthcare providers who have implemented an intervention to increase HPV vaccination rates.   
delaware practice named 2018 c DC HPV Immunization Champion

HPV Vaccine Is Cancer Prevention Champion is an annual award given jointly by the Centers for Disease Control and Prevention (CDC), American Cancer Society (ASC), and the Association of American Cancer Institutes (AACI). This award recognizes clinicians, clinics, practices, groups, and health systems that are going above and beyond to foster HPV vaccination among adolescents in their communities. 

Award Criteria
State and territorial immunization program managers coordinate the nomination and review process, and then send their nomination to the CDC for final review. State and territorial immunization programs base their nominations on the following criteria and considerations. 
Champions must meet the following minimum requirements:
  • Adolescent Health: The candidate must be a clinician, clinic, practice, group, or health system that treats adolescents as part of their overall population.
  • Vaccination Rates: The candidate must reach target series completion rate of 60% for the patient population aged 13-15 years. The rate must account for both female and male patients. Vaccination under the two-dose schedule (two doses given at least five months apart in children ages 9-14 years) satisfies series completion, as does the original three-dose schedule.

2018 Delaware HPV Immunization Champion: N emours duPont Pediatrics, Shipley St., S eaford, DE
The staff at Nemours/Shipley has been recognized as experts in HPV vaccinations on several levels. They have demonstrated that it not only takes a team to improve rates, but also a multi-pronged approach. The lead physician, Dr. Harry A. Lehman, serves on a "Cross Campus" committee comprised of stakeholders to develop in-office education to boost HPV coverage rates. Kim Reed, the lead nurse, is a Vaccine Coordinator within the Nemours Clinic system, and has worked on several pilot programs aimed at tracking and improving immunization rates. 

The office is active in vaccine quality improvement projects, including DelVAX (Delaware's Immunization Information System, or IIS) AFIX (Assessment/Feedback/ Incentives/eXchange) reports training, utilizing Immunization Information System (IIS) reports to accurately maintain the client roster, and using reminder/recall efforts to bring patients in to complete their vaccine series.  HPV vaccine rates are also tracked through Nemours' benchmark reporting and are included in daily Huddle Board discussions. 

Nemours/Shipley focuses on preventative care at the highest level of service. The staff acknowledges that if children and families are not seen on a regular basis, opportunities to build trusting relationships, as well as vaccination opportunities, will be missed. To accomplish this, the clinic schedules adolescent patient check-ups one year in advance for routine wellness visits. They also send reminder/recalls and mailings as well as e-mail and text reminders through their patient portal.

Nemours/Shipley believes in the importance of HPV vaccinations from the top down. These consistent and collaborative efforts have resulted in an 81% HPV vaccine series completion rate for their 13-15 year old patients. They have achieved the Healthy People 2020 goal not only for HPV initiation but completion as well!  
For information on all the 2017 and 2018 HPV champions, please visit the HPV Vaccine Is Cancer Prevention Champion Award Winner Spotlights website.
join quality insights to improve hpv vaccination rates in delaware 

immunization icom Quality Insights is actively working with the Division of Public Health (DPH) Immunization Department to increase HPV vaccination rates. Through collaborative discussions and by using the Delaware Immunization Information System (IIS), DelVAX, practices are identifying opportunities for both initiation of the HPV series and series completion. Although Delaware has an initiation rate of 75.3 and an UTD (up to date) rate of 58.1% according the National Immunization Survey (NIS) teen data, opportunities exist for meeting the Healthy People 2020 goal of 80%.

Small practices and health systems have begun to successfully review their DelVAX data and reports and implement workflows to increase rate today, to help prevent cancer tomorrow. One health system identified the need to remind patients of the 2nd/3rd dose. They are now implementing patient reminders for nurse visits as a system implementation. At a practice level, they are identifying goals for first and second dose and identifying workflows that fit the needs of their population, including using electronic health record (EHR) inbox reminders, running patient lists, and scheduling patients before they leave.

Success Story - Dr. William Funk
The small private practice of Dr. William Funk has been very successful in using DelVAX reports to reach out to patients and complete the HPV series. How do they do it? The office manager, Michele Weiss built reports into their practice management and EHR systems and compares them to DelVAX reports. Weiss and her team leverage the DelVAX patient rosters and report who transferred.  The next step is to call all patients that are in need of a seco nd or thi rd dose. Although this requires extra time, it has helped the office to get on the right foot for cancer prevention. 

From these extra efforts, Weiss reports that over 35 patients have come in to finish their series and, in some cases, got their well check or received other vaccines. For the patients who did not come in, reminders were added to their charts in case the patient came into the office for other reasons. Staff also ensured that a note was placed in the chart as a reminder for the second dose as reminder when the 2 nd dose is due after the first one was given.   

Weiss acknowledges that the practice is well positioned to sustain the momentum now by reviewing their procedures, including scheduling patients after their first dose and having reminders for nurse visits. Also, Dr. Funk starts discussing the HPV vaccine at the 9-10 year old visit. This allows parents who may want more information the time to do some research so that they are more prepared for their child to receive their first HPV vaccine by age 11 or 12 and can complete the series by 13.  

Join Us
Please join Quality Insights in congratulating Dr. Funk and his staff on reaching over 80% initiation for HPV vaccination. And remember, your practice can be  one of our future success stories if you sign-up now to join us in this initiative. 
learn about hpv vaccination success beyond delaware  

success Literature has demonstrated that a multi-pronged approach to increase HPV vaccination rates works best. In a study looking at high performing Louisiana Physicians Increasing HPV Vaccination Rates, researchers assessed successful behaviors and workflow implementations. Twelve providers deemed as above average for HPV vaccine uptake were interviewed and strategies for vaccine receipt were captured in an interview. What did these providers use as successful strategies? The most frequently used strategies were education, standing orders, reminders, and scheduling follow-up doses during the current visit. Other strategies that were used with less frequency were offering the HPV vaccine with other vaccines, discussing the vaccine as cancer prevention, a strong recommendation, and offering during well visits. Nevertheless, it shows that simple changes in combination can lead to increases in HPV rates.
In a Cochrane review looking at patient reminder and recall interventions to improve immunization rates , 75 studies were evaluated to see if reminding people to getting vaccinated (not just for HPV) worked. The studies included various ages, vaccines, and settings, however most were USA based. The reviewers found that reminding people to get their vaccinations increased the number of people getting vaccinated by an average of 8 percentage points, but there is variation in the studies. Single reminder interventions such as telephone and auto-dialer calls, sending a letter or postcard, or sending a text message increased vaccinations. However, combinations of reminders were even more effective in increasing desired rates.

Are you interested in learning more about a successful text message implementation? A study in the Journal of Adolescent Health and another in the Journal of Pediatric Health Care demonstrate how using text reminders can increase series completion in the appropriate adolescent settings.  

No one approach is right or wrong. Quality improvement is a process that takes time and will involve more than one approach. If you are interested in increasing your HPV rates, contact Lisa Gruss at Quality Insights today.
RECORDED WEBINAR highlights successful hpv cancer prevention strategies

e-learning The Preventing HPV Cancers through Health Systems: A Tale from Three Systems webinar focuses on HPV vaccination and using the Large Health Systems Action Guide from the HPV Roundtable. Three providers discuss their strategy to deploy the Clinician & Systems Action  Guides as evidence-based tools for quality improvement initiatives.

Watch this engaging webinar to learn steps to improve your HPV rates today.

Looking for great actionable resources for your practice? Check out the HPV Roundtable Action Guides. Whether you work in a small private office or a large health system, these great evidenced-based tips can help you increase your HPV vaccine rates by getting the entire health team on the same page.
contact information

For more details about the Quality Insights Improving HPV Vaccination Rates in Delaware project,  please email Lisa Gruss or call 1.800.642.8686, Ext. 138.

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This project is in collaboration with the Division of Public Health (DPH) - Comprehensive Cancer Control Program, Immunization and 
Vaccines for Children, and the Centers for Disease Control and Prevention (CDC). Publication number DEDPH-HPV-053119