Improving HPV Vaccine Completion Rates in an Urban Pediatric Clinic

1Henshaw S, 2Kucera N, 3Lukeman J, 1Fugate C
1Oklahoma State University/OMECO, Tulsa, OK, USA; 2CoxHealth, Springfield, MO, USA; 3Warren Clinic, Tulsa, OK, USA

Background: Vaccination against preventable diseases is a fundamental aspect of pediatric care. The Center for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) recommends the human papilloma virus (HPV) vaccine for adolescents at 11-12 years of age.1 At the OSU clinic a 2015 chart review of 200 patients, ages 11-12yrs, revealed 62.6% vaccine coverage with HPV1, 17.2% with HPV2 and 3.5% with HPV3.2 A follow up study in 2016 of patients ages 13-18yrs indicated 74.95% received HPV1, 60.63% received HPV2, and 44.67% received HPV3.3 While these numbers were more favorable there was still room for improvement, which lead to the development of a quality improvement project aimed at improving HPV initiation and completion rates. Prior to implementation of this project the CDC updated the recommended vaccine schedule for HPV to a two dose series if given prior to the patients 15th birthday.4 The quality improvement project consisted of training for residents and attending physicians regarding the newly recommended schedule, and how to discuss the HPV vaccine with parents.
Methods: Charts of 300 randomly selected patients were reviewed; Subjects were males and females, ages 11-18 years, who were seen in the OSU Clinic between February and October 2017. Data was collected on vaccination for HPV including those who followed the 2 dose and 3 dose schedule. Patients were considered “up to date” if ineligible for additional vaccines at the end of the study period. Number of missed opportunities to vaccinate was also recorded.
Results: Vaccination coverage in the cohort was 84.67% for HPV1, 63.67% for HPV2, and 39.67% for HPV3. 22.82% of patients completed the 2 dose series, 38.67% completed the 3 dose series. 69.57% of the patients in the study were up to date on their HPV vaccine. The average number of missed opportunities to vaccinate was 1.6 with 45.05% of patients who were not up to date having at least 2 visits where the vaccine could have been given.
Conclusion: HPV vaccination rates for ages 11-18 years at the OSU Pediatric Clinic are above the national average and have improved greatly after provider education and introduction of the new 2 dose series. However, there are still missed opportunities to vaccinate. This indicates a need to assess physician work flow and office procedure in an attempt to minimize missed opportunities.

1. Elam-Evans, Laurie D., David Yankey, Jenny Jeyarajah, James A. Singleton, C. Robinette Curtis, Jessica MacNeil, and Susan Hariri. "National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years - United States, 2013." Morbidity and Mortality Weekly Report 63.29 (2014): 625-33. Print.
2. Kucera, N., Jones, J., Fugate, C., & Vaughn, K. L. (n.d.). Adolescent Vaccine Rates in an Urban Pediatric Clinic [Scholarly project].
3. Lukeman, J., Kucera, N., Fugate, C., & Vaughn, K. L. (n.d.). Urban Clinic Vaccine Rates in Late Adolescence. [Scholarly project].
4. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405–1408. DOI: