Improving Human Papilloma Virus Vaccination Rates at an Urban Pediatric Primary Care Center

INTRODUCTION: Despite compelling evidence regarding its safety and efficacy, human papilloma virus vaccination rates remain low nationally with high rates of missed vaccination opportunities. Provider recommendation is the most important factor in determining vaccine approval by families; yet, studies show that providers are hesitant to strongly recommend vaccination, especially at younger ages. We hypothesized that educational and quality improvement interventions targeting our clinical team would decrease rates of missed opportunities to vaccinate patients aged 11–13 years and improve vaccination rates among patients aged 9–10 years old. METHODS: This quality improvement project took place at an urban, academic pediatric primary care center in north Philadelphia, which serves as the medical home for over 22,000 patients. A multidisciplinary team performed a series of planned sequential interventions to improve human papilloma virus vaccination rates. The electronic health records of children aged 9–13 who presented to our center from September 2014 through December 2015 were queried. Statistical process control charts and established rules for detecting special cause variation were applied. RESULTS: Rates of missed opportunities to vaccinate 11- to 13-year-old patients decreased from 63% to 18% during the intervention period. Rates of immunization of 9- to 10-year-old patients increased from 56% to 84% during the intervention period. CONCLUSION: This low-cost, multifaceted, interdisciplinary quality improvement project resulted in a decrease in missed opportunities to vaccinate among children aged 11–13 years old and improved the vaccination rates of 9–10 year olds. Ongoing interventions are needed to sustain these efforts and to ensure timely vaccine series completion.