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Quality Improvement/Patient Safety: Primary & Subspecialty Outpatient Quality Improvement

QI 7: Primary & Subspecialty Outpatient QI Group 2

271 - Electronic Health Record Clinical Decision Support and Implementation Science to Close the HPV Vaccination Gender Gap in Children Aged 9 and 10 Years

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 271
Publication Number: 271.453

Carole H. Stipelman, University of Utah School of Medicine, Salt Lake City, UT, United States; Alexis R. Olivas, University of Utah School of Medicine, Salt Lake City, UT, United States; Natalie Quiterio Wilson, University of Utah School of Medicine, Draper, UT, United States; Andie K. Sanders, University of Utah, West Valley City, UT, United States; Kensaku Kawamoto, University of Utah School of Medicine, Sandy, UT, United States

Presenting Author(s)

Carole H. Stipelman, MD MPH (she/her/hers)

Professor of Pediatrics, Informatics
University of Utah School of Medicine
Salt Lake City, Utah, United States

Background: Almost half of human papillomavirus (HPV) positive cancers are in males, but HPV vaccination rates in Utah are lower in males than females. The US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommends HPV vaccine initiation at age 11 y, but the American Academy of Pediatrics recommends initiation at 9 y because earlier initiation is associated with higher rates of completion. Lowering the age of initiation to 9 y may decrease gender-based vaccine refusal by offering the vaccine before sexuality typically is discussed.

Objective:

To evaluate the effects of a 2-phase intervention to increase HPV vaccine initiation frequency and parity between boys and girls aged 9 and 10 y.

Design/Methods:

We included well-child visits (WCVs) for children aged 9 and 10 y at 30 primary care clinics in the University of Utah Health system between July 1, 2021, and December 1, 2022. Phase 1 included leadership meetings to approve policy changes. Phase 2 included implementation of electronic health record (EHR) clinical decision support (CDS) with vaccine alerts for providers and parents beginning age 9 y, provider education, and creation of patient portal messaging and parent outreach letters to emphasize the equal importance of male and female vaccination. The letters were translated into the most frequently spoken non-English languages in the system. Medical assistant competitions were held with prizes for the greatest number of HPV vaccinations at age 9 y, with extra points for vaccinating boys. Proportions of 9-10 y visits with vaccine initiation in phases 1 and 2 were compared by gender using chi-square test. We used interrupted time series (ITS) to assess for immediate effect and trend.

Results: In phases 1 and 2, there were 5522 WCVs (boys, 2863 WCVs [52%];girls, 2659 WCVs [48%]). In phase 1, there were 27% more WCVs with vaccine initiation in girls than boys (Table); ITS trend was not significant for girls but decreased for boys by 0.2% per week (95% CI, −0.3 to −0.07;P = .003) (Figure). In phase 2, the frequency of WCVs with vaccine initiation was equal between boys and girls; ITS showed an immediate increase in proportion of WCV with initiation in boys (39%;P < .001) and girls (30%;P < .001). In phase 2, ITS trend did not change in boys or girls, and there was no difference in trend between boys and girls.

Conclusion(s): EHR CDS alerts, education, and messaging to parents, providers, and medical assistants to initiate vaccination at age 9 y equally for both boys and girls increased early vaccine initiation and achieved gender parity.