SANFORD HEALTH’S STRATEGY TO IMPROVE HPV VACCINATION RATES

ANDREA POLKINGHORN, BSN, RN-BC

IMMUNIZATION STRATEGY LEADER

ABOUT SANFORD HEATH

WHY PRIORITIZE AN HPVIMPROVEMENT PROJECT?

WHY IMPROVE HPV VACCINATION RATES… WHY NOT?

• Low immunization rates• Lack of knowledge about low rates (nationally and

internally)• Focus on preventative medicine• Internal data vs. HP2020 demonstrated need for

improvement

• Funding• Recipient of grants in ND and SD

DATA SPECIFICATIONS

• Data• HPV:

• Males and Females 11-26 years• Simplify vaccination schedule: confusion about

males ending at age 21• Desire to evaluate age eligible population• Zero doses vs. series completion

• Tdap: • Males and Females 11-18 years

• MCV4: • 1 dose between 11-15 years• 1 dose on or after 16 years (pulled for 16-18

years)

ADOLESCENT IMMUNIZATIONS CLINIC LEVEL RATES

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

HPV Zero Doses Given HPV Series Completion TDaP Mening First Dose

Jun-15 (Baseline)

Apr-17

May-17

Jun-17

Jul-17

Aug-17

Sep-17

Healthy People 2020 Goal

Decreased by 30.5%

Increased by 20.5%

INTERVENTIONS

1. Meet with clinic leadership to obtain buy-in2. Staff education (in person)3. Distribution of monthly immunization rates4. Monthly meetings with leadership5. Reminder/Recall6. Marketing7. Merck magnets and text reminders8. Screening of Someone You Love the HPV

Epidemic documentary to local colleges

DATA

COMPLETED CLIENT REMINDERS BY TYPE

20,871 20,12020,705

40,106

02,769

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

Year 1 (7 sites) Year 2 (39 sites)

Televox Mail Phone call

NUMBER OF HPV VACCINE DOSES ADMINISTERED BY PROJECT YEAR

1,554

6,883

2,986

10,234

0

2,000

4,000

6,000

8,000

10,000

12,000

Year 1 (7 sites) Year 2 (39 sites)

Baseline Year End of Project Year

Year 1 (7 sites) Year 2 (all 39 sites)

RATE OF ZERO DOSE HPV VACCINATION AMONG MALES AND FEMALES AGES 11-26 ACROSS PARTICIPATING CLINICS

64.2%

55.9%53.9% 53.0%

50.4%

44.5% 43.5% 43.1% 42.0%

54.0%48.0% 46.0%

53.9%

44.8%

0%

20%

40%

60%

80%

100%

RATE OF HPV VACCINATION SERIES COMPLETION AMONG MALES AND FEMALES AGES 11-26

25.1%

26.2%

27.4%

29.8%

31.7%

34.0%

36.1%

38.4%

39.8%

30.3%

32.5%

33.7%

36.1%

37.7%

24.0%

26.0%

28.0%

30.0%

32.0%

34.0%

36.0%

38.0%

40.0%

06/30/2015 09/30/2015 12/31/2015 03/31/2016 06/30/2016 09/30/2016 12/31/2016 03/31/2017 06/30/2017

Year 1 (7 sites) Year 2 (all 39 sites)

PROGRESS AS OF TODAY: REDUCTION IN ZERO DOSES

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Family Medicine Clinic1

Family Medicine Clinic2

Family Medicine Clinic3

Family Medicine Clinic4

Family Medicine Clinic5

Family Medicine Clinic6

Family Medicine Clinic7

7 Metro Family Medicine Clinics Percent of Patients with Zero Doses of HPV

Jun-15 Jun-19

PROGRESS AS OF TODAY: HPV SERIES COMPLETION

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

F amily Medicine Clinic1

Family Medicine Clinic 2Family Medicine Clinic 3Family Medicine Clinic 4Family Medicine Clinic 5Family Medicine Clinic 6Family Medicine Clinic 7

7 Metro Family Medicine Clinics Series Completion Rates

Jun-15 Jun-19 HP 2020 Goal

ACHIEVEMENTS

1. SD HPV Grant awarded for second year2. Staff and clinics awarded with HPV Champion and various immunization

awards3. Vax Champ program4. National Recognition5. Enhanced knowledge and awareness of staff6. Team member of the IDS HPV Roundtable workgroup7. Participation in other projects (i.e., AMGA learning collaborative)8. Improve immunization rates for other vaccines9. Built a multi-disciplinary group to guide and standardize immunization

practices for all immunizing providers

KEY LESSONS

• Dedicated personnel • Broad impact

• Pull provider and clinic level rates• Data transparency

• Buy-in from executive leadership & key stakeholders

• Education• How to recommend• How to address questions• Vaccines• Payment• Myths• Tools to support the work• Culture change: no missed opportunities

• Create a vaccine champion for each clinic• Assists in expanding the reach and

impact of large system goals• Readily available resource for questions

• Secure funding

• Share wins

• Have conversations with clinics and/or providers who are underperforming