2017 HPV Vaccine is Cancer Prevention Award Winner Spotlights
Maine Medical Partners (MMP) provides care for more than 15,000 children in the most economically and culturally diverse community in its state. Recognizing the importance of vaccinating against a cancer-causing virus, MMP implements evidence-based strategies to improve HPV vaccine completion rates. They take this work very seriously!
MMP providers educate patients and parents on the importance of HPV vaccination—ensuring they understand who should be vaccinated and when. Furthermore, MMP takes every opportunity to vaccinate patients by offering vaccines at both well and acute visits. This helps them avoid any missed opportunities for HPV vaccine.
Recruiting and retaining a highly trained clinical staff who appreciate the importance of vaccines is just the first step in MMP’s impressive work with HPV vaccination. Providers and medical assistants also participate in ongoing trainings that focus on improving the effectiveness of vaccine conversations with parents. Additionally, MMP works closely with the Population Health Department for outreach to the community about HPV vaccine and participates in the Main Quality Counts Statewide HPV Vaccine Learning Collaborative. All of these activities helped MMP achieve impressive HPV vaccine series completion rates of 72%. Maine Medical Partners is the 2017 HHS Region 1 HPV Vaccine Is Cancer Prevention Champion!
The Children’s Health Center (CHC) is a large urban practice servicing an underserved community. A training site for 45 residents and students from the Albert Einstein College of Medicine, CHC employs 10 full-time attending physicians in the ambulatory care setting.
Working hard to increase HPV vaccination series completion rates for several years, CHC realized this significant undertaking would involve focus on educating its staff, physicians, and patient population. To start with, CHC accesses information from the Citywide Immunization Registry (CIR) for every well and acute visit. Nursing staff print, review, update, and brief physicians with CIR reports regularly. Focusing on avoiding missed opportunities, CHC offers walk-in immunizations, schedules follow-up vaccine appointments before patients leave, and uses standing orders for vaccines so RNs can independently vaccinate. CHC also tracks HPV completion rates as performance indicators for the practice and now uses a reminder system in the CIR to text patients missing vaccines. CHC has an HPV vaccine series completion rate of 70.3%. Children’s Health Center is the 2017 HHS Region 2 HPV Vaccine Is Cancer Prevention Champion!
The Office of Sein Win is a small family-owned pediatric practice that opened in 2011. With a total staff of 3, they treat approximately 600 children each year.
The office is committed to maintaining complete Immunization Information System (IIS) records for each child and regularly reporting immunization in Virginia’s IIS. The office systematically schedules adolescent well visits, promptly reschedules missed visits, utilizes standing orders for all adolescent vaccines, and includes education as a significant part of all patient care. Furthermore, parents and patients receive a bundled recommendation—staff recommend HPV vaccination the same way and same day as other immunizations. Using a reminder/recall process and an immunization manager (who reviews vaccination histories, calls patients who are overdue for vaccines, and oversees that all immunization records are up to date) are two quality improvement measures that collectively improved vaccine coverage levels. These initiatives, as well as the strong relationship built on trust between staff and patients, result in an HPV vaccine Series Completion Rate of 72%. The Office of Sein Win is the 2017 HHS Region 3 HPV Vaccine Is Cancer Prevention Champion!
Department of Health Collier Immokalee Clinic works with adults and children from a farm community in southwest Florida. Within the past 4 years, the Clinic took on the massive challenge of improving HPV vaccination rates. This journey to impressive rates began with tracking and offering HPV vaccine to all eligible children.
The Clinic dedicated their focus to making sure all staff with any contact with clients are knowledgeable advocates for HPV vaccine and armed with the knowledge of its importance in cancer prevention. Providers recognized that cultural norms in the community they serve meant that discussing “sexual contact” was uncomfortable when parents asked about HPV vaccine. Therefore, staff refocused their conversations about HPV vaccine from being for an STI to cancer prevention. This also helped frame the conversation in a way that was helpful for both staff and providers. The Clinic then rephrased their intake questionnaire, since it seemed misleading by suggesting that vaccines not required for school entry, like HPV vaccine, were not important. As a response to these efforts, coverage rates steadily improved for HPV vaccine. Series completion rates of 76.2% for 13 to 15 year olds, makes the Department of Health Collier Immokalee Site Clinic the 2017 HHS Region 4 HPV Vaccine Is Cancer Prevention Champion!
Dr. Jane Goleman works in primary care at Nationwide Children’s Primary Care Network and has for over 25 years. She is a founding member of the Pediatric Health Equity Collaborative and leads the HPV Quality Improvement initiative to decrease HPV-related cancers and limit disparities in health outcomes for cervical cancer.
Dr. Goleman formed a quality improvement (QI) project to improve HPV vaccination rates. This QI project started with a small team of clinical staff that learned more about how to discuss HPV vaccine with parents, created an educational handout about HPV vaccine, distributed reminder magnets for return visits, and called patients overdue for their third vaccine. Dr. Goleman worked with the staff to refocus the discussion about the vaccine on cancer prevention and changed the Electronic Medical Records (EMR) Health Maintenance Alerts for HPV vaccine to 9 rather than 11 years of age. This change in the EMR spread HPV vaccine quality improvement work to all 13 clinic sites and updates physicians and nurse practitioners on their HPV vaccine rates every six months. Training providers and residents on the Announcement Approach (starting vaccine discussions with “Your child needs the following vaccines …. We’ll be giving them at the end of the visit today”) and providing immunization rates to each clinic site helped increase rates significantly. Additionally, awarding performance-based incentives to clinics also helped increase HPV vaccination rates. Dr. Goleman spreads the word about these successful HPV vaccine initiatives to increase rates and why it matters through lectures to the local community and her peers. In 2016, she presented “HPV-associated Cancers and Vaccination in Ohio: The Problem and How to Address Disparities” and “Increasing HPV Vaccination in the U.S.: A Collaboration of NCI-Funded Cancer Centers.” All of this dedication results in a series completion rate of 81.7%, making Dr. Jane Goleman the 2017 HHS Region 5 HPV Vaccine Is Cancer Prevention Champion!
St. Anthony Pediatrics is a large pediatric practice in southern New Mexico, 2 miles from Texas and 20 miles from Mexico. Staff realized that patients often missed scheduled appointments and, as a result, adopted a successful no-appointment clinic. All visits are walk-in, same-day visits, and staff screen clients’ immunization status at the time of their visit.
When patients receive the first dose of HPV vaccine, they receive a reminder card informing them when they need to return to the office for the follow-up doses. Clinic waiting and triage area prominently display educational posters to emphasize the importance of HPV vaccine. When parents have questions about the vaccine, they receive informative reading material so that they can prepare their questions while they wait to see the provider. Providers in this clinic actively counsel clients on the importance of HPV vaccine and how it protects them. St. Anthony Pediatrics participates in the New Mexico Statewide Immunization Information System (NMSIIS), entering all immunizations administered into NMSIIS through manual data entry. They utilize the NMSIIS patient rosters to track their active population, and they inactivate clients in NMSIIS when they are no longer seen by the clinic. With a series completion rate of 72%, St. Anthony Pediatrics is the 2017 HHS Region 6 HPV Vaccine Is Cancer Prevention Champion!
The Ozarks Community Hospital (OCH) Noel Clinic is a family practice rural health clinic located in extreme southwest Missouri near the border of Missouri and Arkansas. The OCH Noel Clinic services include primary care to children and adults. The population of patients is incredibly diverse and encompasses many nationalities. The range of cultures and languages presents unique communication barriers. Nonetheless, the clinic works hard to ensure quality access to comprehensive primary care services to those individuals who are traditionally underserved.
The clinic has a Vaccines for Children (VFC) coordinator who keeps track of the VFC program for Noel Clinic, including HPV vaccination for adolescent patients. The coordinator’s approach at the clinic is personal and consistent. For example, she reaches out to VFC patients and their families by sending reminder cards in the mail and follows up with phone calls for any overdue immunizations. She is determined to get to know all of her patients and develop a relationship with them and their families. She educates each one carefully about HPV vaccine, ensuring she addresses their questions. The OCH Noel clinic is proud to have such experience and focus on quality patient care. This dedication results in HPV vaccine series completion rate of 86%, making the Ozarks Community Hospital- Noel Clinic the 2017 HHS Region 7 HPV Vaccine Is Cancer Prevention Champion!
Wind River Service Unit is a tribally-run clinic serving approximately 11,000 members of the Native American Eastern Shoshone and Northern Arapahoe tribes.
Staff at the clinic developed an innovative approach to parental acceptance for HPV vaccine that draws upon buy-in from patients, parents, and at times the local high school, to collaborate in the completion of the vaccine series for all of their patients. For example, when a patient eligible for HPV vaccine comes to the clinic, the parent or guardian receives HPV vaccine Information Statement (VIS) to prepare them for a conversation with their provider. Parents can direct their questions about HPV vaccine to the nursing staff trained to educate parents and patients on HPV vaccine and its role in cancer prevention. To avoid any future missed opportunities, the staff asks parents or guardians to complete a consent form for all doses in the series at the initial dose of the vaccine. Staff developed this innovative approach, in part, after they encountered parents refusing remaining doses of the vaccine in the series—often due to patients complaining about the painful shots or parents stating they did not consent to the initial dose. This also avoids missed opportunities in case someone else accompanies the patient at future visits to complete the vaccine series.
If the clinic does not have a consent for the vaccine on file, staff scan it into the electronic health record and send an HPV vaccine consent form, along with the teen clinic consent, to the Wyoming Indian High School. The school includes this form in registration packets for parents and guardians to complete. Eligible patients can elect to receive HPV vaccine series at any of the weekly teen clinics held throughout the school year. This dedication results in HPV vaccine series completion rate of 78.8% making the Wind River Service Unit the 2017 HHS Region 8 HPV Vaccine Is Cancer Prevention Champion!
Chinle Service Unit (CSU), Navajo Area Indian Health Service, part of a federally operated health care system, is the sole health care provider for over 35,000 people in the central region of the Navajo Nation in northeastern Arizona. Ten health care providers (physicians and nurse practitioners) provide pediatric primary care services, as well as inpatient care, and an emergency department.
Through standing orders for nursing staff, CSU offers HPV vaccine to all eligible patients at primary care or school-based clinics. Taking the initiative to track immunizations through a registry incorporated into the electronic health record, reminds nurses to check immunization status and incorporate this information in notes for providers. CSU relies on the electronic health records and the immunization registry, especially the school-based health clinics. Furthermore, the registry links with the state registry so data on all immunizations given throughout the state is up to date.
Initially faced with some parental refusal for HPV vaccine, patient and family education staff worked together to find a way to communicate the health benefits of the series. CSU worked closely with the native medicine department to develop a culturally appropriate brochure on HPV vaccine that integrates cultural teachings. This significantly helps with HPV vaccine acceptance. The school-based health clinic staff also oversees the vaccination status of students, closely working with schools and parents to complete the series at school.
With a series completion rate of 82.7%, Chinle Service Unit, Navajo Area Indian Health Service is the 2017 HHS Region 9 HPV Vaccine Is Cancer Prevention Champion!
International Community Health Services (ICHS) is an integral part of the some of the most populous and vibrant communities in the region. Specifically, it is the largest Asian Pacific Islander non-profit community health center in Washington. ICHS patients speak close to 50 languages and represent numerous cultures.
ICHS generates the “missing immunization” report monthly through the Washington State Immunization Information System (WAIIS). Based on the information staff find through the WAIIS, they contact parents or patients to schedule appointments for overdue immunizations. Staff diligently update patients’ immunizations in WAIIS at every visit (well child exam visit, problem visit, nurse visit, etc.). Staff use a bundled recommendation (recommending HPV vaccine with Tdap, MCV4, and flu shot) and are equipped to discuss HPV vaccine and how it can help prevent cancer. To educate and inform parents about HPV vaccines, staff offer them the “Plain Talk” immunization booklet.
ICHS acknowledges that maintaining these rates requires continuity and commitment: “It’s not just an individual goal. It requires a cooperation from the whole care team.” This hard work led to a series completion rate of 84%. International Community Health Services is the 2017 HHS Region 10 HPV Vaccine Is Cancer Prevention Champion!