2019 HPV Vaccine is Cancer Prevention Award Winner Spotlights
Laura Williams, MD
Little Rock, AR
Dr. Laura Williams has been in private practice in Arkansas since 1996, and she opened River City Pediatrics in an underserved part of Little Rock in 2009. Dr. Williams strongly believes in the HPV vaccine due to her own personal experiences with cervical cancer. She has lost a grandmother and close friend to cervical cancer and watched young women die from cervical cancer when she was in medical school.
Dr. Williams was a founding member of the Arkansas Immunization Action Coalition (now Immunize Arkansas), serving as president. Currently, she is the medical director on the executive board of Immunize Arkansas and is actively involved in outreach activities with the organization, including a specialized workgroup dedicated to increasing HPV vaccination rates in Arkansas.
Dr. Williams’ practice is a Vaccines for Children (VFC) provider and participates in annual Assessment, Feedback, Incentives, and eXchange (AFIX) visits (now known as Immunization Quality Improvement for Providers, or IQIP). Dr. Williams and staff have achieved their current HPV vaccine completion rate of 85% by implementing several immunization improvement strategies, such as making a strong HPV vaccine recommendation using presumptive language and implementing an adolescent reminder/recall system. Dr. Williams also hired a nurse to contact adolescents 11-18 years of age for adolescent appointments, thereby increasing the number of adolescents coming into the clinic and the number receiving the HPV vaccine.
For her work to improve HPV vaccination rates within her practice and across the state, Dr. Laura Williams is Arkansas’ 2019 HPV Vaccine is Cancer Prevention Champion!
Raymond Perry, MD
Los Angeles, CA
Dr. Raymond Perry is a pediatrician and the director of Hubert H. Humphrey Comprehensive Health Center, an outpatient primary and specialty care center within the Los Angeles County Department of Health Services (LAC DHS). The LAC DHS is the second largest municipal health system in the country, and the health center serves over 40,000 adult and pediatric patients, most of whom live in underserved communities. Dr. Perry has led many initiatives to improve population health efforts across the health center, with a focus on immunizations, preventive health, and cancer screenings.
Dr. Perry has established himself as a leader in HPV vaccination rate improvement within the LAC DHS. In November 2018, Dr. Perry and the American Cancer Society (ACS) worked together to design a quality improvement (QI) project, with the goal of establishing the first-ever HPV task force of clinical champions to address barriers and implement systems practice changes. The project launched in January 2019.
Within the task force, Dr. Perry facilitated collaboration with leaders of additional LAC DHS sites. Patients in Los Angeles County often visit multiple health center sites, so effective communication across the health center network was key to ensure that best practices that were adopted at one health center would be consistent with all centers. In July 2019, all health center sites received co-branded client reminder postcards to send to patients due for vaccination—the first HPV vaccination outreach activity across the entire health system.
The task force also completed a systems and strategies inventory. Dr. Perry worked with ACS to secure an HPV clinical champion to use the “You Are the Key” HPV slide deck to train all LAC DHS pediatric providers on effective communication around HPV vaccination. By July 2019, HPV vaccination rates across all sites had increased an average of six percentage points.
Dr. Perry’s leadership, collaborative spirit, and innovative approach to increasing HPV vaccination rates resulted in a 61% HPV vaccination rate for adolescents for the Humphrey Comprehensive Health Center. This makes Dr. Raymond Perry California’s 2019 HPV Vaccine is Cancer Prevention Champion!
Cobb Pediatric Associates
Cobb Pediatric Associates (CPA) in Smyrna, Georgia, has been a part of the Cobb County community for over 40 years. The serves a population of over 50% Medicaid-insured patients from a variety of ethnic backgrounds.
Cobb Pediatric Associates were active participants in the 2018-2019 Adolescent Immunizations Quality Improvement (QI) Project led by the Georgia Chapter of the American Academy of Pediatrics (GAAAP). The project aimed to increase adolescent immunization rates for Tdap, HPV, and meningococcal conjugate. The CPA QI team consisted of two pediatricians, one practice administrator, and one medical assistant (MA).
The QI team worked closely with four other pediatric practices to implement a PDSA (Plan, Do, Study, Act) cycle over a six-month period. As a result, CPA showed significant reduction in missed vaccination opportunities and an increase in adolescent immunization rates, especially with HPV vaccination.
As part of the QI project, CPA staff started identifying adolescent patients who were missing the HPV vaccine by using monthly reports from the Georgia Registry of Immunization Transactions and Services (GRITS). Based on these reports, an MA would reach out personally to each family on a monthly call list to schedule HPV vaccine visits.
The practice now institutes six-month reminders in the online patient portal, and mails reminder postcards for patients who don’t have email. The practice has also begun hosting onsite EPIC electronic health record training.
Thanks to their QI efforts, Cobb Pediatric Associates have seen their HPV vaccination series completion rate for adolescents increase to 72%. This makes Cobb Pediatric Associates Georgia’s 2019 HPV Vaccine is Cancer Prevention Champion!
At Aiea Pediatrics in Aiea, Hawaii, immunizations are a top priority for Dr. Brent K. Tamamoto and his staff. They work as a team to promote immunizations through training and comprehensive communication with patients and parents.
Aiea is open six days a week, including Saturdays, to make it easier for parents to schedule appointments. The staff schedules immunization-only visits a week in advance, but they frequently accommodate same day appointments upon request. Routinely, the staff reminds parents about vaccines their children are due for when they check in, and schedule appointments for additional doses of the vaccine before the patient leaves the office. The staff uses scheduling software to send text and email reminders to parents about appointments and will call parents with unconfirmed appointments 1-2 days prior to the visit.
The office displays HPV vaccination posters and flyers in the waiting room, giving parents time to read information before entering the exam room. The staff at Aiea have also been proactive about finding new resources to educate patients and parents about the HPV vaccine. Ramona Sergent, an office manager and medical assistant at Aiea, shares short HPV videos with parents and patients who come in for office visits that they can watch on their phones while waiting to be seen. Ms. Sergent and other staff members also regularly check social media to stay up-to-date on current concerns about immunizations, which helps them anticipate questions from parents and be better prepared to respond to concerns. The staff documents any vaccination refusals and Dr. Tamamoto revisits the conversation with parents at future visits.
Aiea Pediatrics has a 90% HPV vaccine rate for adolescent patients. Their commitment to increasing Oahu’s adolescent HPV vaccination rates makes Aiea Pediatrics Hawaii’s 2019 HPV Vaccine Is Cancer Prevention Champion!
Nathan Boonstra, MD FAAP
Des Moines, IA
Dr. Nathan Boonstra is a pediatrician at Blank Children’s Pediatric Clinic in Des Moines, Iowa, and has been a practicing pediatrician for 16 years.
Dr. Boonstra has been involved in vaccine education for many years, with a focus on improving HPV immunization rates. Dr. Boonstra collaborates on HPV immunization education with the Iowa Department of Public Health, Iowa Cancer Registry, and Centers for Disease Control and Prevention (CDC), among others. He has been a frequent presenter for HPV vaccine-related webinars, medical conferences and summits, and teaches immunization education to medical students and pediatric residents from Blank Hospital and the University of Iowa, giving a monthly interactive lecture that focuses on common vaccine myths and how to address them. In March 2019, Dr. Boonstra discussed the findings of the Iowa Cancer Registry with a focus on HPV cancers on Iowa Public Radio’s “River to River” program and has collaborated with the Iowa Cancer Consortium and Iowa Public Health Association to produce literature for healthcare professionals on the importance of the prevention of cancers with the HPV vaccine.
Dr. Boonstra has developed educational material for Blank Children’s Pediatric Clinic outlining the reasons for the clinic’s strong recommendation of the HPV vaccine. He always makes a strong recommendation for HPV vaccine to parents and patients and takes as much time as needed to educate vaccine-hesitant parents. Dr. Boonstra shares the most current scientific information about HPV vaccine with parents, and often shares his email address so they can contact him directly if they have questions after their office visit.
Dr. Boonstra founded the Facebook Group called “Iowa Immunizes,” which brings together Iowans who promote education on the safety and efficacy of vaccinations. He also co-led a month-long social media campaign called #VaxfactsFebruary, which encouraged vaccine experts across Twitter to highlight credible vaccine information daily.
With an adolescent HPV vaccine series completion rate of 94%, and for his tireless efforts to provide HPV vaccination education, Dr. Nathan Boonstra is Iowa’s 2019 HPV Vaccine Is Cancer Prevention Champion!
Sunnyside Pediatrics in Metairie, LA, was established in 2005 by Dr. Ana de Aguiar, a pediatrician, and Dr. Jose Veras Pola, a family physician. They have become an integral part of providing quality healthcare in the New Orleans area, working hard to achieve high HPV vaccination coverage rates among adolescents.
Sunnyside Pediatrics physicians and staff communicate the importance of HPV vaccination to parents, as well as consistently make reminder calls when patients are due for HPV vaccinations. Pediatrics staff also collaborate with the larger Sunnyside Family Practice to ensure all family members are aware of the importance of the HPV vaccine and its role in prevention of related cancers. Many of the families are seen in both the pediatric and family medicine offices, which means the staff often reaches across generations of family members to make sure children or even grandchildren are up to date on the HPV vaccine series. The staff builds a trusting relationship with families by calling when they are due for their immunizations. Many members of the staff speak Spanish, which helps to facilitate effective communication with their Latino families.
The staff at Sunnyside Pediatrics reinforces the importance of protection against cancer-causing infections during adolescence. Because the clinics reach multiple generations of family members, Sunnyside Pediatrics have been successfully able to promote the importance of getting the HPV vaccine at the recommended ages while also ensuring catch-up vaccination for patients who were not vaccinated on time.
For its focus on HPV vaccination education for all family members, and with an HPV vaccine completion rate of 96%, Sunnyside Pediatrics is Louisiana’s 2019 HPV Vaccine is Cancer Prevention Champion!
Maine Medical Partners – Westbrook Pediatrics
Westbrook Pediatrics is a leader in their practice group, Maine Medical Partners (MMP), and the MaineHealth System, for achieving high HPV vaccination rates. Westbrook Pediatrics consists of four physicians and one nurse practitioner, and cares for over 3,400 patients. The practice is part of Tufts University School of Medicine, and its pediatricians teach pediatric residents at Maine Medical Center.
Westbrook Pediatrics implemented several interventions to improve HPV vaccination rates among their adolescent patients. Westbrook utilized available technology to help take advantage of every opportunity to vaccinate. This included using their electronic medical record (EMR) and “check out” note feature to alert the front desk to schedule follow-up doses if needed. Westbrook also used the state immunization registry, ImmPact, to run reports and identify children who are due for vaccines. The front desk staff reached out to patients who had been identified as ‘due soon,’ to get them in the office for vaccines before they became overdue.
Improving conversations with parents is also a priority for Westbrook – the staff starts recommending the HPV vaccine at nine years old. This is an opportunity to connect with parents early, so they have a chance to ask questions and have multiple conversations about the HPV vaccine. Westbrook has also established a specific “Care Team,” which consists of front desk representatives, clinical staff, and providers, to give staff an opportunity to collaborate on best practices and develop scripting that can be used by everyone in the office. The Westbrook Care Team meets monthly to ensure they are on track to accomplish their goals to improve patient care and reduce missed vaccination opportunities.
Another key to Westbrook’s success has been to engage all team members in the vaccination process. During pre-visit planning, the clinical team identifies patients who are due for the HPV vaccine. The support staff and providers explain to these families that their child is due for the HPV vaccine and offers to answer any questions. The Westbrook staff also has regular meetings with MMP’s Quality team to review metrics and engage in conversations about how to make improvements.
Because of their great teamwork and organization, the adolescent HPV vaccination completion rate at Westbrook Pediatrics is 72%. This makes Westbrook Pediatrics Maine’s 2019 HPV Vaccine is Cancer Prevention Champion!
Thomas J. Schuch, MD, MPH
South Boston, MA
For more than a decade as a pediatrician, Dr. Thomas J. Schuch has championed HPV immunization as cancer prevention, treating Boston’s most vulnerable children and teens at an urban Federally Qualified Health Center (FQHC), the South Boston Community Health Center (SBCHC).
As SBCHC’s informatics director, Dr. Schuch has programmed customizations to the electronic health records (EHR) at his clinic to study trends in vaccine uptake, as well as create and refine clinical decision support tools to help providers improve childhood and adolescent vaccine completion rates. Specific to improving HPV vaccination rates, Dr. Schuch built an automated advisory program embedded in the EHR that flags boys and girls at age 9, to encourage providers to initiate HPV vaccination early. This prompt gives providers greater opportunity to complete the two-dose HPV vaccine series on time.
These tools are available to other FQHCs across Massachusetts and the United States through the OCHIN collaborative (which consists of 500+ safety net clinics and 10,000 providers in 47 states), as well as through research partnerships in HPV immunization uptake with the Boston University School of Medicine and the American Cancer Society. Dr. Schuch currently partners with an FQHC in Houston, Texas, to help them replicate the clinical decision support systems he designed and implemented to improve HPV immunization completion rates. Data collected from his work feeds into HPV immunization research conducted at Boston University School of Medicine.
For his innovative work with EHRs and for SBCHC’s 70% adolescent HPV vaccine completion rate, Dr. Thomas J. Schuch is Massachusetts’s 2019 HPV Vaccine is Cancer Prevention Champion!
Ascension Borgess Family Medicine and Pediatrics, Plainwell
Ascension Borgess Family Medicine and Pediatrics is a large practice with 10 providers, who serve over 6,700 patients age 18 and younger in the rural Western Michigan community of Plainwell.
Ascension Borgess offers extended weekday schedule and separate nurse-only visits to accommodate patients for vaccinations. The staff reaches out to families with children eligible for the HPV vaccine through monthly reminder/recall phone calls and emails. Staff uses every opportunity to recommend and administer the HPV vaccine, including offering the vaccine at every visit—whether it’s for a well visit or not—and recommending the vaccine the same way and same day as other adolescent vaccines.
The staff at Ascension Borgess builds a foundation of trust to gain support for the HPV vaccine. They acknowledge that they are the most effective teachers when they’re able to interact with families openly and honestly. Members of the staff proactively discus the HPV vaccine in an effort to provide credible information to families. They recognize that each HPV vaccine conversation is unique, and there’s no “one size fits all” approach to discussing vaccines. The staff often shares personal stories about the many ways HPV vaccination can save lives, and follow up these discussions by providing education materials to families.
This dedication to education about the HPV vaccine has led the practice to a 92% HPV vaccine completion rate for adolescents. This makes Ascension Borgess Family Medicine and Pediatrics Michigan’s 2019 HPV Vaccine is Cancer Prevention Champion!
Andrea Singh, MD
St. Louis Park, MN
Dr. Andrea Singh serves as the Department Chair of Pediatrics for the HealthPartners Medical Group (HPMG) – Park Nicollet Clinic in St. Louis Park, Minnesota, where she promotes various initiatives to improve HPV vaccination. Dr. Singh is also the Co-Lead of the Children’s Health Initiative, a guidance committee for setting and standardizing evidence-based clinical content for pediatric visits for all HPMG locations, as well as part of the Immunizations Disparities Work Group, which looks at processes for improving immunization metrics and closing disparity gaps in race, insurance status, and gender.
Dr. Singh has created relationships and partnerships with several specialty groups throughout HPMG, specifically around the improvement in HPV completion rates. These include urgent care sites, HPMG dental clinics, and the Frauenshuh Cancer Center, which is specifically targeted for education around HPV vaccination for cancer prevention in lower performing clinics. Dr. Singh also fosters the HPMG partnership with the American Cancer Society through their HPV Maintenance of Certification quality improvement initiative, which focuses on HPV vaccination improvement rates in initiation and completion.
Dr. Singh spearheads improvements in electronic efficiencies, to identify patients that need to start the HPV vaccine, as well as completion and catchup. Specifically, Dr. Singh has helped develop the well-child overdue health maintenance alert for HPMG, which created several outreach registries for overdue visits and overdue immunizations.
These registries help prevent gaps in care and missed opportunities. Since the registries went live in summer of 2019, clinicians have reached out to over 20,000 well child patients who were overdue for vaccines, including more than 1,200 patients overdue for the HPV vaccine. Dr. Singh’s partnerships and electronic innovations have resulted in an adolescent HPV vaccine series completion rate of 60%, making her Minnesota’s 2019 HPV Vaccine Is Cancer Prevention Champion!
Vibha Vig, MD
Dr. Vibha Vig trained in medicine in India and came to the United States in the late 1980s. In 1995, Dr. Vig established the first-ever pediatric practice in Canton, Mississippi, along with the first newborn and inpatient children’s services at the local hospital. Now, Sunshine Children’s Clinic and its satellite offices in Carthage and Yazoo City have grown into a medical home for thousands of children.
Dr. Vig’s clinics focus on actively engaging families to ensure vaccinations are scheduled and completed on-time. Sunshine Children’s Clinic sees around 10,000 patients on an active basis in rural and semi-rural areas, where most patients don’t have access to computers or the internet. Because of these challenges, the office staff calls patients and mails postcards to remind them about vaccines that are due, and schedules future appointments well in advance. For example, if a patient gets the first HPV vaccine dose during an appointment, the clinic schedules their six-month HPV vaccine follow-up appointment before they leave. The clinic’s administrative staff also calls families to explain what they should expect in upcoming appointments to address any questions parents may have.
Sunshine Children’s Clinic accepts walk-ins all day for sick visits, well-visits, and physicals. This allows for vaccine administration at the patients’ convenience. When a patient checks in for any appointment, the nurse looks at their immunization forecast in the Mississippi Immunization Information eXchange (MIIX) Registry and circles any required vaccines on the front sheet, which reminds providers to order the recommended vaccines.
Thanks to these effective strategies for avoiding missed opportunities, Sunshine Children’s Clinic’s adolescent HPV vaccine completion rate is 69%. This makes Dr. Vibha Vig Mississippi’s 2019 HPV Vaccine is Cancer Prevention Champion!
Bellevue Pediatrics was founded in 1999 to meet the needs of an at-risk, underserved community in Ewing, New Jersey, which was on the cusp of losing two large community pediatric practices. Currently, Bellevue Pediatrics consists of one pediatrician, Dr. Puthenmadam Radhakrishnan, two advance practice nurses, and five staff members who are cross-trained for both front desk responsibilities and patient care duties.
In 2019, Bellevue Pediatrics participated in HPV Project Extension for Community Healthcare Outcomes (ECHO), in collaboration with the New Jersey Chapter of the American Academy of Pediatrics (NJAAP) and National AAP. Project ECHO is an innovative “spoke and hub” program that uses technology to leverage resources, foster rapid dissemination of best practices, reduce disparities and promote consistency in patient care, and apply case-based learning to improve patient health and wellness outcomes. The NJAAP HPV Project ECHO connected primary care providers (spokes) to a multidisciplinary team of HPV experts (hub), creating a virtual “knowledge network” where participants learn from each other and gain access to evidence-based and capacity-building resources.
Bellevue staff also uses the recently available patient population identification and reminder/recall tools from the NJ Immunization Registry (NJIIS). Bellevue Pediatrics routinely monitors data on their patient population to ensure they have an accurate understanding of their vaccination rates. The staff also sends out postcards and calls patients to remind them of appointments, specifically for the second dose of HPV vaccine.
Bellevue Pediatrics focuses on a team approach for increasing HPV vaccination rates. During check-in, receptionists inform parents that their child is due for the HPV vaccine, regardless of the reason for the visit. The reception area and patient rooms have educational HPV signage and pamphlets available to read. Once the patient is roomed, nursing assistants continue using scripted language to explain that vaccines are due, using the “same day, same way” recommendation. The Bellevue team is knowledgeable about the timing and administration of HPV vaccines as well as about HPV vaccine safety and effectiveness.
With an HPV vaccine completion rate for adolescents at 66%, Bellevue Pediatrics is New Jersey’s 2019 HPV Vaccine is Cancer Prevention Champion!
Indian Health Services – Jicarilla Service Unit
The Indian Health Services – Jicarilla Service Unit (JSU) is a certified, patient-centered medical home clinic in Dulce, New Mexico. JSU provides care to approximately 4,000 patients, primarily within the American Indian/Alaskan Native population and the Jicarilla Apache tribe. The Jicarilla Apache Tribe gave the clinic the name “Nzhonachi’idle’ee,” which means “a place to get well” in the Jicarilla Apache language.
In December 2018, JSU engaged in a Quality Improvement (QI) Plan using Assessment, Feedback, Incentives, and eXchange (AFIX) visits (now known as Immunization Quality Improvement for Providers, or IQIP) to target groups not up-to-date with immunizations. At the time, the adolescent HPV vaccine completion rate was 75%. The entire JSU staff worked together to implement several new strategies to increase this rate. Staff sent missed vaccination notices and reminders to patients each quarter. Pharmacists in JSU and the New Mexico State Immunization Information System (NMSIIS) liaison updated electronic health records and the NMSIIS when vaccines were administered to ensure a coordinated approach to assessing patients’ immunization status. Pharmacists also assisted in maintaining vaccine inventory.
Nursing assistants, registered nurses, and medical providers on staff made strong HPV vaccination recommendations to patients and parents. Medical assistants scheduled follow-up immunization appointments before patients left the clinic, and patients who no longer attended the clinic were inactivated, allowing for more accurate reporting of HPV vaccine completion rates. Finally, the entire JSU staff learned about HPV vaccine benefits and the recommended immunization schedule to ensure everyone was prepared to address questions from parents about the schedule and the vaccine.
At a five-month follow-up assessment in May 2019, the percentage for HPV vaccine completion rate in adolescents rose to 90%. For their hard work to improve the quality of their immunization practices, Jicarilla Service Unit is New Mexico’s 2019 HPV Vaccine is Cancer Prevention Champion!
Anna Belle Hyde, FNP-C
Anna Belle Hyde, FNP-C, is a family nurse practitioner in the School Based Health Centers (SBHC) at the Harold T. Wiley Intermediate School and Case Middle School in Watertown, New York. Both SBHC sites are sponsored by the North Country Family Health Center in Watertown. Ms. Hyde is a trusted healthcare advisor and is sought out as a respected source of HPV vaccine-related information by parents, teachers, and students.
Ms. Hyde has been a vocal HPV vaccine champion in a community where many parents are hesitant to vaccinate their children with HPV vaccine. Ms. Hyde does not assume that parents who refuse HPV vaccine will continue to refuse it in the future. Before each patient visit, she reviews the New York State Immunization Information System (NYSIIS) and offers the HPV vaccine to all eligible children, regardless of if the parent has refused the vaccine in the past. She proactively approaches parents who have refused the HPV vaccine and highlights the benefits of HPV vaccination as cancer prevention. In addition, Ms. Hyde starts the conversation about HPV prevention with parents and children around fifth grade. This early discussion gives parents an opportunity to ask questions and build relationships and trust with her over time.
Ms. Hyde explains how she approaches recommending the HPV vaccine: “Teach, teach, teach. I don’t give up on parents who decline the vaccine the first few times. Often, I will tell parents this is the only vaccine we have to help prevent cancer in your children—this is an opportunity to protect them in the future. I have fifth to eighth graders in my two clinic sites—prime vaccine time for these patients. Keep teaching about the vaccine and many times the parents will change their mind.”
Ms. Hyde’s approach to vaccine education has been successful. With an adolescent HPV vaccine series completion rate of 82%, and for her commitment to HPV vaccination education for adolescents, Anna Belle Hyde is New York’s 2019 HPV Vaccine Is Cancer Prevention Champion!
Reno Center for Child and Adolescent Health
The Reno Center for Child and Adolescent Health (RCCAH) was founded in 2010 by pediatrician and biosurveillance expert, Dr. Ron Aryel. RCCAH serves mainly Spanish-speaking patients with chronic conditions who are covered by Medicaid. Staff at RCCAH include Dr. Aryel, several bilingual medical assistants, and an officer manager, who work diligently to address cultural and language barriers in the community.
RCCAH prides itself on its efficient workflow and an office culture that supports immunizations. RCCAH’s up-to-date HPV vaccine coverage rates for 13-15-year olds are among the highest in Nevada. The Center has achieved these high rates through data maintenance, patient appointment management, and persistent messaging regarding the safety and importance of the HPV vaccine. RCCAH offers bilingual services and a highly culturally competent staff, which earns the trust of their parents and makes them more likely to trust the staff’s vaccine recommendations.
Dr. Aryel regularly encourages parents to vaccinate their children. He also acknowledges the efforts of the Center’s medical assistants. They incorporate immunizations into every visit and address all parents’ questions and concerns with empathy and understanding. They also ensure that parents book follow-up vaccination appointments before leaving the clinic.
With an adolescent HPV vaccine series completion rate of 93%, Reno Center for Child and Adolescent Health is Nevada’s 2019 HPV Vaccine Is Cancer Prevention Champion!
Cincinnati Health Department
The Cincinnati Health Department (CHD) operates seven Federally Qualified Health Centers (FQHC), one free-standing dental center, one free-standing vision and dental center and 14 school-based health centers. The CHD is a leader in HPV vaccination in Hamilton County and the state of Ohio.
As a grantee under the state’s “Get Vaccinated Ohio” initiative, the CHD has implemented several practice changes to increase HPV vaccination rates within its own health centers. The health centers now hold morning huddles to assess HPV vaccination status of patients scheduled for that day. Health center clinicians recommend the HPV vaccine the same way and on the same day as other adolescent vaccines. The CHD has also implemented reminder/recall strategies for the seven FQHCs and monitored HPV vaccination compliance using letters and phone calls.
Through “Get Vaccinated Ohio” grant funds, CHD nurses worked with the Ohio Chapter of the American Academy of Pediatrics to conduct peer-to-peer Teen Immunization Education Sessions (TIES) for nurses in its health centers and other private practices focused on the importance of HPV vaccination among adolescents. The CHD conducted 28 of these sessions from July 2018-June 2019. During the same time period, the CHD performed 29 Assessment, Feedback, Incentives, and eXchange (AFIX) (now known as Immunization Quality Improvement for Providers, or IQIP) audits in their jurisdiction. As a result of these audits and educational sessions, all Hamilton County healthcare providers have been engaged in improving their HPV vaccination rates.
“Get Vaccinated Ohio” has also supported the health department’s efforts to educate the wider community about the importance of HPV vaccine. The CHD provides adolescent vaccine information for families in both English and Spanish at community health fairs. For example, the team created an HPV vaccination flyer listing YouTube videos about adolescent immunizations. The team also promotes HPV vaccination on CHD social media platforms throughout the year.
Thanks to these efforts, the health department’s health centers have achieved an HPV vaccine completion rate of 82%. For its role in promoting HPV vaccination within its own health centers and throughout Hamilton County, the Cincinnati Health Department is Ohio’s 2019 HPV Vaccine is Cancer Prevention Champion!
Southwestern Pediatrics serves a high volume of patients in a large urban area in southwestern Oklahoma. Dr. Ezhilarasi Manickavasagam leads the practice and strives to provide exceptional care to patients and their families.
Dr. Manickavasagam and her team use several best practice techniques to encourage patients to vaccinate on schedule. They present all adolescent immunizations that are due for patients during every clinic visit. The team also recommends the HPV vaccine in the same way as other adolescent vaccines. If patients or parents delay or decline the HPV vaccine, staff discusses the risks and benefits of receiving (or not receiving) the vaccine. They also provide educational handouts with further information regarding the importance of the vaccine to supplement vaccine conversations.
The practice team members also work closely with the state health department to stay informed of their immunization rates. They use the Oklahoma State Immunization Information System (OSIIS) to print out vaccination records for every patient at all appointments to ensure there are no missed opportunities to vaccinate. Additionally, staff generate lists of patients who are overdue for vaccinations and use a reminder/recall system to encourage patients to schedule an appointment to receive their vaccines.
The clinic has an impressive 77% HPV series completion rate for their adolescent patients. Their focus on effective vaccine recommendations and office practices is why they are Oklahoma’s 2019 HPV Vaccine is Cancer Prevention Champion!
Warm Springs Health and Wellness Center
Warm Springs, OR
The Warm Springs Health and Wellness Center, located in central Oregon, is a primary care clinic dedicated to providing quality healthcare to American Indians and Alaska Natives. They work closely with the Confederated Tribes of Warm Springs health programs to ensure effective and high-quality healthcare that is responsive to the needs of their community.
Warm Springs Health and Wellness has built collaborative relationships on local, county, and state levels. Staff effectively partners with the Confederated Tribes of Warm Springs to thoroughly examine each patient’s vaccination record before his/her appointment. Staff also recommends HPV vaccination the same way and same day as other adolescent vaccines. They ensure that the patient receives every vaccine that is due and schedules a follow-up appointment to encourage completion of the vaccine series. This collaboration also includes working with the dental clinic to forecast immunizations needed for dental patients. Dental staff then escorts patients to the primary care clinic to receive vaccines after their dental work is done.
At the county level, the clinic collaborates with the county health department, and participates in quality improvement efforts. Staff also provides leadership to communities throughout the state on HPV immunization. For example, one staff member presented and led a discussion on their clinic’s quality improvement practices at a statewide HPV Summit.
The Warm Springs Health and Wellness Center has achieved an impressive 73% completion rate among their adolescent patients. Their staff’s focus on partnerships at all levels are why the health center is Oregon’s 2019 HPV Vaccine is Cancer Prevention Champion!
University of Pittsburgh Medical Center— St. Margaret Bloomfield Garfield Family Health Center
The University of Pittsburgh Medical Center (UPMC) St. Margaret Bloomfield Garfield Family Health Center was established in 1984, in a disadvantaged urban neighborhood in Pittsburgh, Pennsylvania. The health center serves predominantly low income and African American patients, registering 10,000 patient visits per year. It also serves as headquarters for the school health partnership with five East End Pittsburgh schools.
Over the past few years, the health center pursued two successive quality improvement projects to increase HPV vaccination rates for their patients. These projects have been successful due to strong leadership and enthusiastic participation of the entire staff. Serving as the health center’s vaccine champion, Dr. Donald Middleton teaches residents and faculty to make an effective recommendation using presumptive language. In addition to being a champion for the health center, Dr. Middleton also shares his expertise on how to make effective vaccine recommendations at local, UPMC system, county, regional, and national meetings.
Staff at the health center take prevention seriously, while addressing it in fun, engaging ways. Creativity and perseverance are the hallmarks of their HPV vaccination improvement project. One of the health center’s pharmacists interviewed students at a local high school; the students recommended posters containing facts about HPV consequences, an immediate reward for vaccine receipt, and text messaged vaccination reminders. The health center also sponsors an HPV poster contest in the local community; the winning posters are included in their fifth-grade puberty classes and educational materials.
These efforts led the health center to an impressive 77% completion rate for both male and female patients. For their innovative approach to improving vaccination rates in their community, the UPMC St. Margaret Bloomfield Garfield Family Health Center is Pennsylvania’s 2019 HPV Vaccine Is Cancer Prevention Champion!
Tandem Health is a Federally Qualified Health Center (FQHC) and accredited patient-centered medical home (PCMH) that provides comprehensive, personalized healthcare services to the community in Sumter, South Carolina, regardless of the patient’s ability to pay. Their healthcare team consists of physicians, dentists, physician assistants, nurse practitioners, pharmacists, and health educators.
Spearheaded by Allison C. Shuler, RN, MSN, Chief Clinical Officer, Tandem Health has established itself as a leader in HPV Vaccination among the state’s community health centers. In January 2019, Tandem Health joined the South Carolina Primary Health Care Association and the American Cancer Society as a member system of the South Carolina HPV Cancer Free Learning Collaborative. Ms. Shuler serves as a peer mentor for seven additional FQHC member systems during monthly meetings, where she shares examples of the evidence-based strategies and quality improvement processes which have worked for Tandem Health.
Within the practice, the Tandem team works to reduce missed opportunities for HPV vaccination. Some of these strategies include: conducting assessments of provider’s vaccination rates and establishing incentives to improve rates; establish reminder/recall systems; and outreach to parents on the benefits of vaccination using social media channels. They also conduct frequent staff trainings on strategies for improving HPV vaccination rates, incorporating both clinical and non-clinical staff.
Ms. Shuler and Tandem staff members educate their community on the importance of HPV vaccination by distributing printed materials to parents/guardian at events sponsored by faith-based and community organizations. For example, in August Tandem Health threw a back-to-school event geared toward adolescents and their parents. When attendees signed in, staff checked vaccination records and scheduled HPV vaccination appointments as needed.
Thanks to these efforts, Tandem Health has achieved a 78% series completion rate among adolescent patients. For their efforts to protect their community and mentor others, Tandem Health is South Carolina’s 2019 HPV Vaccine Is Cancer Prevention Champion!
Sewanee Pediatrics and Adolescent Medicine
Dr. Amy Evans founded Sewanee Pediatrics in 1994. A mother of three, Dr. Evans understands the importance of vaccination. After she reviewed an HPV immunization report with her field representative, Dr. Evans discovered that her clinic’s rates were not as high as they could be. She then decided to specifically focus on improving HPV vaccination rates.
To improve HPV vaccination rates among adolescent patients, Sewanee Pediatrics requested a monthly reminder/recall list and forecast report from TennIIS (the Tennessee Immunization Information System). This allowed the staff to find and contact families with adolescents who were due and overdue to receive the HPV vaccine. Every morning, the staff huddled and reviewed the scheduled patients for the day.
The Sewanee staff also made a point of discussing vaccines during each patient visit, using a presumptive approach when presenting vaccines to families. In addition, when walk-in patients came in for sick visits or non-well child appointments, a nurse reviewed the immunization history and determined if they were due for any vaccines.
The adolescent HPV vaccine completion rate for Sewanee Pediatrics increased from 51% in September 2017 to 70% in September 2019. For their consistent efforts to increase adolescent HPV vaccine completion rates, Sewanee Pediatrics is Tennessee’s 2019 HPV Vaccine Is Cancer Prevention Champion!
Southridge Pediatrics, in Riverton, Utah, is part of the Intermountain Medical group, a system of 22 hospitals and around 180 medical clinics. Southridge Pediatrics has eight pediatricians who support and promote HPV vaccination for all eligible patients.
Southridge Pediatrics developed an innovative process to capture and track HPV vaccination rates within their patient population. Southridge staff identifies patients who are of age to receive the HPV vaccine, and the provider gives their professional recommendation to parents and patients to start the series. Once the series is started, a reminder card is given for the next dose of HPV vaccine, which also automatically creates a phone call appointment reminder for the parent. Finally, each child’s immunization schedule is checked at all visit types through the Utah Statewide Immunization Information System (USIIS) Forecast, to accurately identify patient vaccination needs.
Southridge Pediatrics providers are proactive in educating parents/patients on the importance of the HPV vaccine. They want families to understand that the vaccine is safe and prevents cancer. They have held HPV vaccination training for all staff members, so everyone is knowledgeable about the vaccine and able to address questions. Immunizations are an important part of Southridge Pediatrics’ patient care, so the entire staff, from the top down, know how to effectively discuss the HPV vaccine with parents and patients.
The practice’s vaccine tracking process and proactive patient education have resulted in an adolescent HPV vaccine series completion rate of 77%, making Southridge Pediatrics Utah’s 2019 HPV Vaccine Is Cancer Prevention Champion!
Elizabeth Watts, MD
Dr. Elizabeth H. Watts is board certified in pediatrics and has been practicing at the Vienna Pediatrics office of Capital Area Pediatrics (CAP) since 1988. CAP is a group of five practices spread across northern Virginia. Dr. Watts is the CEO and Medical Director for CAP.
Dr. Watts is committed to combatting the challenges associated with HPV vaccination and understands the importance of strong physician recommendations. Dr. Watts has implemented lunch and learn sessions to ensure both providers and support staff have a comprehensive understanding of the importance of HPV vaccination. She consistently works with data quality staff to review each practice’s rates and help each practice set 6-month goals for HPV immunization improvement. Each practice location has a vaccine champion, all of whom come together to form their inter-practice vaccine advisory group. These tactics inspire competition, while ensuring that practices that are falling behind receive the assistance to improve their approach.
Dr. Watts works with the American Academy of Pediatrics-Virginia’s HPV Maintenance of Certification Committee. She is also a member of the INOVA Health System’s Signature Partners group, where she has been able to share her work with other practices. She continuously seeks to encourage the providers in her practice to seek educational and networking opportunities by attending continuing education events and working with the Virginia HPV Immunization Taskforce.
Thanks to the efforts of Dr. Watts, Capital Area Pediatrics has achieved a 74% series completion rate among patients age 13-15 years. For her dedication to reducing challenges to HPV vaccination, Dr. Elizabeth Watts is Virginia’s 2019 HPV Vaccine Is Cancer Prevention Champion!
Lakeshore Community Health Care
Lakeshore Community Health Care (LCHC) provides quality, affordable care to residents of Sheboygan and Manitowoc Counties in eastern Wisconsin, regardless of their insurance status or ability to pay for services. This is especially important because more than 80% of the clinic’s patients are uninsured or on Medicaid. In addition, many patients have limited literacy skills and face complex health issues. In light of these factors, LCHC staff concentrate on wellness and prevention, with a special focus on vaccine-preventable diseases.
LCHC improves HPV vaccine uptake by providing every staff member with motivational interviewing training. These trainings help staff to improve and gain confidence in their communication skills, talk to parents with empathy and understanding, and help them feel comfortable in their decision to vaccinate.
The clinic also uses a “same way, same day” approach to ensure that every patient receives vaccine the day of their appointment, no matter which provider he or she sees. Each provider reviews their patient’s vaccination records before the appointment, including physicians, pharmacists, dentists, behavioral health providers, and chiropractors. This eliminates missed opportunities to provide HPV and other needed vaccines at clinic appointments. Staff members understand that this is especially important with their adolescent population, as young teens tend to not see a primary care provider often. Their hard work has led them to an impressive 77% HPV vaccination rate for their adolescent patients.
For Lakeshore Community Health Care’s dedication to engaging all staff in promoting HPV vaccination in an underserved community, they have been named Wisconsin’s 2019 HPV Vaccine is Cancer Prevention Champion!
The Nursing Team of University of Wyoming Family Practice Clinic
The University of Wyoming Family Practice Clinic is a Federally Qualified Health Center (FQHC) located in Wyoming’s second largest city, Casper. The clinic is a safety net provider to the community, with 20% of their patient population being uninsured.
Along with their FQHC partner clinics, the Wyoming Family Practice Clinic participated in a cohort-based Quality Improvement (QI) project with the National Improvement Partnership Network in order to improve their HPV vaccination rates. As part of the QI project, staff conducted education and training sessions at residency didactic sessions. The nursing team conducted staff surveys to measure perceived barriers to HPV vaccination. They also updated patient and parent HPV handouts to include information on the role that HPV vaccination plays in preventing cancers.
The clinic’s nurse manager, Becky Griffith, served as the HPV champion for the project. Ms. Griffith collaborated with providers, staff, and leadership to improve HPV vaccination rates in the FQHC partner system in multiple cities across the state. One of the most effective interventions Ms. Griffith implemented was to check the WyIR (Wyoming Immunization Registry) to assess vaccination status during the pre-visit planning for every pediatric and adolescent visit. As a result of this intervention, the clinic reduced missed vaccination opportunities by 20%.
Their dedication to improving HPV vaccination rates has led to a 50% increase in their series completion rates. With a 62% series completion rate for their adolescent patients, UWFPC-Casper’s nursing team is Wyoming’s 2019 HPV Vaccine is Cancer Prevention Champion!