OVERVIEW WHY THE TOOL? 5/14/18 ASSESSING HPV IMMUNIZATION TRENDS IN 1 MINUTE WHY THE TOOL? HPV ASSESSMENT TOOL USING THE TOOL TO TAKE ACTION RESOURCES

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1 May 2018 ASSESSING HPV IMMUNIZATION TRENDS IN 1 MINUTE ERIKA LOBE, MPH ADOLESCENT/ADULT IMMUNIZATION COORDINATOR OVERVIEW WHY THE TOOL? HPV ASSESSMENT TOOL USING THE TOOL TO TAKE ACTION RESOURCES WHY THE TOOL? 1

2 ADOLESCENT ACIP RECOMMENDATIONS Age: years Vaccines recommended: * Tdap HPV (multi-dose series) * Meningococcal conjugate 16 years Meningococcal conjugate (booster) All ages Flu (each year, 6 mos.+) Travel-specific vaccines (as needed) *Indicates NJ school requirement Percent Vaccinated 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Adolescent Vaccination Coverage, years, by Antigen, New Jersey and US, NIS-Teen (2016) 91.7% 82.2% *NJ data not available 39.1% 89.9% 88.0% Dose #1 Dose #2 At least 1 dose At least 1 dose UTD Dose for % 60.4% 42.8% 43.4% 48.3% 48.8% MenACWY Tdap HPV Flu* New Jersey United States *FluVaxView: TeenVaxView: MMWR - HPV INFECTIONS Most people will be infected with at least one type of mucosal HPV at some point in their lives Estimated 79 million (about 1 in 4) Americans are currently infected 14 million new infections each year in the US Every year in the US, 27,000 people get cancer caused by HPV. Satterwhite et al. Sex Transm Dis

3 100% Estimated Vaccination Coverage for HPV 1+ Dose, years, by Gender, New Jersey and US, NIS-Teen ( ) 90% 80% 70% Percent Vaccinated 60% 50% 40% 30% 20% 10% 0% Female NJ Female US Male NJ Male US Both NJ Both US TeenVaxView: BCBS ADOLESCENT IMMUNIZATION RATES SOURCE: BLUE CROSS BLUE SHIELD, THE HEALTH OF AMERICA REPORT MOST CLINICIANS WAIT TOO LONG TO MAKE STRONG RECOMMENDATIONS FOR HPV VACCINE Allison et al. 3

4 HPV ASSESSMENT TOOL HPV COVERAGE ASSESSMENT TOOL Tips and reminders about adolescent and HPV vaccination Interactive chart to help track HPV doses administered This specific chart only assess the first dose of the HPV series for patients years. HPV:TDAP RATIO Number of Doses Administered by Month by Antigen (140 Facility Sample) Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q HPV Tdap 4

5 RATIO à COVERAGE 100% HPV:Tdap Ratios as Compared to HPV 1st Dose Coverage for Adolescents years (111 facility sample) HPV FIRST DOSE VACCINATION COVERAGE 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% HPV:TDAP RATIO HOW IS THE TOOL COMPLETED? Step 1 Step 2 Detailed instructions are included with the tool ADOLESCENT IMMUNIZATION COVERAGE REPORT Y N N Y Y Y 5

6 PRELIMINARY RESULTS VFC CYCLE Start VFC sites are selected at random Sites with similar patient population size that are not selected fall into the control group Evaluate at: 3 month 6 month 1 year Facility-specific report generated and tool completed to date Report and tool discussed during VFC compliance visit ADOLESCENT IMMUNIZATION COVERAGE REPORT Facility-specific coverage data (yellow) as compared to national (purple) and state (blue) rates. Facility-specific coverage data from CoCASA for all recommended vaccines. Includes percent of patients with missed opportunity to have received the specific vaccination. Data sources used to create the report. 6

7 ADOLESCENT IMMUNIZATION COVERAGE REPORT HPV doses administered report for the year prior. This presents information by age group on the number of patients who received HPV doses 1, 2, or 3. Graph showing the ratio of HPV (orange) to Tdap (blue) doses administered for each quarter. Reminder that the data used to create this report is from NJIIS. If other doses of HPV were administered but were not entered in NJIIS, then they were not included in this analysis. PRELIMINARY RESULTS Dose administered ratios of HPV first dose to Tdap, in decimal format, for year patients Dose administered ratios of HPV first dose to Tdap, in decimal format, for 7-12 year patients Control (54 facilities) Intervention (52 facilities) Control (59 facilities) Intervention (54 facilities) Pre-intervention Post-Intervention Target Pre-intervention Post-Intervention Target TAKE ACTION 7

8 STRONG PROVIDER RECOMMENDATION The single best predictor of a patient receiving an HPV vaccination is a strong provider recommendation. Mention the child s age Announce the child is due for 3 vaccines recommended for children this age Place HPV vaccine in the middle of list Say you will vaccinate today EVIDENCE-BASED STRATEGIES TO IMPROVE VACCINATION COVERAGE Check vaccination status at each visit Reminder/recall Provider level (e.g., EMR prompts) Parent/patient level (e.g., postcards, telephone calls, text messaging) Standing orders Utilizing immunization information systems (NJIIS) Provider assessment and feedback Assessment of vaccination coverage levels within the practice and discussion of strategies to improve vaccine delivery TIPS TO IMPROVE DATA QUALITY 1 Remove inactive patients from your patient list in the registry 2 Log all HPV vaccinations in NJIIS, regardless of VFC status 3 Add historical vaccinations for new patients in NJIIS if not already recorded 8

9 CDC HPV CHAMPION AWARD Vaccination Rates: must reach target series completion rate of 70% for the patient population aged years. The rate must account for both female and male patients. RESOURCES CDC RESOURCES *Available in hard copy from NJDOH 9

10 NJDOH RESOURCES Available in English & Spanish

11 PROTECT ME WITH 3+ (PMW3+) Annual youth contest, adolescent immunization website, social media campaign Website contains: info for parents and youth, prior winning entries (video & posters), classroom activity ideas, submission forms 11