TxHPVCoalition Rest of the State 46.8% Dallas County 45.7% El Paso County 79.8% Bexar County (San Antonio) 53.4% City of Houston 62.6% #46 out of 51 *NIS-Teen Data: Overall Texas is 49.3% in 1 HPV vaccination coverage. 1
Senate Bill 200 Called for a strategic plan to be developed to increase HPV vaccination rates without the use of a state mandate by December 31, 2016 Health and Human Services Commission collected input from multiple sources for the report: Immunization Branch (DSHS) Texas Cancer Registry Cancer Prevention Research Institute of Texas (CPRIT) External Partners: Texas Medical Association, Texas Pediatric Society, MD Anderson Cancer Center, American Cancer Society, plus many more HPV Environmental Scan 2014 Received National Cancer Institute Cancer Center Supplemental Grant Identified barriers and facilitators to HPV vaccination in State of Texas Published December 2015 Informed design for Information Transfer project http://www.texascancer.info/hpv/ Javid M et al J Community Health 2016 Jul 29 2
To view the strategic plan, visit: https://www.dshs.texas.gov/immunize/ docs/hpv/2016-strategic-plan.pdf The - Who we are American Cancer Society Cancer Prevention and Research Institute of Texas Texas Medical Association AHEC- Area Health Education Centers Texas Academy of Family Physicians Texas Tech University Health Sciences Center, El Paso UT Southwestern, Simmons Comp. Cancer Center Texas School Nurses Organization Merck, Inc. The Immunization Partnership DSHS- Comprehensive Cancer Control Program DSHS- Immunizations Department Texas Children s Hospital Texas Pediatric Society Amistad Clinic UT School of Public Health, Center for Health Promotion MD Anderson Cancer Center Baylor College of Medicine CDC/AFIX Grantee: Houston CDC/AFIX Grantee: San Antonio 3
February 2017, some common assumptions The HPV Vaccine is safe. Vaccines work. The HPV Vaccine is cancer prevention. The HPV vaccine is recommended for 11 & 12 year olds. This coalition is not funded. Future planned activities that require resources may require also securing those resources. This coalition will focus on efforts where we can have a bigger impact through collaboration. Individuals and organizations will continue to maintain their separate HPV projects/initiatives outside of this collaborative space. Cross Sector Collaboration $ Incentives Make Vaccines Accessible Systems Provider Improvement Awareness Data/Tech Legislation Education Research & Development Active Coalition Website with state Resources and Grants Received Availability. People work across sectors for common goal of increasing vaccination. Cross-sector community based initiatives to diffuse knowledge + practice. Effective interventions at community, patient, provider and system levels are widely adopted and implemented. Improve providers reimbursement for HPV administration. Make HPV vaccination rates quality measures. Physician incentives to routinely recommend. School Vaccine Programs. Create Texas HPV Day. Increase Types of Providers. (e.g.. Pharmacists) Cheaper Vaccine. Systematic Implementation of all EBI s by clinics. Standing orders in health systems. Vaccine storage and handling education. Identify champion pediatrician and work through them with the community providing some $. Increase number of providers administering HPV vaccine TVFC providers. Increase demand from parents. Run HPV/Cancer prevention ads, PSA s, social media, etc. More public awareness campaigns. Texans know HPV vaccine is cancer prevention. Effective PSA s in all media. Create statewide HPV vaccination day. Create scalable peer to peer parent hesitancy program. Testimonials use ACS and other resources. Data is used to drive improvement. Statewide HPV Registry or Immtrac Opt out. Schools are scored on their HPV coverage levels on a star system. Interoperability of computer systems and use of technology. Parents have access to school level vaccination data. Schools monitor HPV vaccination (even if not mandated). Direct to provider education. All staff at provider offices are trained on how to make a strong HPV vaccination recommendation. Residency communication skills. Vaccine storage and handling education. Consistent and strong recommendation from all providers for all eligible ages. State mandate for school attendance. State mandated vaccination policy for school entry. Mandate. Mandate linking immunizations with et. Food stamps, WIC, public housing, transportation use. Opt out Immtrac. Require that all vaccinating Medicaid providers participate in TVFC. ACA stays as is. Alternative Delivery System to Shots. Single dose vaccine. (5) (7) (0) (22) (26) (13) (27) (7) (0) 4
Low Feasibility High Feasibility Most Important Least Important Legislative Mandate Pro Vaccine Culture Policy (other than mandate) Awareness $ Incentives Data/Tech Systems Improvement Provider Education Research & Development 5
TEXAS STATEWIDE HPV COALITION WORKING GROUPS Awareness Data/Tech Financial Incentives Systems Improvement Provider Education A Path Forward Steering Committee Workgroup meetings Full Coalition meeting spring 2018 Website (parent & provider use) Campaign Development Enhanced Communication Breaking Silos Leveraging Resources 6
Data and Technology Workgroup Data is Foundational to Impact Our Low Rates Workgroup Goal: Improve the quality and availability of multi-level HPV vaccination data across the state of Texas Coalition members will partner to: 1. Increase awareness about current data inadequacies and importance of high-quality data; 2. Facilitate availability of high-quality data to geographic areas and populations within TX to: Enable providers, clinics, & healthcare systems to benchmark their performance and measure their progress over time; Support evaluation of interventions and quality improvement initiatives 3. Monitor HPV vaccination rates in sub-populations, smaller geographies, and the state overall; and 4. Create infographic-based materials that motivate parents and local stakeholders to support a pro-hpv vaccine culture. 7
Rest of the State 46.8% Dallas County 45.7% El Paso County 79.8% Bexar County (San Antonio) 53.4% City of Houston 62.6% #46 out of 51 *NIS-Teen Data: Overall Texas is 49.3% in 1 HPV vaccination coverage. Provider Education Workgroup 8
In-person Meeting Held in August 2017 Stakeholders gathered at MD Anderson and determined 3 priorities: Create a central repository for resources, tools and data research Early provider education opportunities (core curriculum) Identifying a toolkit for Texas School Nurses Organization to disseminate Further Work-Focused Targets Early provider education opportunities (core curriculum) Focus on future providers- eg. medical students (possibly 1 st years) Cultivate a list of prospective Texas pilot sites Review data from recent medical school survey Discuss with curriculum deans at the medical schools Present information on UTHSC HPV module (year 2) Focus on Texas medical assistants (possible pilot project) Toolkit for Texas School Nurses Organization Identification and tweaking of existing tool kits TSN only with 1/3 of school nurses; DSHS may be best avenue for getting the education/tool kits to SN AHEC partnership and school in-services may be a good goal State Repository Is another repository needed? How to keep it current? How to link with National Efforts (CDC/ACS) Create a website for the coalition to provide both outward facing for parents and teens + internal space for coalition collaboration 9
Parallel Work with Partners Texas Medical Association: https://www.texmed.org/hpv/ National HPV Roundtable: National Provider Work Group (https://www.cancer.org/health-care-professionals/national-hpvvaccination-roundtable.html) National HPV Roundtable: Resource library https://www.mysocietysource.org/sites/hpv/resourcesandeducation/sitepag es/home.aspx National HPV Roundtable: CME on increasing coverage https://www.cmeuniversity.com/course/content/114605 National HPV Roundtable: Oropharyngeal cancer HPV Education Video https://www.youtube.com/watch?v=qnwb2- y_ypu&index=13&list=plru0uhzo7tdkdq1tstwynbsn0kmi8l4-- 10
Financial Incentives Workgroup 11
Workgroup Next Steps 1. The Financial Incentives workgroup is developing a formal survey to determine what the financial incentive barriers and opportunities around creating HPV vaccine uptake would be 2. The survey results can help shed light about real life issues with low immunization rates and help us prioritize our coalition activities Systems Improvement Workgroup 12
Systems Improvement Why Systems Improvement? To support delivery of care To support adoption of evidencebased strategies to increase vaccination To support quality Improvement and evaluation Work Group Process First in-person meeting Monthly calls August 2017 First in-person meeting The Immunization Partnership San Antonio Metro. Health District Department of State Health Services American Cancer Society Merck UT SPH, Center for Health Promotion, Houston Texas Tech University Health Science Center, El Paso MD Anderson Work Group Process Group Brainstorm Barriers & Challenges Develop Achievable Objectives 13
Systems Improvement Year One Objectives 1. To identify use of Health Information Technology (HIT) to implement evidencebased intervention strategies (EBI s ) to increase HPV vaccination initiation and completion 2. To identify trainings and/or programs that deliver HIT-based EBI s that target clinic HPV champions/managers, clinical staff or patients 3. Recognition Program Overall Goals 1. Identify systems-based approaches used to increase HPV vaccination in Texas 2. Identify and disseminate evidence-based tools, resources, and protocols to increase adoption of systems-based strategies aimed at increasing HPV vaccination or completion 3. Maintain and recruit members Systems Improvement: Identify Obstacles - Barriers Challenges Capability of EHR systems vary (e.g., Athena, EPIC, etc.) Capacity of IT to support systems improvements focused on HPV vaccination initiatives Ability to identify clinic-based HPV vaccination champions to coordinate systems improvement Other 14
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New Public Facebook Group: HPV Cancer Free Family 16
Additional HPV Roundtable Resources Provider Training Task Group 2017 work products 17
Oropharyngeal Video: bit.ly/hpv_orovideo Free CME E-Learning for Pediatric & Primary Care Providers CREDIT: https://www.cmeuniversity.com/course/disclaimer/114605#01 NON-CREDIT: http://bit.ly/providerhpvvideo 18
We are not just building a campaign We are building a movement... 19
WE ARE STARTING A MOVEMENT 1959 20
Vaccines Work. OUR GOALS: Increase routine HPV vaccination rates for preteens Eliminate gender disparity and reduce geographical disparities in HPV vaccination 21
OUR OBJECTIVES 1. Increase routine HPV vaccination rates for preteens Increase national HPV vaccination series completion rate among 13-year-olds to at least 80% by June 8, 2026 Increase each state s HPV vaccination series completion rate among 13-17-year-olds to their rate of Meningococcal vaccination among 13-17-year-olds by June 8, 2026 2. Eliminate gender disparity and reduce geographic disparities in HPV vaccination Increase male HPV vaccination series completion rate among 13-year-olds to that of females in each state by June 8, 2026 Increase HPV vaccination rates in geographic locations lagging behind the national average OUR 5 KEY STRATEGIES: 1. STRENGTHEN PROVIDER RECOMMENDATIONS 2. ACTIVATE PARTNERS AND STAKEHOLDERS 3. KNOW YOUR DATA & TRACK PROGRESS 4. EVIDENCE BASED INTERVENTIONS AND SYSTEMS CHANGES 5. INCREASE PARENTAL KNOWLEDGE 22
OUR STRATEGIC AUDIENCES Health systems and providers Parents Staff Key Partner Organizations Donors Discussion and Questions For more information on the, please contact: Greg Parkington Senior Manager, State Health Systems American Cancer Society Greg.Parkington@cancer.org 512-919-1854 TxHPVCoalition 23