HPV Vaccine Completion by 13: a Quality Improvement Initiative in a Large Primary Care Network

Fewer than 40% of U.S. children complete the human papilloma virus (HPV) vaccine series before their 13th birthday. In our large pediatric primary care network, HPV vaccine completion rate by age 13 was 30%. We hypothesized that a phased quality improvement (QI) initiative would increase rates of HPV vaccine completion by age 13 across our network.This QI initiative was conducted in a network of 30 practices located across 2 states, in urban and suburban settings, consisting of teaching and non-teaching clinics, and ranging in size from 3 to 50 providers per office. We used a phased approach incorporating multicomponent network-wide and iterative practice-specific interventions. Key interventions included: updating clinical decision support to default order HPV vaccine due at preventive visits starting at age 9 instead of 11, data audit and feedback to providers and practices, encouraging use of a strong provider recommendation, and standing orders.From April 2019 to October 2022, HPV vaccine completion by age 13 across our network increased from 30% to 55% and met criteria for special cause variation on statistical process control charts. A gap in median HPV vaccine completion by age 13 between patients with public insurance and patients with private or commercial insurance decreased from 9% to 1%.A QI initiative was associated with a sustained increase in HPV vaccine series completion by age 13 and reduced variation in care across a large network of 30 primary care practices.