Implementing Quality Improvement to Address Low Adolescent Vaccination Rates

By Maria Stock, Fairfax County Health Department, VA

This article originally ran in NACCHO’s Stories from the Field.

When the opportunity to join the third cohort of the NIPA Quality Improvement Learning Collaborative arose, the Fairfax County Health Department (FCHD) joined to help address challenges related to adolescent vaccination rates.

A couple years ago, Fairfax County was struggling with low HPV vaccine initiation and completion rates, and the health department was considering how to initiate a quality improvement (QI) project targeting adolescent vaccination. In 2016, we were given the opportunity to join the third cohort of the National Immunization Partnership with the APA (NIPA), a large-scale, QI Learning Collaborative designed to prioritize HPV vaccination at every adolescent visit.

We established an HPV Quality Improvement Project Committee to participate in the NIPA Cohort. The committee consisted of multidisciplinary members that represented all five District Office clinics within FCHD. Members attended all webinars that were presented in the Cohort and met immediately after to discuss each presentation and make plans for implementing the NIPA recommendations at FCHD. We quickly realized we needed to shape the recommendations into ones that worked in a health department setting, where services such as well visits and sick visits are not among the offered services. Through this process, we were able to adjust provided recommendations into guidelines that not only met the spirit of the recommendations, but could also be easily implemented at our District Office clinics.

After viewing NIPA webinars, such as “Giving a Strong Provider Recommendation for HPV Vaccine,” our public health nurses changed their practice to implement strong provider recommendations, which resulted in excellent outcomes! Fairfax County Health Department increased vaccination initiation rate for eligible teens by 11% over the baseline rate and improved the series completion rate of HPV vaccination for eligible teen patients from a baseline of 14.7% to 26.7%. We also reduced HPV missed opportunities for eligible teens by 24% over our baseline.

Through our participation in NIPA’s QI Learning Collaborative, we made many practice improvements that continue today, including:

  • Offering adolescent vaccines the same way, on the same day
  • Providing CDC Adolescent vaccine information sheets to parents of teens at check-in
  • Hanging CDC Informational HPV posters in clinic lobbies and exam rooms
  • Using the “Parent’s Guide to Preteen and Teen HPV Vaccination” handout to aid in exam room discussions with parents/teens
  • Modifying our service slip/billing form to include a “declined” box to help with chart audit analysis
  • Modifying new hire orientation guidelines to include new practices
  • Conducting quarterly chart audits beginning in 2019 to measure progress

We are thankful that we participated in the Cohort as it helped us implement effective, evidence-based strategies and other practice improvements to increase HPV vaccination rates at the Fairfax County Health Department.