Electronic Health Record Alerts for Early Human Papillomavirus Vaccination

Area of Science:

• Public Health
• Vaccinology
• Health Informatics

Background:

• Human papillomavirus (HPV) vaccination uptake remains suboptimal despite recommendations for initiation as early as 9 years of age.
• Identifying effective strategies to improve early HPV vaccination initiation and series completion is critical for public health.
• Quality improvement initiatives are essential for optimizing vaccination schedules and coverage.

Purpose of the Study:

• To compare the effectiveness of two interventions on early HPV vaccine initiation.
• To compare HPV vaccine series completion rates between youths initiating vaccination at 9-10 years versus 11-14 years of age.
• To identify factors associated with early HPV vaccination initiation and series completion.

Main Methods:

• A retrospective quality improvement study analyzed data from 21 US outpatient primary care sites.
• Electronic health record (EHR) best practice alerts (BPAs) recommending HPV vaccination at age 9 were implemented, with one arm including an additional clinician education component.
• Youths aged 9-14 years with no prior HPV vaccination and complete EHR data were included; descriptive statistics and survival analyses were used.

Main Results:

• The intervention combining EHR BPA with clinician education significantly increased the likelihood of HPV vaccine initiation in 9- to 10-year-olds compared to the BPA-only group (adjusted hazard ratio, 1.39).
• While series completion was initially lower among younger initiators, by year 3, those aged 9-10 years had a higher cumulative completion rate (33.9%) than those aged 11-14 years (30.7%).
• Black or African American race and public insurance were associated with both HPV vaccine initiation and completion.

Conclusions:

• An EHR best practice alert coupled with clinician education is an effective strategy to promote early HPV vaccination initiation.
• Early initiation of HPV vaccination, although potentially leading to delayed series completion, ultimately results in improved overall completion rates.
• Addressing racial disparities and socioeconomic factors, such as public insurance status, is important for improving HPV vaccination coverage.