Quality Improvement Partnership to Improve Human Papillomavirus Vaccine Rates: Start at Age 9 Campaign

Human papillomavirus (HPV) infections and HPV-related cancers are preventable with vaccination. Initiating the HPV vaccine series at ages 9-10 years is associated with improved vaccination uptake and series completion. This quality improvement (QI) initiative aimed to increase first-dose HPV vaccination rates among 9- to 10-year-olds through the implementation of evidence-based interventions.

Data were collected from electronic health records (EHRs) of established patients aged 9-10 years with at least 1 documented well-child visit annually from 2021 to 2024. Baseline data were obtained from January 2021 through May 2022. Interventions included provider education, adoption of a system-wide "Start at 9" policy, patient-facing educational materials, and EHR modifications to integrate HPV vaccine orders for patients aged 9 years and older. Monthly vaccination trends were evaluated using a P-chart.

A total of 9315 patients aged 9-10 years were included. The percentage of eligible patients receiving their first HPV vaccine increased from a baseline of 2% to 14% following the adoption of the "Start at 9" policy in conjunction with targeted educational interventions and EHR integration. A P-chart demonstrating special cause variation aligned with 2 QI interventions, indicating a sustained process shift. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination rates, used as balancing measures, remained stable throughout the study period.

A coordinated, systems-level QI approach was associated with significant gains in early HPV vaccine initiation, supporting initiation of vaccination at age 9 years as an effective strategy to promote timely vaccination and strengthen preventive health outcomes.