Background: Each year, 14 million Americans are diagnosed with HPV and 33,700 Americans are diagnosed with a cancer caused by HPV. The HPV vaccination can prevent 92% of these cancers. In 2018 only 42.74% of adolescents in Wisconsin ages 13-18 had completed the HPV series and only 56.47% had received the first dose. Hospitalization represents a critical opportunity to address this significant disease burden. Educating health care providers about ways to recommend the vaccination serves as a route to increasing vaccination rates. In this study, a training seminar regarding the HPV vaccination was presented to pediatric hospital medicine physicians and advanced practice providers and pediatric residents. Our objective was to assess HPV vaccination rates of hospitalized adolescents before and after this training.
Methods: This study included adolescents 13 years and older who were discharged from the hospital medicine service at a tertiary children’s hospital. Baseline data was collected from 05/01/2019-06/31/2019. The seminars took place on 07/17/2019 and 07/19/2019. Post seminar data was collected from 7/20/2019-9/21/2019. Data collected included: demographics, length of stay, reason for hospitalization, admitting service, documentation of routine immunizations, HPV vaccination status, and if the patient received the HPV, Meningitis, or Tdap vaccine prior to discharge. All information regarding patient vaccinations were collected from the Wisconsin Immunization Registry (WIR). The exclusion criteria included patients not from Wisconsin, contraindications for immunizations, and developmental delay or history of traumatic brain injury. The training was presented at a pediatric house staff meeting and a hospital medicine section meeting. This training included information about the HPV vaccine, guidance on how to communicate with patients and families regarding the vaccine and presentation of the baseline data. Follow up materials were sent to providers via email. The discharge order sets were modified to include WIR information as providers prepare a patient’s after visit summary, implemented on 7/15/2019.
Results: 113 patients were initially considered for this study. After 17 exclusions, 96 patients were included in the baseline chart review. Pre-training data revealed that 53% of adolescents were up to date on the HPV vaccine prior to hospitalization. The rate of delivery of the HPV vaccine to hospitalized adolescents due for the vaccine was 4.4%. Post-training data showed an increase to 15.6% (p value=0.95) rate of delivery. Pre-training data also revealed that of patients due for the HPV vaccine, only 66% had this status correctly documented in their admission note. Post-training data showed an increase to 90.6% (p value=0.007).
Conclusions: Pre-training data revealed a missed opportunity in providing the HPV vaccine to adolescents in a hospital setting. A provider training seminar regarding the HPV vaccine was successfully implemented, given the increased HPV vaccine delivery to the population of interest after the provider training. There remains substantial room for improvement. Subsequent work regarding this topic will include additional physician and resident training with regular cycles of provider feedback.