Methods: After surveying families, we targeted two main drivers for failure to complete the HPV vaccine series. Phase 1 addressed adolescents unable to return during normal business hours due to school and extracurricular activities. We created a weekly resident-run HPV evening clinic. Phase 2 addressed family forgetfulness to make appointments due to time between shots. We developed an automated physician voice messaging system to give reminders at 2 and 4 month intervals. During phase 1, we monitored data weekly, trending numbers of patients in evening clinic, as well as surveying families who attended the clinic. Phase 2 data was monitored weekly and tracked percentage of calls and patients who made appointments. All patients and families involved were at our general academic resident and faculty practice in the northwest suburbs of Chicago. The clinic has a volume of over 30,000 visits per year, with over 2,400 physicals for the age 11 and above. A total of 1,600 HPV vaccines were given in 2014.
Results: Phase 1, conducted October 2015 through March 2016, involved initiation of the resident-run evening HPV clinic. Average number of weekly visits was 4. Patient visits up trended throughout the phase with a peak weekly visit of 9. Phase 2 resulted in 30% of appointments made with an increase in evening clinic to 4.25 patients per week, with the remainder being afternoon nurse visits. Parent satisfaction with the reminder measured by telephone calls after the visit was 70%.
Conclusion: Following our quality improvement initiative, we have surpassed our goal of 20% of reminder phone calls resulting in follow-up appointments. Our initiative continues to address the problem of drawing healthy adolescents back to clinic for the HPV vaccination. Future work will include developing further infrastructure to assist other clinics throughout our system.
Illinois Chapter, American Academy of Pediatrics/Centers for Disease Control and Prevention: