Implementing evidence-based strategies to improve HPV vaccine delivery

Melissa B. Gilkey, Michael J. Parks, Marjorie A. Margolis, Annie-Laurie McRee, Jason V. Terk

    Research output: Contribution to journalArticlepeer-review

    15 Scopus citations


    BACKGROUND: High-quality evidence indicates that intervening with health care providers improves human papillomavirus (HPV) vaccine delivery. However, scaling up evidence-based strategies in real-world clinical practice remains challenging. We sought to improve the reach and impact of strategies for HPV vaccination quality improvement (QI) through local adaptation and implementation in a large, not-for-profit health care system.

    METHODS: We conducted an HPV vaccination QI program using existing materials to support physician training coupled with assessment and feedback. Local physicians with high HPV vaccination rates facilitated training, which included didactic instruction and video vignettes modeling effective communication. We randomly assigned 25 clinics with 77 physicians to the QI arm or the wait-list control arm. We used hierarchical linear models to assess HPV vaccination coverage (≥1 dose) over 6 months among patients aged 12 to 14.

    RESULTS: Of 45 physicians in the QI arm, the program reached 43 (95%) with training plus assessment and feedback. In the overall sample, HPV vaccination coverage increased in both the QI and control arms (8.6 vs 6.4 percentage points, respectively), although the 2.2-percentage point difference did not reach statistical significance. Sensitivity analyses that excluded physicians with poor data quality indicated a statistically significant advantage of 3.3 percentage points for QI versus control ( b = 0.034; SE = 0.015; P < .05).

    CONCLUSIONS: Our locally adapted QI program achieved excellent reach, with small improvements in HPV vaccination coverage. Future implementation research is needed to bolster program impact and support health systems in leveraging local resources to conduct these programs efficiently.

    Original languageEnglish (US)
    Article numbere20182500
    Issue number1
    StatePublished - 2019

    Bibliographical note

    Funding Information:
    FUNDING: Quality improvement efforts were supported by Cook Children’s Health Care System. The authors’ time for analysis and article preparation was supported by the National Cancer Institute (K22 CA186979 to M.B.G.; T32 CA057726 to M.A.M.) and the Health Resources and Services Administration (T32HP22239 to M.J.P.). The National Cancer Institute and Health Resources and Services Administration played no role in the design and conduct of the study; the collection, management, analysis, and interpretation of data; the preparation, review, or approval of the article; or the decision to submit the article for publication. Funded by the National Institutes of Health (NIH).

    Publisher Copyright:
    Copyright © 2019 by the American Academy of Pediatrics.


    • Adolescent
    • Child
    • Child Health Services/organization & administration
    • Delivery of Health Care/standards
    • Evidence-Based Practice
    • Humans
    • Immunization Programs/organization & administration
    • Papillomavirus Infections/prevention & control
    • Papillomavirus Vaccines
    • Program Evaluation
    • Quality Improvement
    • Texas
    • Vaccination Coverage

    PubMed: MeSH publication types

    • Research Support, U.S. Gov't, P.H.S.
    • Journal Article
    • Research Support, N.I.H., Extramural


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