Improving Rates of HPV Immunizations

Lacey Coffin Greene, Program Manager
Pediatric Transforming Clinical Practice Initiative – WCAAP 

In September of 2016, Dr. Kristi Rice and I traveled to a Quality Improvement session in Salt Lake City held by the Utah Chapter of the AAP.  The learning session was intended to introduce QI principles based on the Model for Improvement, and to set the stage for a small QI grant from national AAP for interested Chapters to improve the rates of HPV immunizations.

WCAAP applied for and received a $15,000 grant to implement our project.  Our intention was to select 5 P-TCPI enrolled clinics, and to provide support to help them apply the Model for Improvement ( to understand and improve the rates of HPV vaccine series completion for 11 and 12 year olds.  Clinics that fulfilled the requirements of the project would receive MOC part 4 credit, $1200 to compensate for the administrative time spent, and gain valuable knowledge about their own immunization processes, data, and standard work.

We had six clinics apply to be part of the 6 month cohort.  We were excited to work with various sizes of clinics, from a very small office consisting of one ARNP and part time office staff, to a regional health system.  In the end, 3 of the 6 enrolled clinics were able to complete the requirements for MOC.

We learned many valuable lessons along the way. We learned more about the cultural and infrastructure barriers to completing the HPV vaccine series.  It was instructive to hear the challenges providers face in different communities in Washington.

We are excited to implement more QI capacity in the Chapter, and we realize we underestimated the effort it would take to implement. For instance, understanding the difference between data gathering for rapid cycle improvement and data gathering for scientific study was a difficult cognitive concept for myself and for our providers. Improvement science is not as exact as some of us are used to!

We had some wonderful outcomes. With the input of Dr. Rice, our partners at Within Reach, and the Department of Health, we created an HPV information card targeted at the 11 and 12 year old population who, according to the newest AAP guidelines, only need two doses of the vaccine.  With input from our clinics, we had this card translated into Spanish and Russian.  The cards are free to print at

The webinars we presented as part of our project can be viewed for CME credit at (Dr. Yolanda Evans) and (Dr. Ed Marcuse).

Our project ended on September 30, 2017.  We are already looking forward to the next one!

I offer a big thanks to Charis Clinic, SeaMar Legacy Salmon Creek, Pediatric Associates of Whidbey Island, Skagit Pediatrics, Confluence Health, and Richmond Pediatrics for their efforts to implement this short QI project and improve their HPV rates to protect kids from cancer. Thanks also to Kateri and Melissa at national AAP, and JoAnn, Karen, Tawn, and Christine from the Department of Health for their partnership.