1. Increasing HPV Vax rates and cervical cancer screening rates: Best practices, and resources

2. Objectives
The case for increasing rates in CHCs
What works – QI strategies, evidence-based interventions, screening policy and navigation
Common barriers to increasing rates
Ways to overcome barriers
ACS support for identifying and overcoming barriers
Tools and resources to help

3. The Case for Increasing Cervical Cancer Screening Rates
Indiana FQHC Cervical Cancer Screening Rate*
2014 = 62.6% = 51.2%
Healthy People 2020 Goal – 93%
*Source: HRSA: UDS Health Center Program Grantee Data

4. The Case for Increasing HPV Vaccination Rates
Indiana is 40th
in the nation for HPV
Indiana State Department of Health

5. The Case for Increasing HPV Vaccination Rates
Indiana State Department of Health

6. Improving Rates – What Works
Quality improvement strategies
Process mapping
Gap analysis
PDSA cycles
Ongoing evaluation
Implementing one or a combination of evidence-based interventions*
Patient reminders
1:1 education
Reduction of barriers – structural or financial
Provider reminder/recall systems
Provider assessment and feedback techniques
A system-wide, comprehensive screening policy
Some form of patient navigation
*Source: The Community Preventive Services Task Force: The Community Guide

7. Common Barriers to Increasing Rates
Staff capacity
Inconsistent provider messages
Electronic Health Records – Data
There are other barriers like patient fear, patient refusal, but those are more inherent to the patient and harder to influence.

8. Staff Capacity The problem:
Reminder systems and navigation is time-consuming
Staff have many other duties
Turnover happens

9. Staff Capacity Possible solutions:
Consider assigning tasks to support staff: MAs, lab techs, schedulers, in-reach or volunteers to work at “top of experience”
Who can give shots or perform Pap tests?
Have policies written and posted for continuity
Standing orders for HPV vaccine
Vaccine refusal forms
Same visit Paps
Track data to make the case for navigation staff
Consider process mapping to find where you may have gaps

10. Inconsistent Provider Messages
The problem:
One or more providers have trouble “buying in”
Thinks HPV vaccinations are needed at 11 or 12
Thinks that only “women’s health providers” should do Paps
Not enough time to educate on screening or thinks a majority of parents will refuse HPV vaccine
Priority is to take care of comorbidities or vaccines for school
Provider doesn’t offer a STRONG recommendation

11. Inconsistent Provider Messages
Possible solutions:
Work with all staff on how to educate patients
Educate providers to make a STRONG HPV recommendation
Identify a provider “champion” to encourage other providers
Make sure provider EHR prompts/alerts are turned on (EBI)
Start a provider assessment program and use data to benchmark (EBI)
Implement standing orders for cancer screenings and prevention
HPV vaccine for any type of visit
Every provider should do Pap
Support staff huddles to identify which patients are due (PCMH)
Show the research: Most parents don’t argue with a strong HPV recommendation – HPV Vaccination is cancer prevention

12. Data Barriers The problem: Data validation
CHIRP doesn’t match EHR or population health software
Finding baseline data for comparison
EHR doesn’t tell date of patient’s last Pap
Coding/entering correctly
Who has access to EMR or CHIRP

13. Data Barriers Possible solutions:
Partner with health systems with the same EHR system who do it well
Work with ISDH on understanding CHIRP data and bi- directional data issues
Staff education about coding properly
Provide CHIRP access to more staff who can help enter data
If last Pap is unknown, can one be done to satisfy measure?
Check boxes rather than free-type notes

14. ACS Tools and Resources
ACS Staff partner Quality Improvement assistance
Systematically work on improving screening and/or vaccination rates
Setting goals, process mapping, gap analysis, PDSA cycles, implement interventions, tracking
HPV Education or training for providers and staff
ACS co-branded, bilingual, reminder cards – breast, cervical, colorectal and HPV
Baseline data tracking worksheet for HPV vaccinations
Small media brochures and fact sheets – breast, cervical, HPV and colorectal

15. Toolkits
CDC – Increasing Population-Based Breast and Cervical Cancer Screenings
ACS – Steps for Increasing HPV Vaccination in Practice: An Action Guide to Implement Evidence-Based Strategies for Clinicians
Large Health Systems
Providers
Private Practices
Cancer Control Coalitions
Dental Providers

16. Additional Resources National HPV Roundtable – hpvroundtable.org
Resource library
CMEs
Presentations
Videos
Toolkits
Social media tools
Posters, flyer and brochures
Screening guidelines
Statistics
Programs/services for patients and survivors
If we know specifically what resources you need, we can help you find support.

17. Indiana Primary care team
Josh Kellems (Northern IN)
Office:
JOSH KELLEMS
Leigh hunt
ANDREA RADFORD
Andrea Radford (Central IN)
Office:
CALEB NEHRING
Caleb Nehring (Southern IN)
Office:

18. Thank you!
cancer.org |
©2018, American Cancer Society, Inc. No Models used for illustrative purposes only.