P3C030: Medical-dental Integration to Increase Clinic HPV Vaccination Rates in Community Clinic

Purpose/Objectives: The goal of this study is to evaluate the impact of a quality improvement initiative on childhood HPV vaccination rates by offering vaccinations during dental visits to patients who have not completed their full 2 or 3 dose series within our integrated medical clinic. The objectives are to establish a clinic flow between April 2022 and April 2023 to increase HPV vaccination rates of children who visit the dental clinic. Current clinic HPV completion rate was 63% in the year prior to study initiation. The goal was >20% of patients will receive HPV vaccination during their visit and all eligible children/families will receive vaccine education in order to contribute to a system-wide total vaccination rate >70%.

Design/Methods: This study was performed at a community-based, federally qualified health center offering medical and dental services. Children between the ages of 9-17 with outstanding HPV vaccines were identified while presenting for routine dental visits and offered same-day HPV vaccines in conjunction with their dental visits. Vaccines were provided by one primary care medical assistant during the hours of 9AM - 4PM. Data was input into a secure online database and vaccine rates were tracked weekly. PDSA cycles were performed: Cycle 1 (4/2022 - 7/2022), Cycle 2 (7/2022-12/2022), Cycle 3 (12/2022 - 3/2023) and vaccine rates and challenges facing the project success were identified.

Results: Between 4/4/2022 and 4/9/2023, 115/490 (24%) children were vaccinated against HPV during their dental visits. Vaccine rates after PDSA Cycle 1: 30/123 (24.4%), PDSA Cycle 2: 51/164 (31.1%), and PDSA Cycle 3: 26/141 (18.5%). Modifications made prior to each cycle described in supplemental run chart.

Conclusion/Discussion: The results show that children and adolescents were able to be vaccinated against HPV during their routine dental visits. Overall, medical-dental partnerships are an innovative way to increase childhood vaccine rates and may provide a unique opportunity to capture children who may not have consistent interaction with their medical providers. The HPV vaccination rate at our integrative clinic was 63% in the year prior to this intervention, suggesting that our intervention will be able to further increase overall total vaccination rates closer to achieve herd immunity. Factors impacting success included a finalized standard work flow for dental and medical staff, which has been used as a model across the health system. Limitations include personnel and schedule changes, need for transport of patient from dental to medical area for vaccination to avoid vaccine administration errors and medical-legal challenges. This project is ongoing and next steps include pre-registration for dental patients, preparation for anticipated surges in pediatric dental visits (spring break and holidays), and studying completion of full HPV vaccine series during this study period.