Spotlight on Excellence – Process and Messaging Changes Boost HPV Vaccination Rates for NRV Pediatrics in Southwest Virginia

December 4, 2018
Photo of care team at NRV Pediatrics in Virginia.

NRV Pediatrics in southwest Virginia has been recognized as an exemplary practice and is the focus of HQI’s “Spotlight on Excellence” in December. Some of the team at NRV Pediatrics, shown here at their Radford, VA office, include, from left, Amanda E. Preedom, MD; Cindi Benson, nurse care coordinator; and Lee Cox, practice manager.

NRV Pediatrics, serving Virginia’s New River Valley area, is being highlighted as an exemplary practice in December’s “Spotlight on Excellence” feature for implementing process changes that boosted their Human Papillomavirus (HPV) vaccination rates from 37% to 43%. NRV Pediatrics is privately owned serving rural areas with offices in Radford and Blacksburg, VA. They also have admission privileges at Carilion NRV Medical Center and LewisGale Hospital in Montgomery.

  1. What changes did you make to increase your HPV vaccination rates?

Our focus started with educational materials on the front end. We placed posters that were created by the Centers for Disease Control and Prevention (CDC) in waiting rooms and patient rooms and handed out educational material to parents about the vaccine. We also changed the way we worded our conversations about the vaccines. Our messaging helped address the various mindsets of some parents to help move them from the stigma that the vaccine would “open the door to sex” to new thinking that the vaccine will “close the door to cancer.”

  1. What barriers did you encounter and how did you overcome them?

Aside from changing the mindsets of parents that the vaccines would not make it more likely for adolescents to engage in sexual activity, we had to contend with the fact that it’s not simply one vaccine but rather multiple vaccines that must be administered in a series within a certain timeframe. On top of that we had changes to our electronic medical records that occurred right in the middle of the initiative, which made our tracking system somewhat unreliable in the beginning. Partnering with MERCK helped us with vaccination tracking and sending text reminders about upcoming appointments to our patients. Our care teams also took into consideration transportation issues and other factors to help patients and their families show up for subsequent injection visits within the appropriate timeframe.

  1. What positive outcomes resulted from your efforts?

We saw our care teams unite in their desire to do the best job they could to protect our adolescent patients. The increase in vaccine compliance shows a direct impact of improvement in the protection of that population against potential cervical cancer. And while we are at a 43% compliance rate, we continue to use the text reminders to hopefully increase vaccinations even more. We also position ourselves to receive a rebate from MERCK at the end of the year if we hold our vaccination compliance rates.

  1. What has your experience been like participating in the Transforming Clinical Practice Initiative (TCPI)?

It’s allowed us to go even beyond the Patient-Centered Medical Home (PCMH) care delivery model, really, because there are certain criteria or suggestions that HQI has evaluated us on or given us (like employee surveys, co-management agreements) and we’ve received assistance on different approaches. There were areas we would not have focused on without being part of HQI’s Practice Transformation Network (PTN), but our participation has helped us provide better patient care. We benefit from the resources provided from being part of the PTN. We hear what others are doing and adopt what works for us. Recently, in a group call we participated in, we heard another practice talk about how they were able to get kids to come back at a higher rate by placing informational posters on the back of patient room doors that described the well visits and when each one is due. We’re actually implementing that now.

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