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

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

The Case for Increasing Cervical Cancer Screening Rates Indiana FQHC Cervical Cancer Screening Rate* 2014 = 62.6% 2017 = 51.2% Healthy People 2020 Goal – 93% *Source: HRSA: UDS Health Center Program Grantee Data

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

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

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

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.

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

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

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

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

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

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

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

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

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

Indiana Primary care team Josh Kellems (Northern IN) Josh.Kellems@cancer.org Office: 574-257-7966 JOSH KELLEMS Leigh hunt ANDREA RADFORD Andrea Radford (Central IN) Andrea.radford@cancer.org Office: 317-344-7844 CALEB NEHRING Caleb Nehring (Southern IN) Caleb.Nehring@cancer.org Office: 618-998-9258

Thank you! cancer.org | 1.800.227.2345 ©2018, American Cancer Society, Inc. No. 080310. Models used for illustrative purposes only.