1. WIAAP HPV Quality Improvement Project Spring 2016 Update Sarah Campbell, M.D. Mala Mathur, M.D., M.P.H.

2. WI-AAP and QI Projects  WIAAP discussed having a QI focus for our chapter members at the 2014-2015 Board Retreat  CDC grant through AAP focusing on HPV; Wisconsin QI Committee created  HPV QI training at District VI meeting August 2015 (2 WI-AAP members attended)

3. WIAAP QI Committee  The WI-AAP QI Committee discussed over Fall 2015 ideas on how to facilitate this HPV MOC Project.  Wisconsin is working with other AAP District VI states on this HPV District Wide collaborative MOC project (sharing resources, ideas)  First WI-AAP led MOC Part 4 project in Wisconsin for WI-AAP members

4. WIAAP HPV MOC Project  Pediatricians are leaders in immunizations  Provider education alone does not increase rates but coupled with QI methods, has been successful.  AAP received funding from CDC to improve HPV vaccination rates through  District QI training (Summer 2015)  Chapter led QI Project (MOC)

5. WIAAP MOC Project April-June 2016  Over 20 physicians from over 5 different practices from all over Wisconsin  QI process using baseline data, 2 PDSA cycles to improve HPV immunization rates  Support from AAP, District VI, WIAAP  Database to enter data: QIDA (Quality Improvement Data Aggregator)

6. Basic outline of project  Collect and enter data by end of the month (for 3 months), analyze data, complete project survey  Participate in the 4 statewide webinars (statewide webinars will be recorded)  Optional participation in HPV summits May 2016  Optional continuation of project beyond 3 months.

7. QI Teams  Each physician champion involved in this WI statewide project is grouped into a QI team with one QI Team Leader  QI Team Leaders keep track of physician participation in MOC webinars and ensure data is entered into QIDA and annotated at the close of each cycle (end of the months of April, May and June)

8. QI Teams – Local Teams  Each clinic team/provider will want to determine who is on their HPV QI team.  Many different individualizes are involved in the discussion of immunizations from the staff person making the appointment, the staff rooming a patient and finally the provider.  Many opportunities to affect change at all steps of the immunization process.

9. Why is HPV a good starting project for a QI project.  Most commonly transmitted STI  In U.S. 80 million people are affected; 14 million people each year  27,000 cases of new cancer every year: oropharyngeal, cervical, anal, vulvar, penile, vaginal  150 subtypes of HPV with 40 causing infection (High risk HPV subtype 16 and 18)  Most infections are asymptomatic but can lead to cancer.

10. What about Wisconsin HPV vaccine rates? o Wisconsin HPV Vaccination completion rates (13-17 year old): 30% girls 10% boys o Why are our numbers so low? o Anticipated parents hesitation o Physicians not providing a strong recommendation o Difficult to get families back into clinic

11. Study design: PDSA cycles Plan, Do, Study, Act

12. Example PDSA Cycle Changes for HPV vaccine o Strong Provider Recommendation o Rooming staff saying “Today you child is due for three immunizations, HPV, Meningitis and Tdap.” Saying HPV first, not “and HPV” as an optional vaccine at the end. o Reminder Recall systems for immunizations o Immunization opportunities at non WCC visits. o Staff HPV education and involvement o AAP HPV toolkit has great examples of HPV PDSA cycles to review.

13. HPV Toolkit – AAP and District guides for MOC 4 credit.  AAP Toolkit https://www.aap.org/en-us/advocacy- and-policy/aap-health- initiatives/Pages/HPV-Champion- Toolkit.aspx  District Toolkit

14. Wisconsin HPV Summit: You are the Key to Cancer Prevention  Join us at one of two locations for the 2016 HPV Vaccine Summits  May 11th - HPV Vaccine Summit - Wausau May 11th - HPV Vaccine Summit - Wausau  May 12th - HPV Vaccine Summit - Milwaukee May 12th - HPV Vaccine Summit - Milwaukee  Register at www.wiaap.orgwww.wiaap.org

15. Contact Information:  If you would like more information on WIAAP QI Committee or this project please contact:  Sarah Campbell: sacampbe@affinityhealth.org sacampbe@affinityhealth.org  Mala Mathur: mmathur1321@gmail.commmathur1321@gmail.com