Dr. Rajiv Naik is a Pediatrician at Gundersen Health System in La Crosse Wisconsin. Some of his areas of interest include pediatric and adolescent medicine, pediatric infectious diseases, immunizations, evidence-based medicine and quality improvement. One of his specific accomplishments include his systematic approach to increasing HPV vaccination rates. Below are some of the key points of the process used within his department.
Comprehensive, Multimodal, Systematic Approach
Development of automatic electronic tools within the electronic health record system (EMR)
Instituting centralized, system-based processes
Health care provider and departmental staff education and training
Patient education and overall change of approach in engagement with patients/families
Methodology
Electronic Medical Record (EMR)
Utilize alerts, reminders, and electronic scheduling for additional visits
These tools support medical team
Use EMR prompts to address HPV myths with patients through education
Staff training
Training with entire staff (front desk to provider) regarding myths and facts, use the CASE approach
Different training strategies for family medical sites and pediatric sites
Reminder notices that engage the family noting due or overdue immunizations and recommended vaccines by age 13
Looking at QI data, able to target education and training at low performing sites/healthcare providers.
How to Improve HPV Vaccination Rates
Creation of automatic alerts and reminders within EHR for health care provider use
Centralized process for electronic alerts and reminders
Electronic scheduling of subsequent doses to help eliminate missed opportunities
System-wide health care provider education and training (C-A-S-E Approach)
HPV Myths: real-time health care provider prompting with simultaneous patient education
Targeted education and training for low performing sites and health care providers
Results
Dramatic increase in HPV Vaccine rates when electronic alerts, reminder, and centralized system (EMR) began.
Seeing continued improvement with training and additional EMR prompts/systems
Males still lag behind females in 3-dose series completion
Gundersen Health System female and male rates are above the national immunization survey rates for ages 13-17
Summary
Using a comprehensive, multimodal, systematic approach to improving HPV rates in an integrated health care system, steady rate improvements have been seen over a sustained period of time at every age in both females and males.
Similar approaches could be adopted in other health care system.