HPV Quality Improvement: Completing the Series

A Part 4 QI MOC Project for Primary Care Providers

The IAFP has developed a quality improvement (QI) activity to assist primary care practice increase their patient’s HPV immunization completion rates. Application for the ABFM MoC Part IV has been applied for and is pending.

How to start a QI in your practice

1. View online educational activity on:  Immunizing Adolescents against Human Papillomavirus (HPV): What You Need to Know (1.0 CME credit)
You must complete the online CME and past the post test in order to start the QI activity

2. Sign up to participate! click here

Once you sign up IAFP staff will send you a link to instructions and online tools to help collect data and complete your QI. Please allow 7-10 business days to receive your personalized web page. Use that time to gather your team!!

3. Read HPV Overview & the following instructions:
Quality Improvement: Making a Positive Change to Your Practice

Quality Improvement (QI) involves three steps—setting a goal, selecting a change in practice habits & establishing measures to assess this change, and forming a team for implementation. A quality improvement project begins with choosing an area within your practice to improve patient health—or setting a goal. The goal chosen for a quality improvement project may be self-directed by the physician or healthcare team or driven by an outside source such as an insurance carrier. Either way, the goal of a QI project should be time-specific, measurable, and define the specific patient population that will be affected.

Selecting a change that will improve outcomes for the patient and the practice is the second step in the QI process. To assess whether the change is producing desired benefits, measures must be developed. Recommended steps in the development of measures include using sampling, plotting data over time, seeking usefulness rather than perfection, and integrating the measurement into routine care or office practice. Patient satisfaction measures should be included in the assessment.

The QI process follows a “Plan-Do-Study-Act” (PDSA) model, in which results are evaluated and new approaches are implemented based on the data. QI is a dynamic, iterative, and evolving process to reach the stated goal.

HPV Immunization: Collecting Data Toward Improving Immunization Rates

To support an overall goal of completing the three-dose HPV vaccine series for all eligible patients, this tool will help providers promote, schedule, and track the second and third installments for individuals who have received an initial dose of HPV vaccine. The complete exercise will require approximately three months and will include pulling/reviewing charts at three time points (baseline plus two follow-up pulls at six-week intervals).

Step 1:  Gathering Baseline Data. To gather baseline data from a representative sample of adolescent and young-adult patients

Step 2: Implementing Change using a PDSA Cycle.

  1. Based on the identified gaps, convene a team to create a plan to achieve your immunization goals. For example, if those patients who failed to receive their second HPV dose were not routinely reminded to schedule their follow-up dose(s), then consider adjusting your recall system or developing standing orders for non-physician personnel to administer vaccines. Refer to the IAFP training modules and other resources as needed.

  2. Conduct a test of change through a PDSA cycle and implement positive changes.

Step 3: Collecting Follow-Up Data. The change that you implement will apply to all eligible patients. To assess whether these changes have had an effect, a second and third set of data should be collected at consecutive six-week intervals after the baseline data were gathered.

  1. At each of these points, select a random sample of ten charts or Electronic Medical Records of eligible patients (males or females ages 13-26) from any visit during the previous six weeks. Review the information documented for each patient and answer the data collection questions for each patient. Enter your responses into the online tool.

  2. IAFP staff will generate a report using the data you have entered. Review the second chart pull report again your baseline report to assess your progress. Repeat the PDSA cycle and report data to the online tool for each cycle.

  3. Data should be collected at a minimum of every six weeks. A total of three chart pulls (baseline plus two subsequent pulls) will be required.

Step 4: PDSA Final Questions  QI is a dynamic, iterative, and evolving process. Now that you are at the end of three months, reflect on your process and answer questions outlined in the survey.


Ready to start???  Sign up today!



 1 CDC. http://www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet-Feb-2013.pdf.

2Petrosky E, et.al. MMWR 2015;64(11)300-304.

3US Department of Health and Human Services (DHHS). Office of Disease Prevention and Health Promotion (ODPHP). http://www.healthypeople.gov/node/4657/data_details. Accessed September 3, 2015.

4US DHHS. ODPHP. http://www.healthypeople.gov/node/4657/data_details. Accessed September 3, 2015.

5National Committee for Quality Assurance. “Human Papillomavirus for Female Adolescents.” http://www.ncqa.org/ReportCards/HealthPlans/StateofHealthCareQuality/2014TableofContents/HPV.aspx#sthash.WAwrE6C0.dpuf. Accessed September 3, 2015.

6Reagan-Steiner S, et.al. MMWR 2015:64(29):784-792.

7Holman DM, et.al. JAMA Pediatr 2014;168:76-82.

8Dunne EF, et.al. MMWR 2014;63:69-72.