Parkland improves HPV vaccination rate in Dallas County
Many Dallas residents diagnosed with HPV-related cancer each year
Parents have the potential to prevent their child from developing cancers caused by the human papillomavirus (HPV) if they decide to give their child the HPV vaccine series at the recommended age. However, physicians at Parkland Health & Hospital System say that in Dallas County, as in the U.S., too few adolescents are getting vaccinated as recommended by the Centers for Disease Control and Prevention. The three-dose series should be given on a schedule of 0, 1-2 and 6 months to adolescents aged 11 through 12 years.
“Over the 10 years of vaccine availability in the U.S., national data show that parents are hesitating, delaying or deciding not to vaccinate,” said Sentayehu Kassa, MD, Senior Lead Staff Physician at Parkland’s Vickery Health Center. The U.S. is falling well short of the Healthy People 2020 goal of 80 percent series completion and many children go unprotected, she stated.
“For the Dallas community, delivery of this cancer prevention tool is particularly important because a large number of Dallas residents are newly-diagnosed with a HPV-related cancer each year,” Dr. Kassa said. “For example, approximately 100 women are diagnosed with cervical cancer (more than 10 percent of all cases in the state of Texas) and on average 60 men are diagnosed with head and neck, anal or penile cancer each year. Parkland’s partnership with the Simmons Comprehensive Cancer Center enables high quality cancer care and delivery of cancer prevention services.”
To understand how to optimize HPV vaccine delivery for the most vulnerable members of the Dallas community, Parkland began a research and quality improvement (QI) collaboration with the University of Texas Southwestern Medical Center in 2009. Current leaders of the project are Drs. Kassa and Jasmin Tiro, PhD, an Associate Professor in UT Southwestern’s Department of Clinical Sciences. The goal was to increase the rate of HPV vaccination of eligible patients in order to reduce the incidence of pre-cancers and cancers linked to the HPV virus.
In 2009-2010, Dr. Tiro secured an American Cancer Society pilot grant to conduct a retrospective chart review and interviews about HPV vaccine delivery at Parkland. Like national and Texas estimates, vaccine uptake was poor—HPV vaccine initiation was 29.1 percent and completion of the 3-dose series was 6.9 percent.
In 2010, Parkland implemented standing orders per U.S. Task Force on Community Preventive Services recommendations. Standing orders allowed nurses to assess HPV immunization status and administer vaccines according to the protocol approved by Parkland and authorized physicians. As a result, HPV vaccine initiation increased to approximately 40 percent.
Aided by a Cancer Prevention and Research Institute of Texas grant in 2011-2012, the project team evaluated the impact of educational pamphlets mailed to parents of young patients before clinic visits to increase initiation and telephone recalls to improve series completion.
“Surprisingly, the pamphlet was effective at increasing initiation among Hispanics but not African Americans,” said Dr. Tiro, “suggesting the need for education tailored to the parent’s informational needs. The telephone recalls were effective for both race/ethnic groups and increased HPV series completion to 29 percent.”
In 2013, Dr. Austin Baldwin, Associate Professor of Psychology from Southern Methodist University joined the team. With funding provided by the National Cancer Institute, Parkland developed and is now testing the Project Voice app, an intervention based on self-persuasion to motivate hesitant parents to get the HPV vaccine for their child. A small preliminary study found that 80 percent of Parkland parents decided in favor of the HPV vaccine after using the Project Voice app.
Also in 2013, Parkland was awarded a Delivery System Reform Incentive Payment (DSRIP) Program grant (part of the Medicaid 1115 Waiver Program) to implement telephone recalls and increase HPV completion among African American girls. The program had a major impact and the current African American HPV series completion rate is 53.7 percent. Parkland also began training providers on best communication practices during vaccine discussions.
According to Dr. Tiro, “During the eight years since launch of the program, there has been a tremendous impact by the Parkland/UT Southwestern collaboration on adolescent HPV vaccination. This project showcases how national, state and non-profit funding agencies were leveraged to understand and intervene on this key cancer prevention area.”
As a result of these research and QI activities, in 2016 Parkland’s HPV vaccine up-to-date rate was 61.4 percent, showing vast improvement since the collaboration began in 2009. The National Immunization Survey-Teen 2016 estimate for Dallas County was much lower—23.9 percent.
“This Parkland/UT Southwestern partnership is ensuring that the HPV vaccine, one of the greatest cancer research discoveries in the past century, reaches and benefits the Dallas safety-net population at highest risk for developing HPV-related cancers,” said Noel Santini, MD, Senior Medical Director, Ambulatory Services at Parkland.
To learn more about services at Parkland hospital, visit www.parklandhospital.com
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