Importance Despite recommendations to begin human papillomavirus (HPV) vaccination as early as 9 years of age, uptake remains low. Objectives To compare early HPV vaccine initiation between 2 interventions, compare vaccine completion rates between youths initiating HPV vaccination at 9 to 10 vs 11 to 14 years of age, and identify factors associated with early HPV vaccination initiation and series completion. Design, Setting, and Participants This retrospective quality improvement study was conducted from January 1, 2019, to December 31, 2023. The study analyzed a quality improvement project using descriptive statistics and survival analyses. Youths aged 9 to 14 years with no prior HPV vaccination, who had at least 1 in-person visit, and who had complete electronic health record (EHR) data were included. The study took place at 21 US outpatient primary care sites within a large health system. Site assignments were based on patient volume and geographic location (urban and rural). Exposures An EHR best practice alert (BPA) recommending HPV vaccination beginning at 9 years of age implemented with or without an added clinician education component. Main Outcomes and Measures The primary outcome was HPV vaccine initiation at 9 to 10 years of age. Secondary outcomes included vaccine series completion within 2 years after initiation and factors associated with early initiation and completion. Outcomes were measured using EHR-recorded vaccination status and timing. Results A total of 15 743 eligible patients (mean IQR age, 9.9 9.0-11.0 years; 7946 50.5% male; 1260 8.0% Asian, 5082 32.3% Black or African American, 7621 48.4% White, 420 2.7% unknown race, and 1360 8.6% other race, including American Indian or Alaska Native, Guamanian or Chamorro, and Native Hawaiian or Other Pacific Islander) participated in the study. Overall, 10 102 (64.2%) initiated and 5198 (33.0%) completed the vaccine series. In the group aged 9 to 10 years, the BPA plus education arm had a significantly higher likelihood of initiating vaccination than the BPA-only arm (adjusted hazard ratio, 1.39; 95% CI, 1.17-1.65; P lt; .001) compared with the group aged 11 to 14 years. Completion increased from 16 (2.2%) to 464 (19.6%) among youths aged 9 to 10 years and from 183 (13.9%) to 323 (66.6%) among youths age 11 to 14 years. By year 3, the group aged 9 to 10 years had a higher cumulative completion rate than the group aged 11 to 14 years (3899 33.9% vs 1299 30.7%, P lt; .001). Black or African American race and public insurance were associated with HPV vaccine initiation and completion. Conclusions and Relevance In this quality improvement study of early HPV vaccine initiation, an EHR BPA combined with education was associated with a higher likelihood of early HPV vaccination. Delayed but meaningful improvements in series completion were observed among early initiators.
Kumra et al. (Mon,) studied this question.