Ambulatory Care Services, Denver Health, Denver, Colorado; and
Department of Pediatrics, University of Colorado, Aurora, Colorado.
Pediatrics. 2016 Nov;138(5). doi: 10.1542/peds.2015-2653. Epub 2016 Oct 5.
Despite national recommendations for adolescent human papillomavirus (HPV) vaccination, rates have lagged behind those of other adolescent vaccines. We implemented interventions and examined rates of vaccination coverage in a large, urban, safety net health care system to understand whether our tactics for achieving high rates of adolescent vaccination were successful.
Denver Health is an integrated urban safety net health system serving >17 000 adolescents annually. The process for achieving high vaccination rates in our health system includes "bundling" of vaccines, offering vaccines at every visit, and standard orders. Data from vaccine registry and utilization statistics were used to determine vaccination rates in adolescents aged 13 to 17 years from 2004 to 2014, and these findings were compared with state and national rates for 2013. Regression analysis was used to identify characteristics associated with vaccination.
In 2013 (N = 11 463), HPV coverage of ≥1 dose was 89.8% (female subjects) and 89.3% (male subjects), compared with national rates of 57.3% and 34.6%. Rates of HPV coverage (≥3 doses) were 66.0% for female subjects and 52.5% for male subjects, versus 37.6% and 13.9% nationally. For both sexes, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed, vaccine coverage was 95.9% (86.0% nationally), and meningococcal conjugate vaccine coverage was 93.5% (77.8% nationally). Female subjects, Hispanic subjects, non-English speakers, and teenagers <200% below the federal poverty level were more likely to have received 3 doses of HPV.
Through low-cost, system-wide standard procedures, Denver Health achieved adolescent vaccination rates well above national coverage rates. Avoiding missed opportunities for vaccination and normalizing the HPV vaccine were key procedures that contributed to high coverage rates.
尽管国家建议青少年接种人乳头瘤病毒（HPV）疫苗，但接种率仍落后于其他青少年疫苗。我们实施了干预措施，并在一个大型城市、综合性医疗保障体系中检查了疫苗接种覆盖率，以了解我们实现青少年高接种率的策略是否成功。
丹佛健康是一个综合性的城市医疗保障体系，每年为超过 17000 名青少年提供服务。我们系统内实现高疫苗接种率的过程包括疫苗“捆绑”、每次就诊时提供疫苗以及标准医嘱。利用疫苗注册和使用统计数据来确定 2004 年至 2014 年 13 至 17 岁青少年的疫苗接种率，并将这些发现与 2013 年的州和国家数据进行比较。采用回归分析来确定与接种相关的特征。
2013 年（N=11463），HPV 疫苗接种率≥1 剂的比例为 89.8%（女性）和 89.3%（男性），而全国的比例分别为 57.3%和 34.6%。HPV 疫苗接种率（≥3 剂）分别为女性 66.0%和男性 52.5%，而全国的比例分别为 37.6%和 13.9%。对于男女双方，破伤风类毒素、白喉类毒素和无细胞百日咳疫苗、吸附疫苗的接种率均为 95.9%（全国为 86.0%），脑膜炎球菌结合疫苗的接种率为 93.5%（全国为 77.8%）。女性、西班牙裔、非英语者和青少年的贫困率低于联邦贫困线 200%以下的人更有可能接种 3 剂 HPV 疫苗。
通过低成本、全系统标准程序，丹佛健康实现了远高于全国疫苗接种率的青少年疫苗接种率。避免错过接种机会和将 HPV 疫苗规范化是实现高接种率的关键程序。
