My Toolkit

Your AVP Champion will use the AVP-IT to set up five HPV immunization strategies in your clinic. Champions can be volunteers or be selected by the clinic head. This may be a physician, nurse, or practice manager with time to devote to the project, access to staff, and ability to take on a leadership role.

STEPS FOR A SUCCESSFUL AVP CHAMPION:

I.Onboard the AVP Champion

1. Identify an AVP Champion.

Your AVP Champion can be a volunteer or be selected by the clinic head. They can be a physician, nurse, or practice manager with time to facilitate the strategy rollouts, access to staff, and ability to take a leadership role.

TIP: Appoint a back-up AVP Champion to provide continuity in the AVP rollout if the prime appointee is unavailable.

TIP: Recommended qualities of your AVP Champion

Dedicated: Is vested in optimizing clinic function and giving patients the best health service possible.

Eager: Excited about the opportunity to use the AVP-IT to implement proven strategies in their clinic to increase HPV vaccination rates.

Capable: The AVP-IT simplifies and demystifies the process of setting up your clinic for success. Irrespective, it is important that the champion be organized and able to communicate with the clinic personnel. Prior QI experience and/or training is helpful but not essential.

2. Ensure the AVP Champion understands their role

The AVP Champion is your clinic’s first strategy. The AVP Champion will use the AVP-IT as a guide to setting up five remaining strategies to improve clinic HPV vaccination rates.

TIP: The 5 remaining evidence-based strategies are explained in this Action Plan and comprise:

1. Assessment & feedback reports for clinicians
2. Access to the AVP continuing education training for all clinic members
3. Automated prompts to clinicians on patient HPV vaccination status
4. Parent reminder systems, and
5. Providing the AVP HPVcancerFree app to parents of vaccine-eligible patients.

TIPS FOR A SUCCESSFUL AVP CHAMPION

These quick tips have been used successfully to help AVP CHAMPIONS complete the AVP strategy rollout and may be helpful to your AVP champion.

• Ensure the person taking on the AVP Champion role has encouraged past program objectives and reinforces HPV vaccination as a priority at your clinic.
• Include “AVP Champion” in the employee’s job title and add the champion responsibilities to their job description.
• Announce the AVP Champion at the clinic staff meeting.
• Confirm that the champion has reviewed the AVP Champion training video and has the necessary information on their role and responsibilities.
• Allow the champion designated time to execute champion tasks.
• Encourage the champion by including responsibilities in different areas of the clinic

The AVP assessment and feedback (A&F) reports are given quarterly to providers and clinic staff to raise awareness about their delivery of the HPV (1st dose and completion), Tdap, and Meningococcal vaccinations over time and to set goals for the future. The reports are tailored by clinic size (i.e., number of providers). If your clinic has multiple providers, then A&F Reports comprise 1) vaccine trends (Tdap, MCV, HPV) for the provider, 2) HPV vaccination rates for each provider in the clinic, and 3) HPV vaccination rates for the clinic over time. Report metrics include percentage of eligible patients who have ever received vaccines for Tdap, MCV, and HPV, and percentage of patients who have completed the HPV vaccine series.

STEPS TO DEVELOP AND DISTRIBUTE ASSESSMENT & FEEDBACK

1. The A&F Reports can be created by the AVP Champions or a designated staff member.
2. To create your A&F Report, you will need to enter adolescent vaccination data for each of the physicians at your clinic. If this EHR data is not available, you can also use ordering data to get a general idea of the number of patients who are receiving Tdap vaccine compared to HPV vaccine. This method is described at the end of this section under ‘How to use ordering data for assessment and feedback.'
3. The following is a guide to build your clinic A&F Reports. Instructions are provided for each component in the order that they appear in the A&F Report Template.
4. Download the A&F Report Template. The ‘Tools’ section of the Action Plan contains a ‘#docs AF Template’ to download. This guide uses screenshots from the ‘2docs AF Template’ as an example.


TIP:The A&F Template is labeled with a number that should correspond to the number of physicians in your clinic. This is drawn from the data entered when creating your Action Plan. Therefore, a file titled ‘6docs AF Template’ would be the correct template for a clinic with 6 physicians. If the template indicates an incorrect number or this number has changed, simply go to the ‘My Toolkit’ page on the AVP-IT, then proceed to the ‘Assessment & Feedback’ dropdown section and click the ‘View More’ button next to ‘Tools’ . Once you’re in the ‘Tools’ section, select the correct template from the list of A&F Templates.

5. To create your A&F Report, open the ‘#docs AF Template’ by double clicking on the file. The template is an Excel file. The A&F Template will open at the Data Entry page (Figure 1). The tabs of the report template include:
• Data Entry – To enter your data.
• Clinic Report – Clinic level data reported in a table and graphic.
• Physician 1* - Report for your first physician presented in table and graph form.
• Physician 2*- Report for your second physician presented in table and graph form

*NOTE: There will be a tab for each physician based on the report template that you are using. The template you use should coincide with the number of physicians at your clinic.

Figure 1. Screen capture of the AVP-IT A&F Template Data Entry Screen




TIP:If the report opens at a page other than the Data Entry page go to the bottom left of the spreadsheet and select the tab marked ‘Data Entry.’ Depending on the amount of physician tabs that you have, you may be required to click the ‘left arrow’ in order for the ‘Data Entry’ tab to appear.

6. Complete the 10 steps to build your A&F Reports. Please read the questions carefully and answer all questions to receive a complete A&F Report.
7. In the Data Entry page (shown in Figure 1 above), complete the first two tables: ‘Enter the Quarter and Your Clinic Name (Steps 1-2)’ and ‘Enter Data About Each of Your Physicians (Steps 1-8)’. As you enter data, it will auto-populate your Clinic Report and Physician Reports.
   1. Step 1: Select data cell 5D (row 5 and column D) to activate a drop down list of quarters. Select the quarter that you will report data on. This will appear in the header of your final reports.
   2. Step 2: Type in your clinic name in cell 6D (row 6, column D).
   3. Step 3: Select each cell in Row 9 and enter the physician’s name. This will appear in the physician’s personal A&F Report.
   

   TIP:The A&F Reports have been most effectively used with transparency where each is identified by name. However, if you wish to maintain greater anonymity, simply use another identifier rather than your physician name (e.g. Physician 1).

   4. Steps 4-8: Complete these steps by entering the requested data for each physician you have listed in Step 3. Query your EHR to extract data specific for each physician you have listed in Step 3.
   

   TIP: If the AVP Champion is not familiar with extracting data from the EHR database, identify someone else in your clinic who can take on this task.

   

   TIP: You may need to team up with your EHR vendor to learn how to construct a query to extract the data elements listed in the ‘Data Entry’ tab of your ‘#docs AF Template’ that can be found in the ‘Tools’ section of the Action Plan.

   5. Steps 9 & 10. Once you have completed entering all of the data, select the active cells in Table 3 ‘View and Print Reports’ (Step 9-10) to access your reports. These cells are hyperlinked to make the reports easily accessible. You can either hover and click ‘Click Here to View Report for Physician #/Clinic Report’ or go to the ‘Clinic Report’ and ‘Physician #’ tabs (bottom left of the spreadsheet) to view your complete A&F Reports.

   Figure 2. Example Physician and Clinic Reports as seen in the Template Tabs

   
8. Print each Physician Report and the appropriate number of Clinic Reports to provide a copy to all nurses, clinical staff, and the practice manager. Note that the Physician Reports contain two pages (the individual physician report and the clinic report) so these can be presented in a single page (2-sided) printout to the physician. The Clinic Report is a single page that can be provided to the rest of the clinic staff.
9. Deliver the A&F Reports to physicians and other clinic staff in person during clinic meetings, huddles, or one-on-one, and track distribution using the ‘A&F Tracking Form’. Respond to any questions or concerns.
10. Distribute A&F Reports each quarter. At the end of the following quarter, either open up a new ‘#docs AF Template’ and input the data for the current quarter, or edit the data in your template from last quarter.

Here is a list of tips that we encourage you to consider in order to successfully extract data to produce Assessment & Feedback reports. We have found these tips to be successful in previous work when assembling Assessment & Feedback reports, and think they can benefit you as well!

• Consult with your IT personnel on the method for extracting data through your EMR system to create reports as efficiently as possible.
• Frame the conversations about the reports as a tool of encouragement for the clinics’ quality care standard so that physicians will want to improve their rates, and their clinic rates as a whole.
• Enlist the help of the AVP Champion, your practice manager, or a trusted employee to decrease the workload of compiling reports for your physicians and staff.
• Consider using a third party program such as Qlikview to help with data extraction to ensure its appropriateness for the reports.

STEPS TO PROMOTE AND COMPLETE THE AVP CONTINUING EDUCATION (CE):

1. Notify all clinic staff involved in vaccination, including physicians, nurses, and medical assistants, about the AVP CE.
   1. Print the AVP CE Flyer (accessible in the Tools section of the Action Plan).
   1. Distribute the AVP CE Flyer to clinic staff.
   2. Hang the AVP CE Flyer in areas of your clinic that are highly visible to staff, such as the break room.
   2. Notify clinic staff at clinic meetings.
   3. Distribute an email to clinic staff with information about the AVP CE. A sample email to clinic staff can be accessed in the Tools section of the Action Plan.
   4. Note that the activity is an easy way to obtain ethics CME or CNE credit.
2. Set up a timeline for completion (within 30 days).
   

   TIP:The desire for CME/CNE ethics credit may vary based on personal timelines. While the timing of completion can be negotiated, research results indicate it is best to complete the training for all clinic personnel within a 30-day period. This promotes the cultural shift toward increasing HPV vaccination and is easier to monitor.

3. Access the AVP CE.
   1. Register for an account.
      1. Go to the website: http://bit.ly/avpitCE
      2. On the REGISTER/TAKE COURSE tab, click register.
      
      3. Under VISITOR LOGIN, click CREATE NEW VISITOR ACCOUNT.
      
      4. Complete the registration form, and then click CREATE NEW ACCOUNT at the bottom of the page.
      
   2. View the video presentation.
      1. Under FEATURED ENDURING ACTIVITIES, click Optimizing HPV Vaccination: Improving Communication Through Ethical Principles and Evidence-based Clinical Strategies.
      
      2. Click TAKE COURSE.
      
      3. Under COURSE NAVIGATION at the bottom of the course homepage, click Start course.
      
      4. Read the course instructions, and then click Next at the bottom of the page.
      
      5. The first page lists references related to the presentation. Click Next at the bottom of the page to access the video presentation.
      6. Click the play button to view the video presentation.
      
   3. Assist clinic staff with troubleshooting, as needed.
4. Obtain CME or CNE ethics credit.
   
   1. After viewing the video, click Next at the bottom of the page to move on to the posttest.
   
   2. Click START QUIZ at the bottom of the page to access the posttest. Participants must answer 7 out of 10 questions correctly in order to obtain ethics CME or CNE credit.
   
   3. After completing the posttest, click Next at the bottom of the page to move on to the evaluation.
   4. Compete the evaluation, and then click Next at the bottom of the page to view your awarded credit.
   
   5. Click Next at the bottom of the page, then click Download certificate to view your Certificate for Participation.
   
   6. If you have any questions about this process, please e-mail the Baylor College of Medicine Office of Continuing Medical Education at [email protected] or phone 713-798-8237.
5. Ensure that all clinic staff (and new members) complete the CE.
   
   1. The AVP-IT provides an AVP CE Tracking/Sign-Off Form that can be used to ensure everyone has completed the education program. The form can be provided to the clinic team at huddles or mounted on a notice board.
   2. For continuity of the AVP initiative, provide the CE to new staff as part of their on- boarding protocol.
6. Compile a record of CME/CNE certificates.
   
   1. Collect and file copies of the CME and CNE accreditation certificates in the AVP Champion Binder.

Tools to Promote and Complete the AVP Continuing Education (CE)

Recommended promotional and tracking materials to help you introduce the AVP CE to your providers are attached below. These comprise:

1. AVP Continuing Education Flyer
2. Sample Continuing Education Introduction to Staff
3. Sample Continuing Education Email to Staff
4. AVP Continuing Education Tracking Form

AVP Continuing Education Flyer

Click to download AVP CE Flyer

Sample CE Introduction to Clinic Staff

I am excited to inform you of a new ETHICS continuing education (CME/CNE) opportunity titled Optimizing HPV Vaccination: Improving Communication through Ethical Principles and Evidence-Based Clinical Strategies! The online module was specifically developed for all clinic staff involved in vaccinating adolescents, including physicians, nurses, and medical assistants. It covers: how the principles of medical ethics apply to HPV vaccination, the rising burden of diseases associated with HPV, HPV vaccination guidelines/coverage, clinical strategies to improve HPV vaccination rates, and effective strategies to improve communication with parents about HPV vaccination. Following the video presentation, there will be a short survey that is required to complete in order to obtain ethics CME or CNE credits.

I strongly encourage you all to view this presentation. Instructions to complete this activity are provided on the flyer.

Sample CE Email to Clinic Staff

Subject: New ETHICS CME/CNE Opportunity

Dear Clinic Staff,

I am excited to inform you of a new ETHICS continuing education (CME/CNE) opportunity titled Optimizing HPV Vaccination: Improving Communication through Ethical Principles and Evidence-Based Clinical Strategies! The online module was specifically developed for all clinic staff involved in vaccinating adolescents, including physicians, nurses, and medical assistants. It covers: how the principles of medical ethics apply to HPV vaccination, the rising burden of diseases associated with HPV, HPV vaccination guidelines/coverage, clinical strategies to improve HPV vaccination rates, and effective strategies to improve communication with parents about HPV vaccination. Following the video presentation, there will be a short survey that is required to complete in order to obtain ethics CME or CNE credits.

I strongly encourage you all to view this presentation. Please see the attached flyer for instructions to complete this activity.

AVP Continuing Education Tracking Form

Click to download Tracking Form

TIPS FOR SUCCESSFUL PROMOTION AND TRACKING OF THE AVP CE

These quick tips have been used successfully to promote and track the AVP CE use and may be helpful for you.

• Make the AVP CE program an expectation for all providers and staff at your clinic.
• Create a schedule with your providers for who, when, and where they and staff can take the AVP CE to minimize the time away from competing responsibilities.
• Reinforce that the AVP CE is associated with greater knowledge and confidence to discuss the HPV vaccine with parents and negotiate hesitancy.
• Incentivize CE with small congratulatory tokens for completion (i.e. words of affirmation, candy, stickers, etc.).

Provider prompts let healthcare providers know when clients are due for specific vaccinations. They usually consist of electronic prompts in Electronic Health Records (EHRs) or notes/flags in paper charts. Most EHR provider prompts are automatic pop-up alerts that notify the viewer that the patient is due or overdue for an immunization. Many EHR systems provide built-in reminder functionality for this, such as Best Practice Alerts, Health Maintenance, or other similar features. Other EHR provider prompts may show up as a "to-do" task, even if the patient is not scheduled that day for an appointment. Many EHRs have provider prompts pre-installed that can be customized in the office. Notes/flags in paper charts must be added manually, after review of the chart for due vaccines.

STEPS TO IMPLEMENT PROVIDER PROMPTS:

1. Team up with your EHR vendor and learn if/how EHR-based provider prompts for HPV vaccination can be configured for your practice. To determine vaccine eligibility of your patients you can use the Provider Reminder Logic in the ‘Tools’ section of your Action Plan. The basis for this logic is the HPV vaccination schedule dated October 2019. CDC’s Adolescent Immunization Schedule can be reviewed for any updated information at https://www.cdc.gov/vaccines/schedules/index.html

Tip: Many EHR systems provide built in reminder functions such as Best Practice Alerts or Health Maintenance. These functions are adjustable to trigger based on HPV vaccine eligibility.
If automated EHR-based provider prompts are not possible, use alternative approaches to notify providers that patients are eligible for the HPV vaccine. For example:

1. Clinics with an EHR:
   

   A clinic with an EHR and access to basic patient data can construct a report of eligible patients. This report can be run manually at specified intervals and the results delivered to those managing the provider reminder delivery. An office staff or clinical team member can then place a note in the patient’s electronic chart in a location that clinicians review for each patient (e.g. a patient summary screen).

2. Clinics without an EHR:
   

   Clinics without an EHR can implement the ‘traditional’ approach of placing notes or stickers on the patient’s paper charts.

TIP: Use the Provider Reminder Logic in the ‘Tools’ section of the Action Plan to identify patients eligible for HPV vaccination.

AVP parent reminders notify parents when their child is due or overdue for any dose of the HPV vaccine. Reminders are delivered through varied channels (e.g., telephone, letter, postcard, text message), may be tailored for individual parents, and may include educational messages about the importance of vaccination.

STEPS TO IMPLEMENT PARENT REMINDERS:

1. Establish internal quality control to ensure patient contact information is up to date.
2. Use the AVP Parent Reminder Logic in the ‘Tools’ section of the Action Plan to identify patients eligible for HPV vaccination. The basis for this logic is the HPV vaccination schedule dated February 2020. CDC’s Adolescent Immunization Schedule can be reviewed for any updated information at https://www.cdc.gov/vaccines/schedules/index.html .
3. Configure your EHR. Team up with your vendor to learn if/how EHR-based parent reminders for HPV vaccination can be configured for your practice.

TIP: There are varied algorithms that EHRs utilize to identify patients eligible for a dose of the HPV vaccine and send them a reminder message. For example:
• Many EHR systems come with a patient portal option. Practices can use this feature to send e-mails to patients or parents prompting them to check their patient portal, which will remind them of vaccinations that are due.
• Data from patients identified as eligible for HPV vaccination can integrate with an automated reminder system. Reminders are then auto-generated and sent directly to patients as voice messages, text messages to their mobile phones, or as email.
4. Use an alternative approach if EHR-based patient reminders are not possible. Numerous alternative methods exist to identify eligible patients and send reminders using a logic- based approach.

TIP: Examples of alternate manual-based patient reminder approaches:

• Many EHR systems have functionality to run a report of patients who are due or overdue for the HPV vaccine. This report can run manually at specified intervals and the results delivered to those managing the patient reminder delivery. Phone or mail reminders can then be delivered by office staff
• To maximize completion of HPV vaccine series, ask families to fill out reminder cards for follow-up doses (e.g., dose 2 or 3 of HPV vaccine) when in the office.

 

 

 

 

These quick tips have been used successfully to help clinics identify vaccine eligible patients and follow-up with reminders to parents on their youth’s vaccination status and may be helpful for you.

• Schedule a specific day/time to have uninterrupted time to send Parent Reminders so that your staff is not overburdened with this task.
• Consult with your IT personnel to see if automated Parent Reminders can be generated through your EHR system to decrease workload on staff.
• Encourage parents of patients to schedule a follow-up dose appointment before they leave to ensure that they do not forget to schedule the next appointment.
• Consider adding ‘live-calls’ to your Parent Reminder protocol as a way to reach out to parents without them needing to call back upon being answered.

HPVcancerFree is an iOS and Android compatible smartphone app for parents of adolescents (10-17 years) who have not completed the HPV vaccine series. The self-administered app is designed to:

1. Raise awareness of HPV and the potential for cancer prevention;
2. Reduce barriers to HPV vaccination by reducing vaccine hesitancy; and
3. Enable parents to schedule HPV vaccination reminders through their smartphone.

HPVcancerFree contains four self-tailored components:

1. HPV A-Z (a compendium of facts regarding HPV and HPV vaccine);
2. Bust a Myth (educational modules addressing the most salient HPV vaccination barriers accompanied with provider testimonials and parent role models);
3. Notes 4 Doc (a place to keep notes to cue further discussion with providers); and
4. Get the Vax (a sequence of steps to guide appointment setting and a reminder schedule for HPV vaccination initiation and follow-up doses).

STEPS TO PROMOTE AND USE HPVcancerFree:

TOOLS TO PROMOTE HPVcancerFree

AVP-IT HPVcancerFree App Promotional Materials

These promotional materials (below) can assist providers in recommending the HPVcancerFree app to parents:

1. Promotional Flyer
2. Talking points for champions to explain the app to providers and staff.
3. Draft e-mail to notify providers and staff about the app
4. Talking points for providers to explain the app to parents.

HPVcancerFree Talking Points for Champions

• HPVcancerFree is a great resource for parents of patients ages 10-17
• The app provides:
  • Education about HPV and the HPV vaccine
  • Answers to common questions parents have about HPV and the HPV vaccine
  • A notes section for parents to save questions for their provider
  • Reminders for follow-up doses
• Parents can access this free app by searching “HPVcancerFree” in the Apple App Store (iPhone users) or Google Play Store (Android users)
• Clinic staff should provide the HPVcancerFree Flyer to parents of 10-17-year-old patients during both well and sick child visits

 

HPVcancerFree Talking Points for Providers

• HPVcancerFree is a great resource for parents like you!
• The app provides:
  • Education about HPV and the HPV vaccine
  • Answers to common questions parents have about HPV and the HPV vaccine
  • A notes section to save questions for your provider
  • Reminders for follow-up doses
• Access this app by searching “HPVcancerFree” in the Apple App Store (iPhone users) or Google Play Store (Android users)
• For more information, see the HPVcancerFree Flyer

These quick tips have been used successfully to help promote the HPVcancerFree app to parents and may be helpful for you.

• Promote the app to parents including that it is user-friendly, clearly explains what HPV is and everything about the HPV vaccine, addresses common misconceptions about the HPV vaccine, and provides a reminder function to keep on track with the vaccine schedule.
• Promote the app to staff as part of patient education that can answer parents’ questions and address their major concerns about the vaccine with information that is CDC accredited. This is particularly useful program if face-to-face time with parents is limited.
• Print out the promotional flyer and post it in common areas for parents and clinic staff.