Choose a Metric
Motivating healthcare teams to make changes requires meaningful and clear metrics. For example, HEDIS (Healthcare Effectiveness Data Information Set) measures are government endorsed standards for measuring performance of healthcare and health insurance plans. Many systems use these metrics for their QI projects in order to meet those standards.
Important considerations for choosing an HPV vaccine quality metric include:
- Which dose will you measure?
Many teams prioritize HPV vaccine initiation—or receipt of the first dose—because QI projects are likely to achieve larger changes in initiation than completion. However, completion is also an important public health goal, as it aligns with the HEDIS measure and Healthy People 2020 goal.
- Which patient age group will you follow?
Many QI projects focus on adolescents, ages 11-12, who are in the age range for routine HPV vaccination. Other metrics, including the HEDIS measure, assess vaccination more narrowly among adolescents as they turn 13; this measure has the advantage of assessing “on time” vaccination, but may not include sufficient patients for smaller clinics or short-term projects. Assessing “late” vaccination among ages 13 and older is not recommended, as it does not promote on-time vaccination.
- Which patients are “eligible”?
Teams must decide whether to assess HPV vaccination among all patients attributed to a clinic or to focus more narrowly on those with a clinical visit or other vaccine dose during the project period. Raising coverage among all patients reflects the public health goal, but is also more difficult to change, particularly if patient attribution is out of date.
- Will you track HPV vaccination at the provider or clinic level?
Assessing HPV vaccination at the provider level offers the best data for informing practice improvements. However, this approach requires high-quality data and can be difficult if providers share patients. In these cases, clinic-level data may be preferable.
- Where will you get data?
QI partners may have access to state immunization information systems (IIS) which can allow for comparisons with state level data or with other health systems. However, health systems may have more confidence in their own EHR data. EHR systems differ in their data tracking and reporting capacities, so it is important to find out details about health systems’ current and potential HPV vaccine reporting.
- Which vaccines will you include?
Assessing HPV vaccine separately from other adolescent vaccines will give a QI project more focus than using a combination measure, such as the HEDIS metric. However, health systems prefer to use HEDIS because of familiarity or existing data systems.
Set a Goal
Setting a goal is important for motivating practice improvements. The best goals will represent clinically meaningful improvement, but still be achievable.
- What type of increase will you choose?
Goals are often based on an absolute percentage increase in HPV vaccination. For example, “We will raise HPV vaccine initiation among our 11-12 year old patients by 15 percentage points (or 15%) in 1 year.” Such goals are preferable to specific benchmarks like the Healthy People’s 80% coverage goal in the case that clinics are unlikely to achieve the goal.
- What is the time period for achieving this goal?
Goals based on a full year often align with health systems’ QI cycles and also account for the seasonality of HPV vaccination.
- Who will be involved in choosing the goal?
In some healthcare systems, decisions about QI projects, including metrics, are made by leaders in the system or a system-wide QI team. In other health systems, individual clinics or providers may be able to set their own QI goals. Understanding how decisions are made in the system is important for setting an improvement metric. QI partners won’t get support for projects without the input of decision makers. However, even when metrics are set by leaders across the system, getting buy-in from providers and clinics will help increase the chances for success.