Parkland, UT Southwestern receive Texas Hospital Association Bill Aston Award for Quality
DALLAS – Feb. 14, 2018 – Parkland Health & Hospital System and UT Southwestern Medical Center received the 2017 Bill Aston Award for Quality at the annual conference of the Texas Hospital Association (THA) on Feb. 7 in Houston for a project that has significantly improved the rate of voluntary human papillomavirus (HPV) vaccine delivery in Dallas County.
THA established the prestigious award in 2010 to honor hospitals that have distinguished themselves through measurable success in improving quality and patient outcomes through the sustained implementation of a national and/or state evidence-based patient care initiative that involves physicians, hospital governing board members and staff.
To understand how to optimize voluntary HPV vaccine delivery for the most vulnerable members of the Dallas community, Parkland began a research and quality improvement (QI) collaboration with UT Southwestern Medical Center in 2009. Current leaders of the project are Sentayehu Kassa, MD, senior lead staff physician at Parkland’s Vickery Health Center and Jasmin Tiro, Ph.D., associate professor at UT Southwestern’s Department of Clinical Sciences.
The goal was to increase the rate of voluntary HPV vaccination of eligible patients in order to reduce the incidence of pre-cancers and cancers linked to the HPV virus.
As a result of these research and QI activities, in 2016 Parkland’s voluntary 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.
“Texas hospitals are leaders in quality and patient safety, and we are proud to recognize innovative hospital teams like the one at Parkland Health & Hospital System,” said Ted Shaw, THA president and CEO.
“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.
“HPV-related cancers are preventable but vaccination rates are low in Dallas and across the U.S. The Harold C. Simmons Comprehensive Cancer Center at UT Southwestern is supremely proud to be part of an effective program to increase voluntary HPV vaccination rates and prevent future cancers,” said Dr. Carlos L. Arteaga, Director of the Simmons Cancer Center.
“Parents have the potential to prevent their child from developing cancers caused by HPV if they decide to give their child the HPV vaccine series at the recommended age,” Dr. Kassa said. However, physicians at Parkland say that in Dallas County, as in the U.S., too few adolescents are agreeing to be vaccinated as recommended by the Centers for Disease Control and Prevention. The two-dose series should be given on a schedule of 0 and 6 months to adolescents aged 11 through 12 years. If an adolescent starts the series after age 14, then three doses are recommended at 0, 2 months, and 6 months.
For the Dallas community, delivery of this cancer prevention tool is particularly important because a large number of Dallas residents are newly-diagnosed with an HPV-related cancer each year, Dr. Kassa said. 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.
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 to those who voluntarily agreed 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 voluntary initiation and telephone recalls to improve series completion.
“Surprisingly, the pamphlet was effective at encouraging 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, another voluntary 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.
About UT Southwestern Medical Center
UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 22 members of the National Academy of Sciences, 17 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The faculty of more than 2,700 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in about 80 specialties to more than 100,000 hospitalized patients, 600,000 emergency room cases, and oversee approximately 2.2 million outpatient visits a year.
