title: Improving HPV Vaccination Rates Using Maintenance-of-Certification Requirements.
abstract: BACKGROUND
  Many pediatricians are now required to participate in American Board of Pediatrics Maintenance of Certification (MOC) Part IV programs focused on improving health care quality, but the benefits of participation are unproven.
  
  
  METHODS
  Twenty-seven primary care pediatricians from 11 primary care practices participated in a 1-year MOC program for human papillomavirus (HPV) vaccine. Participants received education and electronic health record (EHR)-generated performance feedback reports with their rates of captured HPV immunization opportunities (dose given at eligible visit) and those of peers. In each of 3 cycles, clinicians collectively identified a goal for improvement. Rates of captured opportunities among adolescents 11 to <18 years old were tabulated, and statistical process control charts were created to evaluate changes over time among participants compared with 200 nonparticipants. Provider perceptions of the program and time invested were recorded via survey.
  
  
  RESULTS
  Participating clinicians missed fewer opportunities for HPV vaccination than nonparticipants. MOC participants significantly increased their captured opportunities relative to nonparticipating clinicians by 5.7 percentage points for HPV dose 1 at preventive visits and by 0.7 and 5.6 percentage points for doses 1 and 2, respectively, at acute visits. There were no significant differences for other doses. The estimated program cost was $662/participant. Of the participating pediatricians, 96% felt the effort to participate was warranted, and half would not have joined the project without the MOC requirement.
  
  
  CONCLUSIONS
  Participation in MOC Part IV improved vaccination at modest cost and with high pediatrician satisfaction, demonstrating benefits of the program that may help to inform future initiatives.
authors.affiliation: The Pediatric Research Consortium (PeRC), Department of Biomedical and Health Informatics, Center for Pediatric Clinical Effectiveness (CPCE), PolicyLab, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania fiks@email.chop.edu.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Fiks
authors.affiliation: Office of Clinical Quality Improvement, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Xianqun
authors.initials: X
authors.lastname: Luan
authors.affiliation: Center for Pediatric Clinical Effectiveness (CPCE), PolicyLab, and.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Mayne
mesh_terms: D000293:Adolescent; D002568:Certification; D005260:Female; D006801:Humans; D008297:Male; D009515:New Jersey; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines; D010372:Pediatrics / Q000592:standards*; D010414:Pennsylvania; D011320:Primary Health Care / Q000592:standards; D011787:Quality of Health Care; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines