HPV vaccination could prevent most of the 34,000 HPV-attributable cancers diagnosed in the U.S. each year, but uptake remains suboptimal. Given the increasing consolidating of pediatric primary care, large healthcare systems are key partners in implementing interventions to improve HPV vaccination. To inform future partnerships, we sought to explore implementation strategies systems currently use to improve HPV vaccination. Methods: We conducted in-depth telephone interviews with a multi-state sample of QI leaders in 15 large healthcare systems. Guided by Powell and colleagues's typology of implementation strategies, we analyzed data qualitatively via content analysis. Results: QI leaders reported using a wide range of implementation strategies for improving vaccination services generally, but described barriers to improving HPV vaccination specifically. Many prioritized assessment and feedback, or giving providers data on their vaccination rates, to inform practice improvements. However, several leaders noted that their electronic medical records did not offer HPV vaccine-specific quality metrics, but rather reported on adolescent vaccines in combination, limiting their ability to focus on HPV vaccination. QI leaders also generally favored provider financial incentives, but none were using this strategy to improve HPV vaccination, either due to the lack of an HPV vaccine-specific metric or low prioritization of the metric compared to others. QI leaders perceived provider training as an effective strategy for improving prescribing practices; however, many noted that time with providers for HPV vaccine-specific training was extremely limited. Conclusions: The emergence of large healthcare systems provides an opportunity to leverage existing QI infrastructure for addressing underuse of evidence-based preventive services. Large healthcare systems are motivated to improve vaccination services and use diverse implementation strategies to do so. However, in the case of HPV vaccination, our findings suggest that limitations in existing quality metrics, along with payment structures that constrain time for provider training, are two key barriers to practice improvements.

The following are the 17 highest scoring abstracts of those submitted for presentation at the 44th Annual ASPO meeting held March 22–24, 2020, in Tucson, AZ.