Factors related to the diffusion of HPV vaccination in a state Medicaid program

The overall objective of this research is to determine who HPV vaccination rates may be improved through the determination of diffusion patterns and provider characteristics related to provision of the vaccine. Ultimately, understanding the diffusion and provision of HPV vaccine within an at risk population will lead to the development of innovative models for increasing provider compliance with HPV vaccine recommendations. Utilizing Iowa Medicaid claims and enrollment files and the Iowa Health Professions Tracking database for the period 2005-2012. We defined the diffusion pattern for adolescent females and males,identified the providers who vaccinated adolescents, and determined the vaccine intiation and completion rates.During the period 2006-2012 over 30,000 adolescents received and initial HPV vaccination, while during this same period only 10,000 completed the three dose vaccination series. OF the 20,000 that did not complete, less than 8,000 received a second dose. Nearly 500 received more than 3 doses indicating attempts to 'restart' the series. Approximately 2,300 providers were responsible for these vaccinations, with the majority having a family practice or pediatric specialty. However, there were a significant proportion who identified their specialty as "General". Though adolescent males do receive the vaccination they are far less likely to initiate and complete. We did find that adolescents with a cognitive impairment or serious mental illness were less likely intiate but more likely to complete. These adolescents were also likely to initiate at an older age. Regression to determine the factors the predict whether a provider will vaccinate are currently being completed.