{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T19:56:05Z","timestamp":1772740565681,"version":"3.50.1"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Despite recommendations to begin human papillomavirus (HPV) vaccination as early as 9 years of age, uptake remains low.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To compare early HPV vaccine initiation between 2 interventions, compare vaccine completion rates between youths initiating HPV vaccination at 9 to 10 vs 11 to 14 years of age, and identify factors associated with early HPV vaccination initiation and series completion.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective quality improvement study was conducted from January 1, 2019, to December 31, 2023. The study analyzed a quality improvement project using descriptive statistics and survival analyses. Youths aged 9 to 14 years with no prior HPV vaccination, who had at least 1 in-person visit, and who had complete electronic health record (EHR) data were included. The study took place at 21 US outpatient primary care sites within a large health system. Site assignments were based on patient volume and geographic location (urban and rural).<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n An EHR best practice alert (BPA) recommending HPV vaccination beginning at 9 years of age implemented with or without an added clinician education component.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was HPV vaccine initiation at 9 to 10 years of age. Secondary outcomes included vaccine series completion within 2 years after initiation and factors associated with early initiation and completion. Outcomes were measured using EHR-recorded vaccination status and timing.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 15\u202f743 eligible patients (mean [IQR] age, 9.9 [9.0-11.0] years; 7946 [50.5%] male; 1260 [8.0%] Asian, 5082 [32.3%] Black or African American, 7621 [48.4%] White, 420 [2.7%] unknown race, and 1360 [8.6%] other race, including American Indian or Alaska Native, Guamanian or Chamorro, and Native Hawaiian or Other Pacific Islander) participated in the study. Overall, 10 102 (64.2%) initiated and 5198 (33.0%) completed the vaccine series. In the group aged 9 to 10 years, the BPA plus education arm had a significantly higher likelihood of initiating vaccination than the BPA-only arm (adjusted hazard ratio, 1.39; 95% CI, 1.17-1.65;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) compared with the group aged 11 to 14 years. Completion increased from 16 (2.2%) to 464 (19.6%) among youths aged 9 to 10 years and from 183 (13.9%) to 323 (66.6%) among youths age 11 to 14 years. By year 3, the group aged 9 to 10 years had a higher cumulative completion rate than the group aged 11 to 14 years (3899 [33.9%] vs 1299 [30.7%],\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Black or African American race and public insurance were associated with HPV vaccine initiation and completion.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this quality improvement study of early HPV vaccine initiation, an EHR BPA combined with education was associated with a higher likelihood of early HPV vaccination. Delayed but meaningful improvements in series completion were observed among early initiators.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.59670","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:30:31Z","timestamp":1771259431000},"page":"e2559670","source":"Crossref","is-referenced-by-count":0,"title":["Electronic Health Record Alerts for Early Human Papillomavirus Vaccination"],"prefix":"10.1001","volume":"9","author":[{"given":"Tina","family":"Kumra","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins Community Physicians, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongyi","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Blash","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Johns Hopkins Community Physicians, Hagerstown, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Crocetti","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins Community Physicians, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu Bin","family":"Na","sequence":"additional","affiliation":[{"name":"Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Prichett","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins Community Physicians, Baltimore, 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