The present study was conducted by the Prevention Directorate of the Veneto Region to improve the quality of the HPV vaccine provision to the specific at-risk population of women who have not undergone vaccination and can be compared with other experiences in Italy and Europe. More in general, QI in healthcare provision can be seen as a systematic, ongoing effort to solve problems, improve services, and ultimately achieve better patient outcomes. To significantly influence quality improvements in the provision of healthcare, the application of EBPs needs to be followed up with efforts to overcome the inconsistent incorporation of research findings in clinical practice. QI proved vital as a contextual organizational factor in the adoption of evidence-based practices (EBPs) and can be used to support their introduction and consolidation. Quality improvement (QI) in the provision of healthcare is described as a systematic, information-driven, change-focused activity. This includes: adapting guidelines to local contexts identifying barriers to their use selecting and implementing tailored interventions to promote their adoption monitoring and assessing the associated outcomes, and the sustainability of the recommendations. An iterative process consisting of several steps is recommended. The study also confirms the need for more efforts in communication to ensure that any citizen has the opportunity to access preventive healthcare.ĭespite the evidence in the literature on the efficacy of prevention strategies, the degree to which they are adopted in healthcare practice remains uncertain, and it is worth taking action to promote their implementation. These findings underscore the importance of providing training to promote vaccination for general practitioners and other clinicians. After implementing the quality improvement strategy, the proportion of women given a first dose of HPV vaccine within 3 months of being diagnosed with CIN2+ lesions at 1st-level screening rose to 50% (compared with 30.85% beforehand), and the median time elapsing between a diagnosis of CIN2+ lesion and a first dose of HPV vaccine dropped from 158 to 90 days.
The LHUs differed considerably in how they managed each step, in terms of training for healthcare personnel, organization and assessment of the pathway from cervical screening to HPV vaccination, and in dedicated website communication. Changes in practice were measured using data relating to women diagnosed with CIN2+ lesions extracted from the regional oncological screening database before and after the publication of a Regional Procedure on the topic. Strategies to close the gap between ideal procedure and real practice were decided collegially, and a checklist to support good practices was developed and shared with operators at the LHUs. An additional specific assessment concerned the quality of the related web pages available on the LHU websites. The questionnaire was administered to nine expert doctors, one at each of the region’s Local Health Units (LHUs).
The Veneto Regional Health Service developed a 22-item questionnaire to measure the gap between ideal procedure and real practice regarding the offer of vaccination against HPV for women undergoing routine cervical screening.
The aim of this study was to assess the impact of a healthcare quality improvement strategy designed to increase the rate of vaccination against HPV in women diagnosed with cervical lesions graded as CIN2 or higher (CIN2+) during routine screening. HPV is the most common cause of sexually-transmitted infections the world over.
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