Prevalence and Inclusiveness of Pay-for-Performance Incentives for HPV Vaccination

OBJECTIVES: We examine the prevalence of payfor-performance (P4P) incentives to promote human papillomavirus (HPV) vaccination and eligibility for P4P incentives as reported by clinical staff. STUDY DESIGN: A 2022 survey of primary care clinical staff in the US who provided HPV vaccination to children aged 9 to 12 years (N = 2527; response rate, 57%). METHODS: The primary outcome was a mutually exclusive categorical variable for the type of P4P quality metrics used in the past year: HPV vaccination, other pediatric vaccinations, other quality metrics, or none. The secondary outcome was an indicator variable for whether the respondent was, or would be, eligible for P4P incentives. We adjusted logistic models for clinical staff and clinic characteristics. RESULTS: Only 8% (n = 193) of respondents reported use of P4P incentives for HPV vaccination in their clinic. Clinics that were part of a health care system were more likely to have used P4P incentives for HPV vaccination (relative risk ratio [RRR] for respondents in systems of ≥ 5 clinics vs respondents not in systems, 2.06; 95% CI, 1.38-3.08), and clinics that saw more children were more likely to have used P4P incentives for HPV vaccination (RRR for respondents in clinics seeing ≥ 50 children vs clinics seeing 0-9 children per week, 2.64; 95% CI, 1.44-4.82). Physicians were more than twice as likely as other clinical staff to be eligible for P4P incentives (eg: OR for physician assistant, 0.40; 95% CI, 0.28-0.59). CONCLUSIONS: Opportunities exist to extend P4P incentives in primary care to promote HPV vaccination.