AFIX For Your Practice

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AFIX For Your Practice
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What is AFIX?

• Acronym for
• Assessment of Coverage
• Feedback of Information
• Incentives for Outcomes
• eXchange of Information

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Purpose of AFIX
Made Changes

• Eliminate Vaccine Preventable Diseases
• Increase Immunization Coverage
• Help private providers to understand their true
  coverage rate
• Summarize Immunization Practices
• Provide an Educational Opportunity

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Assessment

• Standardized routine collection, analysis and
  summary of immunization records
• Purpose
• Generate immunization coverage rate
• Identify service delivery problems
• Identify useful changes in policy and practices
  procedures

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Feedback
Made Changes

• Return of diagnostic and performance information
  to front-line staff and decision makers
• Purpose
• Motivate practice to improve immunization rate
• Develop solutions specifically related to their
  practice

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Incentives

• Provide motivation to improve service and achieve
  goals.
• Purpose
• Recognize accomplishments
• Enhance pride in workmanship
• Reinforce sense of organizational mission
• Emphasize priorities

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eXchange

• Comparison to peers and focus on organizational
  mission.
• Purpose
• Compare process and outcome indicators
• Exchange ideas with peers
• Provide mutual support
• Stimulate friendly competition

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All You Need For An AFIX Assessment

• Two visits to your office
• ASSESSMENT 4 DTP, 3 Polio, 1 MMR
• Space for AFIX Coordinators to work
• 100 charts 50 12-23 month olds and 50 24-36
  month olds charts are chosen from a random sample
  
• 3-5 Hours for assessment

Made Change- Could change slide to What You
Need to do an AFIX Visit
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What Is a Feedback Session?

• FEEDBACK and EXCHANGE session
• 30 minutes - 1hour
• Compilation of CASA Reports
• Informal discussion with office staff about
  findings

Made change
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Immunization Status
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Up-To-Date (UTD)

• Coverage rates
• 4-3-1 (4DTaP - 3IPV - 1MMR)
• 3-2-2-2 (3DTaP - 2IPV - 2Hib -2HepB)
• Varicella
• PVC7

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Late UTD

• 24-35 months
• 4-3-1, but not by 24 months
• 3-2-2-2, but not by 12 months
• 12-23 months
• 3-2-2-2, but not by 12 months

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Not UTD

• Missed opportunities
• Missed opportunity for simultaneous
  vaccination
• Missed opportunity during a sick visit
• Drop Off Rate

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UTD in 1 visit

• Children who could be brought up-to-date (UTD)
  with One additional visit by 24 months of age
• and needing 1 vaccine
• and needing 2 vaccines
• and needing 3 vaccines

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Late starts

• Children who begin the primary series, (DTaP,
  IPV, HIB) after 3 months of age are more likely
  to be not UTD

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AFIX visits
Made Changes

• 250 Private Providers have received an AFIX
  visit
• Coverage rates have ranged from 26 to 100

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AFIX Statistics
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What Is a Repeat Visit?

• An assessment to compare AFIX results from
  previous visit to current visit results

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Does AFIX Really Work?

• 35 Providers have had repeat AFIX Visits
• 87 improved their 431 rates
• The average increase was 7
• The most common increase was 12
• The largest increase was 40
• The largest decrease was 16

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AFIX IN CABARRUS COUNTY

• Background
• Vaccinations for Everyone
• Overall Goal To assure community protection
  against vaccine-preventable diseases and
  eliminating immunization disparities among North
  Carolinians

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AFIX IN CABARRUS COUNTY

• Background
• Vaccinations for Everyone
• Objective To increase age appropriate
  immunization coverage levels among children by
  age two

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AFIX IN CABARRUS COUNTY

• Intervention I
• Determine the current immunization status of
  children in private medical practices in Cabarrus
  County through record audits (using CASA)

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AFIX IN CABARRUS COUNTY

• Intervention II
• Assist private practices, and the CHA, in
  identifying strategies tailored to their
  particular needs that will increase the age
  appropriate immunization rates (using Feedback
  Sessions, including discussions of Best
  Practices)

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AFIX IN CABARRUS COUNTY

• Intervention III
• As a component of the Evaluation process -
  Reassess immunization status, via record audits,
  of children in private practices (again using
  CASA, followed by Feedback Sessions)

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CASA RESULTS FOR CABARRUS PRACTICES
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AFIX Helping Your Office

• Benefits of AFIX
• Understanding issues affecting coverage
• Best immunization practices
• Repeat examples

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Benefits of AFIX
Made changes

• Benefits
• Extraordinary opportunity for Education
• Continuous Quality Improvement
• Assisting in Public Health shift from shot
  delivery to quality assurance

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Reasons Patients Dont Come Back To the Office?

• Parents only bring children in for sick visits
• Population is very transient
• Cannot schedule next appointment ahead of time
  due to office systems
• High staff turnover or short of staff

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Staffs level of commitment

• Staff stresses the importance of immunizations
• Staff educates parents
• Next appointment is scheduled before patient
  leaves
• The whole staff works on immunizations

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Best Practices for Excellent Immunization Services

• Prioritize vaccinations in terms of staff
  responsibilities and communication among ALL
  staff members
  

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BEST PRACTICES cont...

• Review of needed vaccinations
• Tickler File
• Up-to-date flow sheet
• Consolidate immunization records
• Document transfers
• Write legibly and clearly

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BEST PRACTICES cont..

• Document attempted communication
• Placement and design of immunization flow sheet
• Document any adverse reactions or
  contraindications to vaccines.
• Educate parents

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BEST PRACTICES

• Reminder/Recall
• Schedule next visit
• Check immunization status at every visit
• Give all needed vaccinations at each visit

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AFIX in Action gt 90 431 Rates

• ADOLESCENT CARE
• ARBORETUM PEDIATRICS
• AUMAN ANDERSON MUNT DAUMEN KELLY
• CAPITAL PEDIATRICS
• CAROLINA PEDIATRICS
• CAROLINA PEDIATRICS OF WILMINGTON
• CARY PEDIATRIC CENTER

• CHILDREN'S HEALTH SERVICES
• COMMUNITY FAMILY PRACTICE
• CONCORD CHILDREN CLINIC
• EDEN PEDIATRICS
• FAYETTEVILLE CHILDRENS CLINIC
• FORD SIMPSON LIVELY RICE PEDIATRICS
• FUQUAY VARINA PEDIATRICS
• GAIL STONE, M.D.

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AFIX in Action contd

• GATEWAY PHYSICIANS GROUP
• GOLDSBORO PEDIATRICS P.A.
• HIGH POINT FAMILY PRACTICE
• LE MASTER
• LEXINGTON PEDIATRIC CLINIC, PA
• MACCLESFIELD HEALTH CARE CENTER
• MOUNTAIN AREA PEDIATRIC ASSOCIATES

• MURTHY G. K. MANNE PEDIATRICS
• NORTH STATE MEDICAL CENTER
• NORTHWEST PEDIATRICS IN
• OBERLIN ROAD PEDIATRICS
• PARK AVENUE PEDIATRICS
• PEDIATRIC CLINIC
• PIEDMONT PEDIATRICS
• PITT CHILDREN'S CLINIC
• ROCKY MOUNT NASH PEDIATRICS

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AFIX in Action contd

• ROSE HILL MEDICAL CENTER
• SNITZ PEDIATRICS, PA.
• SOUTH LAKE PEDIATRICS
• STEDMAN MEDICAL CARE
• SUNRISE PEDIATRIC ASSOCIATES, PA
• THE DAVIDSON CLINIC

• UNIVERSITY PEDIATRICS - MALLARD CREEK
• W. STANLEY RULE
• WEST PARK PEDIATRICS
• WHITEVILLE MEDCAL ASSOCIATES
• WINSTON-SALEM HEALTH CARE

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Contact Information

• Jammie Johnson - Immunization Branch Eastern
  Region AFIX Coordinator
  
  919-218-5852 jammie.johnson_at_ncmail.net
• Beth Quinn - Immunization Branch Western
  Region AFIX Coordinator
• 919-218-5859
  beth.quinn_at_ncmail.net

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Questions?