A F I X to Increase Immunization Rates

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A F I X to Increase Immunization Rates
Becky Houston Holly Kiel Ashley Luck NC
Immunization Branch
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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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History of AFIX

• In 1986 Georgia Department of Public Health
  introduced a state wide program
• The program concentrated on public health clinics
• Rates increased from 40 to 91 between the years
  1986 to 2001
• North Carolina introduced AFIX in 2000, and
  employed two AFIX Coordinators

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A NEW BALL GAME!

• North Carolina Immunization Registry
• (NCIR) AFIX 2009

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PURPOSE

• Eliminate Vaccine Preventable Diseases
• Increase Immunization Coverage
• Help Immunization Providers to Understand Their
  True Coverage Rates
• Summarize Immunization Practices
• Provide an Educational Opportunity

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Benefits of AFIX

• Extraordinary Opportunity for Education
• Identifies Issues Affecting Coverage Rates
• Helps Develop Best Immunization Practices
• Introduces Strategies for Improving Immunization
  Rates

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S-P-E-L-L I-T O-U-T

• A-F-I-X

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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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Methods to Obtain Assessment Rates in
NCIR
1. assessment report (NCIR Assessment Summary
Report)
2. request reminder (Reminder Request Process
Summary Reminder Request Output Options)
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Assessment Report
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Reminder Request Process Summary
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Reminder Request Output Options
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Feedback

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

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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

• Sharing information from office to office and
  among all relevant staff
• Use opportunities to get out the news
• Tell your best practice stories to anyone who
  will listen

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eXchange

• Purpose
• Compare process and outcome indicators
• Provide mutual support
• Exchange ideas with peers
• Stimulate friendly competition

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Strategies for Improving Immunization Rates

• Prioritize vaccinations in terms of staff
  responsibilities and communication among ALL
  staff members
• Use Reminder/Recall
• Schedule next visit
• Check immunization status at every visit

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STRATEGIES CONTINUED

• Give all needed vaccinations at each visit
• Document attempted communication
• Placement and design of immunization flow sheet
• Document any adverse reactions or
  contraindications to vaccines
• Educate parents

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STRATEGIES CONTINUED

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

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Assessment Report in the
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How Will This Assessment Report Help Me?

• Numbers only report- helps you see your
  immunization rates right away.
• Keep track of your clients immunization
  status. Are they up to date? Do they need to come
  back in?
• Show the number of clients that could have
  been brought up to date with additional
  immunizations.
• Assessment of missed opportunities.

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What information do you need to run the report?
Evaluation Date used to set the age range for
the clients in the report.Client Population
options are available based on what type of
provider is requesting the assessment.
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How Do I Run an Assessment Report
Select the Client Population
Private Providers will see...
Health Departments will see...
Choose assessment report
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How Do I Run an Assessment Report
Select your client population
Select your evaluation date
Remember to only click Generate once!!!
Click Generate when done
Choose assessment report
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Assessment Report Status !!!
Stage 1
If Status is Complete click on link under Job name
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How to understand the NCIR Assessment Summary
report
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The key variables on the first page are

• Evaluation Date
• Date Report Was Run
• Age Group
• Birth Date Range
• Records Analyzed
• Understanding these variables is critical to
  understanding the report!!!

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Start by reviewing the number of Records Analyzed
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The age groups include clients who are

• 36-72 months of age
• 24-35 months of age
• 12-23 months of age
• lt12 months of age

as of the Evaluation Date, which was selected
when the report was generated.
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• The Records Analyzed shows how many active
  clients were in each Age Group as of the Date
  Report Was Run.

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• Data included in this report is NOT updated real
  time, but rather on a nightly basis. This means
  that certain information for clients whose
  information changes during a particular day will
  not be reflected until the following day.

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Verify the correct Client Population
Review the number Of Records Analyzed
Note the Date Report Was Run
Verify that the Birth Date Range corresponds with
the age group(s) of interest. These birth date
ranges will be used to generate the Request
Reminder report to identify clients who are not
up to date
Notice the Evaluation Date and How it
corresponds to the Birth Date Range
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Look in the Immunization Status table shown
below. There are 3 columns in this table
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• The 1-4 notation refers to the footnotes
  beneath the Immunization Status table at the
  bottom of the page. These footnotes describe the
  vaccination series benchmarks at which a
  particular age group is being assessed per age
  i.e., UTD by 7 months of age is UTD for 3 DTaP, 2
  HepB, 2 Hib, and 2 Polio.

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This is the UTD for the 2 yr olds
Focus on this age group
Benchmarks
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Page 2 of the Assessment Report looks at each
individual vaccine at different ages (benchmarks).
A benchmark is used as a standard for measuring
or assessing something.
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• The Age Specific Immunization Benchmarks grid
  shows how many vaccines are needed to be
  considered UTD at specific age milestones.

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The following age milestones are used for this
portion of the report
At each age milestone, a specific of doses of
each vaccine are required in order for a client
to be considered up-to-date.

• _at_ 3 months
• _at_ 5 months
• _at_ 7 months
• _at_ 9 months
• _at_ 12 months
• _at_ 16 months
• _at_ 19 months
• _at_ 21 months
• _at_ 24 months
• _at_ 72 months

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In this section of the report, clients are
considered UTD _at_ 16 months if they have
received 4 DTaP, 3 HepB, 3 Hib, 1 MMR, 3
Polio, 3 Prevnar, and 1 Varicella.
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Assessment of Clients Meeting Age Specific
Benchmarks
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Page 3 of the Assessment Report looks at 3
different age groups and the number of clients
who could have been UTD with ONE additional visit.
This represents 25.0 of the total clients in
this age group.
There were 2 clients 24-36 months of age who
could have been UTD with additional
immunizations.
1 client needed only 1 vaccine to be brought
UTD.
That 1 client represents 50.0 of the 2 clients
who could have been brought UTD.
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This table on page 4 of the Assessment Report
displays information for Children Who Got A Late
Start or Have Dropped Off Schedule After A Good
Start.
The upper portion of this table shows Late Start
Rates for 3 different age groups.
The lower portion of this table displays Drop Off
Rates for 5 different age groups.
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Studies have shown that clients who start late
are more likely to continue to be behind and
therefore are not age appropriately immunized.
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The footnotes 2 and 3, beneath the table explain
how the Drop Off Rate _at_ 24 months, as well as the
Drop Off Rate at 12 months was calculated.
Footnotes
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The second table on page 4 of the Assessment
report displays the number and percent of Clients
Who Do Not Have a Birth Dose of Hep B and Have
Not Completed the 3 Dose Series.
Note the footnotes here for further clarification
of the clients being assessed.
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Page 5 of the Assessment Report displays Missed
Opportunities and shows the count of and percent
clients who were not UTD by a specific benchmark,
and of those, the count and percent that had a
Missed Opportunity for an immunization(s) on
their LAST VISIT.
Please be aware that the missed opportunity on
last visit may reflect incomplete documentation
of immunization histories rather than true missed
opportunities for simultaneous vaccination.
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Assessment Report

• In summary
• Know the variables
• Evaluation date
• Birth Date Range
• Date Report Was Run
• Age Group
• Records Analyzed

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Assessment

• Up-to-Date (UTD)
• Late UTD _at_ Assessment
• Benchmarks
• UTD with one additional visit with additional
  immunizations
• Dropped Off
• Late Start
• No birth dose of HepB
• Missed Opportunity on last visit

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Request Reminder
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How Will the Reminder Recall Report Help Me?

• Going to help you determine which clients are
  not up to date with their immunizations.
• Provide a fast way to run a report with all
  the contact information for those clients that
  need to come back in.
• Improve the immunization rates because you
  will be able to keep your clients up to date.

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Request Reminder

• Serves to generate reports, letters, address
  labels, or a client listing for clients active
  in the organization.
• Unlike the Assessment report, the Request
  Reminder reports will show client specific
  information.

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What will make the reports options work to your
advantage?

• If all children are entered into the NCIR
• If historical immunizations are entered properly
  and completely
• If the Notices box is selected for at least one
  responsible person

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How Do I run the Request Reminder Report?
Private Providers
Which one are you?
Health Departments
Click on the request reminder link under the
Reports section
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Private Providers
Choose your vaccine group
1.
Type in your birth date range
2.
3.
Click Generate when done
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Local Health Depts
1.
Select the Client Population
2.
Select the Vaccine Group(s) if you want specific
vaccines
3.
Type in your birth date range
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Go to request reminder
Enter the birth date range
Click Generate
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Stage 1 Click Refresh
Status Updates
Stage 2 Wait, Its thinking!!!
Stage 3 Ok cool, Its Finished!!
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Request Reminder Process Summary
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Important Points about the Request Reminder
Process Summary

• Discuss Active and Inactive
• Born between ? ? (Birth Date Range)
• County, School, Provider
• Weeks since last notice
• Recommended or overdue as of date?
• Target Date Range From and To dates
• Vaccine groups
• Exclude Overdue Reminders
• Responsible Persons, Notices
• City, Zip Code not specified
• Omitted Clients

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RR Part 1
Click on Omitted Clients
Click Refresh
When your report is ready click on the Omitted
Clients link
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Omitted Clients
Notice this client has a Chart Number

• What do I do with the Omitted Clients?
• Print the omitted client list
• Go back to Manage Client
• Add the responsible person information

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More on the Client Query Listing and Omitted
Clients
The client query listing is the best way to find
those clients for a certain age group in the
assessment report.

• From here you have two options
• Take the omitted list and the client query list
  and clean up those records as much as possible
• Take notice of those that are omitted, and the
  clients in the client query listing and go back
  later and fix them

How do I fix the Omitted Clients???
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Click Find
If you have chart numbers, you can search by that
number
Go back to Manage Client
Take the first client on your Omitted Clients
list and enter the info into the Client search
screen
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Click on the Responsible Person(s) Tab
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Responsible Person Information
Note that the v has been removed from the
Notices? box
Note the last updated date and time
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Request Reminder Output Options
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When you click the back button from the omitted
clients, you will come back to the status page

Click the report link which is underlined in blue

Click the link here
Type in the name of the report
Click here
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What can you do with the Client Query Listing?

• Use it to look up chart or EMR copies of
  immunization records to ensure that all
  historical doses are entered
• If you want to fix those records- you can go back
  through Manage client and add those historical
  doses

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You can use the back button here
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Use the Client Query Listing to clean up
address information for the responsible person(s)
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Mailing Labels
Mailing Labels will have duplicates if the
Responsible Person(s) info is not cleaned up
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Things to Remember
Every time you change a listing factor the
Request Reminder report must be run again
Before you run the Reminder Recall again, look at
the client query listing, to see if you can
update more information in the clients record
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• Summary slide
• AFIX
• Assessment
• Feedback
• Incentives
• eXchange

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PURPOSE

• Eliminate Vaccine Preventable Diseases
• Increase Immunization Coverage
• Help Immunization Providers to Understand Their
  True Coverage Rates
• Summarize Immunization Practices
• Provide an Educational Opportunity

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Benefits of AFIX

• Extraordinary Opportunity for Education
• Identifies Issues Affecting Coverage Rates
• Helps Develop Best Immunization Practices
• Introduces Strategies for Improving Immunization
  Rates

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Our goal for the of 2 year olds with UTD
immunizations, is 90 for each vaccine

• The of NCIR AFIXs completed this year is 75
• The UTD range for the 43133 _at_ 24 months is 50

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• If youre interested in learning more about AFIX,
  please contact your RIC (Regional Immunization
  Consultant)
• www.immunizenc.com/Providers.htm
• Questions ???

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Thanks to the AFIX Team!

• Becky Houston
• Ashley Luck
• Holly Kiel
• And to everyone who has participated and
  contributed to this valuable effort and its
  eXchange of information!!!