KEYWORDS:
Assessment, Feedback, Incentive, eXchange (AFIX); Lot Quality Assurance (LQA); Immunization Assessments, Vaccines for Children (VFC); Vaccine Management

BACKGROUND:
MIP has conducted AFIX visits utilizing CDC’s Clinic Assessment Software Application (CASA) since 1993. In 2000, MIP adopted an LQA protocol to maximize the number of pediatric provider sites assessed each year. The LQA methodology resulted in more than a 5-fold increase in sites assessed, from 74 in 1999 to greater than 400 in 2002.

OBJECTIVE:
Describe results of immunization assessments conducted in 2001.

METHOD:
Sites enrolled in MIP’s VFC program were selected if they served children at greatest risk for under-immunization, “failed” an assessment in 2000, or had never been assessed. Sites were assessed for: a) 2 year-olds up-to-date with 4-3-1-3-3 immunization series; b) immunization practices related to reminder/recall, missed opportunities, and documentation; c) VFC compliance; and d) vaccine storage and handling practices. Each assessment also involved an intensive quality assurance feedback component and a review of evidence-based successful strategies to improve immunization levels.

RESULT:
MIP conducted a total of 344 assessments in 2001, as compared to 74 when using the practice-based assessment (PBA) protocol in 1999. Of these 344 assessments, 206 (60%) “passed” and 138 (40%) “failed”. Missed opportunities for immunization was the most frequent reason children were not up-to-date (40%), followed by reminder/recall (29%) and documentation (28%) problems. Suggestions were offered during the quality assurance feedback component to resolve specific problems identified at each site.

CONCLUSION:
MIP has been able to conduct increased numbers of assessments while maintaining the ability to identify reasons why practices are not up-to-date and to assist practices with improving immunization levels, VFC compliance, and vaccine management practices. The more intensive quality assurance feedback component has facilitated improving immunization levels based on specific problems identified at each provider site.

LEARNING OBJECTIVES:
Describe LQA methodology; identify strategies for improving the AFIX process.