KEYWORDS:
Registry-based assessments, AFIX, continuous quality improvement (CQI)

BACKGROUND:
In 2000, CASA-based assessments were generated using data exclusively from Oregon's Immunization ALERT registry for private providers participating in AFIX. The process of administering a quality improvement program externally created improved internal quality as a byproduct.

OBJECTIVE:
Identify areas of Oregon's VFC, AFIX, and ALERT programs where improvements can be made in service delivery and data quality.

METHOD:
Implementing a voluntary AFIX initiative throughout Oregon, and using registry-based assessments has afforded the Oregon Immunization Program the opportunity to examine and process internal issues that would not have been addressed without such a comprehensive multi-disciplinary CQI initiative.

RESULT:
AFIX assessments in Oregon are registry-based, and AFIX participation by private providers is voluntary and separate from VFC. Yet, these characteristics of AFIX have posed unique challenges and opportunities. Issues deserving special focus include: how importing incomplete immunization histories into the registry can render assessment results inaccurate; how submitting immunization records to the registry can be a conduit for submitting and tracking VFC eligibility codes; how hospitals' IT applications and processes of charting the birth dose of hepatitis B may erroneously depress coverage rates for individual providers; and others.

CONCLUSION:
These singular challenges create an internal CQI mechanism for program staff and processes, analogous to the external continuous quality loop that AFIX creates for provider practices. This mechanism promotes the development of an enhanced AFIX program, whereby data and in-house expertise become more robust in the process.

LEARNING OBJECTIVES:
Participants will be able to: understand how applying AFIX externally can affect internal processes; and identify areas for improvement within an immunization service delivery program.