BACKGROUND:
Assessment, Feedback, Incentives, and eXchange (AFIX) is a quality improvement (QI) initiative that assesses pediatric vaccination completion rates of physicians participating in the Vaccines for Children (VFC) program and offers evidence-based strategies for improving their rates. AFIX is now conducted in public and private practices nationwide, but providers' attitudes toward it are unknown, and the relationship between AFIX-linked quality improvement strategies and practice-specific coverage rates is not well-understood.

OBJECTIVE:
To determine whether providers value the AFIX process; to assess the relationship between AFIX recommendations and completion rates for the 4:3:1:3 (4 doses DTaP, 3 doses Hib, 1 dose MMR, 3 doses Polio) series; to identify practices that distinguish providers with high or improving rates from those with persistently low rates.

METHOD:
In November 2004, 134 Indiana VFC-enrolled providers received a 25-item mailed survey asking about: their participation in and attitudes toward the AFIX process; their motivation to implement and use strategies to improve their pediatric vaccine completion rates; how they decide which strategies to implement.

RESULT:
State immunization program data showed that, for this group, average 4:3:1:3 completion rates increased from 69% in 2000 to 92% in 2003. Survey data collection will be summarized in terms of descriptive summaries of providers' attitudes toward AFIX assessments, the decisions on which quality improvement strategies were based, and of motivators cited as reasons for implementing new strategies. Multivariate analyses of attitudes and strategies that differentiate practices with high or improving completion rates from those with low or stagnant rates will be presented.

CONCLUSION:
Findings will clarify the perceived value of AFIX and its role in improving immunization completion rates, and will identify factors most predictive of high or improved rates.

LEARNING OBJECTIVES:
To better understand (1) providers' attitudes toward AFIX and (2) the relationship between AFIX-linked quality improvement strategies and practice-specific coverage rates.