Size Does Matter: A Simple Method for VFC Site Visit Prioritization

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
1.Describe how the ‘80:20 rule' can be applied to VFC providers
2.Develop a simple size-based scheme for prioritizing VFC site visits

Background:
State VFC programs have an obligation to periodically visit their enrolled providers to assure VFC vaccine and service quality. How to do this is largely left up to each state, although CDC does mention the need to ‘prioritize'.
The 80:20 rule or “law of the vital few and trivial many” is a business principal that states that for any phenomenon, 80% of the consequences come from 20% of the causes. Concentrating activities on the “vital few” (30% of VFC providers account for 80% of VFC vaccine shipped) rather than the “trivial many” can greatly increase efficiency.

Objectives:
To increase California VFC/AFIX site visit efficiency.

Methods:
California VFC providers were ranked by size based on the numbers of VFC doses received in 2006, then divided into High, Medium, and Low volume groups based on total doses received. A simple protocol directing that sites be visited in a 1:1:1 High/Medium/ Low ratio was developed.

Results:
In 2007, CA developed and implemented a simple size-based method for prioritizing routine VFC/AFIX site visits. Whereas the size-neutral selection process used in 2006 accomplished oversight of 20.9% of total VFC doses shipped, the size–based prioritization scheme expands oversight to 76.1% of total VFC doses shipped, an ~3.5 fold increase in ‘yield'. Actual 2007 results will be presented.

Conclusions:
Prioritizing ‘routine' VFC/AFIX provider site visits by provider size has the potential to increase program efficiency by ‘extending' yearly oversight to greater numbers of VFC-eligible children. Size-neutral methods put most effort into small practices administering very few shots (the long tail). Other issues to be discussed will include field training and acceptance, plan for adding new providers, etc.