Integrating IIS with AFIX to Improve Feedback and Follow-up

Background:
Michigan has 1,000+ VFC providers and has conducted "classic AFIX" since 1994. An annual average of 100 providers received time consuming and expensive 2-visit classic AFIX, including a review of up to 200 charts and a 1-hour feedback meeting. It was prohibitive to reach 25% of providers with a classic AFIX. A 3 year intensive quality assurance process (QDC) was conducted, comparing data collected at chart reviews with data in the registry. As a result, thousands of dose dates were added to the registry and reviewed with staff at feedback meetings. The results of the QDC along with a well populated “opt-out” legislated registry prompted collaboration with technical staff to integrate AFIX into the web-based registry, with 35,000+ registered users. The availability of registry based AFIX reports allows additional providers to receive annual AFIX feedback at visits and routine follow-up.

Setting:
VFC public and private providers, Local Health Department (LHD) immunization staff, State AFIX coordinator

Population:
VFC Providers and 19-36 months olds

Project Description:
This presentation highlights the expansion of AFIX, including training of LHD staff in the art of presenting feedback in an encouraging and positive environment. The AFIX reports offer options of missed opportunities, coverage level percentages, invalid doses, and children not up-to-date. The AFIX reports are modeled after CoCASA and eliminated the 2-visit classic AFIX. An additional one-page Basic Overview report was created, listing a summary of data and possible barriers. AFIX feedback is conducted by LHD staff at every VFC site visit. Sites with low coverage levels or with identified areas of improvement receive a 6-month AFIX follow-up visit, through phone calls or another visit to the practice.

Results/Lessons Learned:
LHD staff required extensive training regarding “how-to” conduct effective feedback meetings. AFIX reports are available through the web-based registry to all LHD staff. In 2008 AFIX visits, including feedback, increased to 800.