25516 Restructuring AFIX (Assessment-Feedback-Information-Exchange) and VFC (Vaccines For Children) Programs to Improve the Quality of Site Visits

Tuesday, March 29, 2011
Columbia Hall
Paula Francis-Crick, MPH , Public Health Epidemiologist, NYC Department of Health and Mental Hygiene

Background: In 2008, the NYC Immunization Program merged AFIX and VFC units into the Provider Quality Assurance (PQA) unit with the goal of reducing service duplication, increasing combined AFIX and VFC visits, and facilitating communication with providers. PQA field staff received training on CoCASA, obtaining immunization coverage reports through the Citywide Immunization Registry (CIR), and other electronic tools

Setting: The PQA unit compared the number of AFIX and VFC visits from 2007 to those in 2010 to determine the impact of program restructuring.

Population: As of November 2010, 1,634 providers were enrolled in NYC VFC. 

Project Description: Cross training on AFIX and VFC began in December 2008.  Initially, EpiInfo was used for analyzing AFIX, and MS Access for entering and analyzing VFC site visit questionnaire data.  In 2009, PQA transitioned to CoCASA for all AFIX and VFC data entry.  Although the methodology for conducting CIR-based AFIX evaluations was initiated in 2006, by August 2010 all AFIX evaluations were conducted through CIR because they took 2 hours compared to up to two days for office-based chart reviews.  To improve efficiency, VFC questionnaire data are entered directly into CoCASA, and electronic feedback reports and educational materials are provided. To enhance visits, PQA staff demonstrates CIR tools such as reminder/recall and online vaccine ordering.

Results/Lessons Learned: From January-October 2007 to January-October 2010, VFC visits increased from 359 to 668 (86%), AFIX visits increased from 268 to 447 (67%), and combined AFIX and VFC visits increased from 103 to 434 (321%).  Establishing the PQA unit by combining resources within the AFIX, VFC, and CIR units streamlined work flows, maximized efficiency, and helped increase the number of visits while reducing field staff from 15 to 10 (33%).  In 2011, NYC expects to visit 50% of VFC providers and will conduct a VFC provider satisfaction survey.