Using a Standardized AFIX Procedure to Enhance the Effectiveness/Outcomes of Site Visits and Improve Immunization Rates

Background:  Before 2010, there were no standardized procedures on how to conduct an AFIX site visit in Maine.  AFIX staff verbally delivered suggestions to providers on identified areas for improvement for most of the site visits.  Therefore it was hard to measure the outcomes of these visits.

Objectives:  Standardize AFIX site visit procedures with a written template of feedback, Quality Improvement (IQ) Workplan, to each provider visited for improving the effectiveness of AFIX sessions.

Methods:  In 2010 before starting AFIX visits, involved staff received a training that focused on the standardized procedure and the development of a written QI Workplan for each visit.  After an AFIX site visit, each provider received a written copy of their AFIX visit feedback; their 2010 QI Workplan along with a site visit satisfaction survey.  Survey responses were analyzed to evaluate the level of provider satisfaction with the AFIX process.  A follow-up to providers checked how providers implemented the QI Workplan.

Results:   Evaluation of site visit satisfaction survey responses showed that 92% of providers were satisfied with the AFIX process.  Responses from the QI Workplan provider survey indicated that 58% of providers felt implementation of the QI Workplan strategies was beneficial.  Benchmark assessments of immunization rates, prior to the implementation of QI Workplans, were compared with assessment rates after implementation of QI Workplans, in the same providers.  Up-to-date rates for 4DTaP3Polio1MMR3HIB3HepB1Var4PCV increased from 49% (4647 children assessed) in 2010 to 69% (6191 children assessed) in 2011.

Conclusions:  Implementing a standardized AFIX visit procedure allowed providers to better understand where their areas of improvement were and how to target those identified areas to enhance their immunization services.  Evaluation of this standardized procedure offers evidence that a majority of providers were satisfied with the new AFIX process and QI Workplans from the visits contributed to improved immunization rates.