MINNESOTA
ASSESSMENT,
FEEDBACK,
INCENTIVES,
EXCHANGE
(AFIX)
PROGRAM
Contents
Program Background.............................5
Program Eligibility..................................9
Assessment..........................................13
Feedback..............................................17
Incentives.............................................21
Information Exchange..........................25
Program Resources..............................29
Minnesota Assessment, Feedback, Incentives, eXchange (AFIX) Program
February 2016
AFIX PROGRAM
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AFIX PROGRAM
PROGRAM
BACKGROUND
Program Background
1. Continuous Quality Improvement:
a. What is Continuous Quality Improvement (CQI) in public health?
i. CQI is a continuous, ongoing effort to achieve measurable improvements in the
efficiency, effectiveness, performance, accountability, outcomes and other indicators of quality services or processes which achieve equity and improve the
health of the community. It is an approach to quality management that builds
upon traditional quality assurance methods by:
A. Focusing on the process of conducting business.
B. Emphasizing organization and systems.
C. Promoting the need for objective data to analyze and improve processes.
ii. CQI commonly involves:
A. A quality improvement (QI) team.
B. Training.
C. Mechanisms for selecting improvement opportunities.
D. A process for analysis and redesign.
E. A link to an organization’s strategic plan.
F. An organizational culture that supports continual learning systems and
process improvement.
2. CDC AFIX Program:
a. What is AFIX?
i. Assessment, Feedback, Incentives, and eXchange (AFIX) is a continuous quality
improvement process informed by research and used for improving immunization rates and practices at the provider level. AFIX involves:
A. Face-to-face interaction.
B. Sharing immunization rates.
C. Educating providers on the use of MIIC to improve immunization rates
and practice.
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D. Maintaining contact with immunization champions at clinic and/or system level.
The structure of the program is rooted in a face-to-face interaction with provider staff involved in immunization. This interaction is a very important and
unique opportunity for education, outreach, and consensus toward improved
immunization services and the attained benefits of CQI. Once understood and
implemented by providers, the AFIX components can assist practices in meeting
immunization coverage goals for a variety of standards, including but not limited to Healthy People 2020 and Healthcare Effectiveness Data and Information
Set (HEDIS) measures.
ii. When implementing AFIX, it is important to understand the basic steps of CQI
and define the parameters that can be best addressed through AFIX implementation:
A. State the problem and desired result.
B. Use data to understand the problem.
C. Identify and select strategies for improvement (for example, strategies
to reduce missed opportunities).
D. Implement selected strategies on a small scale.
E. Test the selected strategies.
F. Expand scope and spread throughout an organization or system.
G. Evaluate the outcomes of CQI.
iii. There is strong evidence that assessment and feedback, along with other elements such as incentives and exchange, are effective in increasing vaccination
rates. In 2008, the Task Force on Community Preventive Services updated its
original 1999 literature review on the topic and reaffirmed its earlier recommendation of using assessment and feedback “based on strong evidence of its
effectiveness across a range of settings and populations.” In addition, the Task
Force recommends assessment and feedback for their effectiveness in improving immunization rates in adults and children when used alone or with additional components (such as incentives). This same review is cited in CDC’s Advisory
Committee on Immunization Practices (ACIP) 2011 General Recommendations
in its endorsement of assessment and feedback.
3. Minnesota AFIX:
a. The AFIX program in Minnesota has had a strong relationship with the Minnesota Vaccines for Children program (MnVFC). Local public health and state staff would combine
the questions and content for both the AFIX and the MnVFC site visits in order to maximize efficiency and make the most of the face-to-face time with busy clinic staff. Federal changes within the AFIX and VFC programs have made this relationship no longer
possible. From 2016 onwards, the administration of the AFIX program is in the hands
of Minnesota Immunization Information Connection (MIIC) regional coordinators, who
will perform visits, work with local public health staff to ensure visits are completed,
and provide MIIC support to AFIX-eligible clinics for their CQI activities. While this
program will still prioritize MnVFC-enrolled clinics for AFIX visits and use MnVFC data,
non-MnVFC clinics will now be able to receive these visits upon request.
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b. MIIC was established in 2002 and has long been a cornerstone of the AFIX program.
Rather than relying on chart audits and CDC’s CoCASA system, the Minnesota AFIX program worked with MIIC staff to create MIIC-based assessment reports in 2006. These
reports were then redesigned and enhanced in 2010.
c. See map of MIIC regions on the MIIC Regions and Regional Coordinators (http://www.
health.state.mn.us/divs/idepc/immunize/registry/map.html) page.
Program Background |
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PROGRAM ELIGIBILITY
Program Eligibility
1. CDC recommendations:
a. Practice is an active or suspended participant in the state’s Vaccines for Children program.
b. Practice serves a large population (30 or more patients in the assessment age group).
Smaller provider sites (29 or fewer patients in the assessed age group) are equally as
eligible for AFIX as larger providers; however, if your time and/or resources require a
choice between a smaller provider and a larger one, and if all other eligibility criteria
are equal, the larger provider should be prioritized for an earlier visit and the smaller
provider for a later one. Improved coverage and immunization practices resulting from
the AFIX process have a larger public health impact when applied to providers that
serve a larger population.
c. Practice had low immunization coverage during a prior assessment. Low immunization
coverage may be based on:
i. A prior AFIX assessment completed through a chart-pull audit.
ii. An Immunization Information Systems (IIS)-generated report that shows the
coverage for VFC-enrolled providers. It is recommended that an IIS coverage
report be run in advance of planning AFIX visits. Providers showing low immunization coverage in the report should be prioritized for visits.
d. Practice expresses an interest in improving their coverage and immunization practices.
e. Practice has new staff involved in immunization practices and would benefit from an
AFIX visit.
f. Provider is newly enrolled in the VFC program and would benefit from AFIX based on
immunization program’s consideration criteria.
2. MDH AFIX staff use CDC recommendations to create annual clinic lists and to assign priorities
for AFIX visits.
3. MN AFIX prioritization method:
a. Clinic selection:
i. MDH AFIX staff use MIIC data to create a query that pulls clinics with Primary
Care Clinic and Local Public Health type indicators in MIIC, as well as indicators
for FQHC/RHC and tribal/IHS designations.
ii. This query also pulls childhood and adolescent immunization coverage rates for
patients in each relevant age range (ages 24-35 months and 13-17 years, re-
Program Eligibility |
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AFIX PROGRAM
spectively) associated with clinics included in the query.
iii. MIIC Regional Entity responsibilities: primary care clinics within region only.
A. Tribal organizations, local public health clinics, and clinics in Crow Wing,
Cass, Todd, Wadena, and Morrison will be covered by MDH for the
2016-2018 grant duration.
b. Clinic size:
i. For primary care clinics (non-county or tribal organizations) that are eligible for
childhood and/or adolescent visits:
A. Higher priority is assigned to primary care clinics with a count of 30 or
more children ages 24-35 months and/or adolescents ages 13-17 years.
c. Immunization coverage rate categories:
i. Higher priority is assigned to those primary care clinics with an up-to-date
(UTD) rate for the childhood immunization series lower than 59% (based on MN
statewide coverage, summer 2015).
ii. Higher priority is assigned to those primary care clinics with an HPV 3 coverage
rate lower than 20% for adolescents ages 13-17 years (based on MN statewide
coverage, August 2015).
d. MnVFC status:
i. Clinics with an active MnVFC status gets highest priority.
ii. Clinics with a suspended status gets next priority.
iii. “Not Interested” gets “outreach” indicator:
A. Not counted in total clinic denominator, but should receive some outreach from MIIC regional entity to ensure MIIC user engagement.
iv. “Closed” should be highlighted in red and not assigned a priority.
e. Clinics that get childhood visit only:
i. Count for children should be higher than 30.
ii. Immunization coverage rate categories:
A. UTD for childhood lower than 59%.
iii. VFC status:
A. Active gets highest priority.
B. Suspended gets next.
C. “Not Interested” gets “outreach” indicator:
a. Not counted in total clinic denominator, but should receive some
outreach from MIIC regional entity to ensure MIIC user engagement.
D. “Closed” should be highlighted red and not assigned a priority.
f. Clinics that get adolescent visit only:
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i. Count for adolescents higher than 30.
ii. Immunization coverage rate categories:
A. HPV 3 for adolescents lower than 20%.
iii. VFC Status
A. Active gets highest priority.
B. Suspended gets next.
C. “Not Interested” gets “outreach” indicator:
a. Not counted in total clinic denominator, but should receive some
outreach from MIIC regional entity to ensure MIIC user engagement.
D. “Closed” should be highlighted red and not assigned a priority.
g. These three main categories of visits are of equal priority (i.e. adolescent or childhood
only visits are not higher or lower priority than an adolescent/childhood visit).
h. The prioritization ranking is not meant to be followed exactly. The priority assignments
are a way for MDH AFIX staff to help MIIC Regional Coordinators and site visitors organize and perform their AFIX site visits. Regions may decide to reprioritize their clinic
lists in a way that works best for their public health practice.
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ASSESSMENT
Assessment
1. Assessment is the first component of AFIX. It provides a standardized method for collecting
and analyzing data and information. It provides valuable opportunities to understand practice
patterns that may encourage or unintentionally discourage the delivery of immunizations to
the practice’s patient population.
2. The purpose of Assessment is to quantify a provider’s vaccination coverage and evaluate a
provider’s immunization practices. The process incorporates both quantitative and qualitative
components. The quantitative components are covered using the MIIC Childhood and Adolescent Assessment Reports, while the qualitative components are covered during the Feedback/
initial site visit portion of AFIX (see the Feedback section for more details).
3. Requirements for Assessment:
a. All of the required quantitative elements are present in the currently available MIIC
Assessment Reports. Please refer to the MIIC User Guidance and Training Resources
(http://www.health.state.mn.us/divs/idepc/immunize/registry/hp/train.html) Web
page for more information on how to run these reports.
b. The following immunization rates must be run, shared with the clinic during Feedback,
and sent to MDH with the initial visit paperwork:
i. Childhood Vaccine Coverage Level Results:
A. 4 DTaP.
B. 3 IPV (Polio).
C. 1 MMR.
D. 3 Hib.
E. 3 HepB.
F. 1 VAR.
G. 4 PCV13.
H. 2-3 RV.
I. Hep A.
ii. Childhood Series Coverage Level Results (series 4:3:1:3:3:1:4)
iii. Adolescent Vaccine Coverage Level Results
A. 1 Tdap
B. 1 MCV4
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C. MCV Booster
D. 1 HPV
E. 3 HPV
iv. These reports should be run no more than five business days before Feedback/
the site visit.
c. Pre-visit outreach:
i. When reaching out to a clinic to schedule an AFIX visit, the AFIX site visitor
should send the clinic staff contact person the following information:
A. Information on the visit:
a. Offer a variety of days and times to accommodate clinic staff
schedules.
b. Tell clinic that visit should take no more than 1-1.5 hours, depending on discussions and clinic questions.
c. Tell clinic that all clinic staff that immunize patients or work with
scheduling and charting of immunizations are welcome. Medical assistants, nurses, physicians, nurse practitioners, physician
assistants are all part of the clinic work flow and have a hand in
maintaining and improving clinic immunization rates.
d. Educate clinic staff on what content to expect to be covered
during the visit and what the expectations will be for clinic staff.
Make sure to mention the discussion of the rates, the questionnaire, the formation of the CQI plan with two activities, and the
follow up discussion between three and six months after the
initial site visit.
B. Required documents:
a. MIIC Childhood/Adolescent Assessment Reports as of “today”:
i. Send reports to clinic. Instruct clinic to look at rates to
determine if they reflect current internal clinic data. Send
instructions on how to inactivate non-active patients to
the clinic.
ii. AFIX site visitor must re-run these reports no more than
five business days before site visit.
C. Blank Immunization Assessment Questionnaire:
a. Send questionnaire to clinic. Clinic staff may complete the questionnaire and send it back to the site visitor before the visit, complete the questionnaire and share it with the site visitor during
the visit, or wait to complete the questionnaire during the site
visit under the guidance of the site visitor.
b. The questionnaire is meant to guide the Feedback session in a
productive manner. For more information on how to better use
the questionnaire and on resources to help clinics develop CQI
plans, please see the AFIX Resources (http://www.health.state.
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mn.us/divs/idepc/immunize/registry/afix.html) Web page.
ii. Recommendations for Assessment:
A. Site visitors should keep an open line of communication with clinic during visit scheduling and pre-visit work. Prompt responses to clinic staff
will build good rapport.
B. Site visitors should ask clinic staff about specific directions, parking facilities, and features of the building to prevent getting lost.
iii. Multiple clinics sites discussed at one site visit:
A. Minnesota has many health care systems of varying sizes. These health
care systems frequently have one or two staff members in charge of QI
and data tracking for two or more sites within the system. It can make
sense for the AFIX site visitor to meet with this person and discuss multiple clinics during one visit. This approach can maximize everyone’s time
and ensuring that the clinic staff present are the ones that can work on
CQI initiatives.
B. Covering multiple clinics with one visit may be allowed after consultation with MDH. If you are planning to meet with one clinic manager or
CQI specialist in charge of multiple sites, please schedule a discussion
with the AFIX Coordinator at MDH. This approach may not be appropriate in all cases. The AFIX coordinator will work with each region or site
visitor that wishes to take this approach on a case-by-case basis.
iv. Summary:
A. Eligible providers are identified for a calendar year based on MDH MIIC
AFIX query run annually.
a. Site visitors should track clinic lists and visit progression using
AFIX tracking tool on SharePoint or by working with the appropriate MIIC Regional Coordinator.
B. Pre visit outreach: Send assessment reports to clinic staff before the site
visit to work on any uncertainty about the accuracy and/or completeness of the MIIC data. If data are updated by the provider office, be sure
to re-run the updated assessment data and use them for the AFIX visit.
C. Ensure that time and date of site visit is convenient for clinic staff.
D. Run final reports no more than five business days before the visit.
E. Documents to take on site visit:
a. The site visit questionnaire.
i. Use the Site visit questionnaire guidance for more information on how to facilitate discussion using this document.
b. MIIC Assessment Reports (take copies for all clinic staff that will
be present).
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FEEDBACK
Feedback
1. Feedback, or the initial site visit, is the second component of AFIX.
2. Feedback provides a face-to-face opportunity for discussing a provider’s immunization delivery
system and ways to improve its quality. The discussion usually focuses on a provider’s immunization coverage, missed opportunities, and ways to improve rates and reduce missed opportunities to immunize. This discussion is the perfect avenue for advocating for MIIC use, understanding any current problems with the clinic’s MIIC use, and sharing any necessary resources
to support the clinic’s continued use of MIIC functions.
3. Feedback should be a two-way conversation which results in the development of QI activities
that are clear, achievable, and agreed upon by the provider and the AFIX program.
4. Requirements for Feedback:
a. Final childhood and adolescent MIIC assessment reports generated for the clinic must
be shared with the clinic during the site visit. Make copies of reports to leave with the
clinic and email them to MDH.
i. Discussing Assessment Reports
A. Before the visit, the site visitor should review the report(s) and identify
the following points for discussion:
a. Which antigens are low?
b. Which vaccine series does the clinic seem to have trouble completing?
c. What are they doing well?
B. Compare rates to state average:
a. Where are the biggest gaps between the state average and the
clinic’s rates?
b. Where is the clinic performing above the state average?
C. Compare rates to Healthy People 2020 goals:
a. Has the clinic met any of the 2020 goals for immunization coverage?
b. What are some of the vaccine coverage rates the clinic can work
on improving to reach the 2020 goals for coverage?
D. MIIC coverage rates may not always line up with the clinic’s own immu-
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nization data. There are many reasons for this discrepancy, so if the staff
you are with seem surprised by their MIIC rates, here are a few tips to
pass on:
a. MIIC does not currently have a definition for patients who have
left the clinic/area/state. These “moved or gone elsewhere”
(MOGEs) patients can stay attributed to the clinic in MIIC, leaving an incomplete series attached to the clinic’s data. The clinic
staff can solve this problem by looking at the NUTD patients and
removing the MOGEs from their data in MIIC. This can happen
during the pre-visit assessment or after the visit as an improvement activity/QI project.
b. Incomplete vaccines: If a provider enters a vaccine given at the
wrong time into a patient’s record, MIIC will consider that vaccine invalid and it will not count towards a complete series. Clinics should make sure that their immunization schedules match
up with current standards and train all providers to stick to the
schedule.
c. If their clinic is doing batch loads on a weekly/monthly/time
bound basis, recent vaccines may not show up on the report.
Make sure they can check back at a later time to get a better
portrait of their rates.
E. Are there any potential data gaps or known data quality issues?
a. Contact MDH MIIC staff and/or the county’s MIIC Regional Coordinator for any information on data quality or interoperability
issues.
b. After the visit with the clinic, the site visitor should share any
questions or issues they were unable to address with MDH and/
or the appropriate MIIC Regional Coordinator.
b. Site visitors must discuss the AFIX site visit questionnaire at the site visit with clinic
staff. If the questionnaire is filled out during the visit, a copy should be made and left
with the provider or emailed to the provider immediately after the visit. The completed
questionnaire must also be emailed to MDH.
i. Discussing the Site Visit Questionnaire
A. Go through each question and discuss the clinic’s response. Ask questions specific to the clinic.
B. Use the “A Guide to AFIX Site Visit Strategies for Quality Improvement”
document on the AFIX Resources (http://www.health.state.mn.us/divs/
idepc/immunize/registry/afix.html) Web page for more information on
the intent of each question and relevant resources to share with the
clinic.
ii. Completing the Questionnaire:
A. Each question should have the “Yes” or “No” box checked under the
Childhood and/or Adolescent column.
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B. The “QI Project” column should have two checked boxes, indicating two
activities the clinic has committed to completing over the next three to
AFIX PROGRAM
six months.
a. Clinic staff may make up their own QI activities. These should be
written down in the “custom objectives” section of the questionnaire.
5. Recommendations for Feedback:
a. In-person initial site visits are a best practice for AFIX. The one-on-one Feedback process with the provider office staff allows for a personal and positive environment to
provide education and work collaboratively.
b. All immunization office staff should be invited to attend the feedback session. The
Feedback session is, in part, an educational session that immunization staff, regardless
of their role, will benefit from. AFIX protocols have always encouraged as much staff
participation in Feedback as possible.
c. Site visitors should request materials for the Feedback session ahead of time from
clinic staff, such as space for the site visit, a wireless connection, etc.
d. As part of Feedback, it is recommended that providers be sent or left resources on the
following:
i. Information about MIIC.
ii. CDC AFIX resources and information.
iii. Immunization resources and information.
iv. Information about efforts by the MDH immunization program or local public health immunization projects to improve immunization coverage, reduce
missed opportunities, and improve provider immunization practice.
6. Feedback summary:
a. At Feedback session, cover the following subjects:
i. Coverage levels for specific vaccination series and individual antigens. Clinic’s
areas of strength and opportunities for improvement.
ii. The questionnaire should be discussed and CQI strategies should be defined
and explained.
b. Help clinic form a CQI plan consisting of two objectives to be implemented over the
next three to six months.
c. Discussion among clinic staff should be encouraged throughout the session.
d. The site visitor should explain that follow-up will take place three to six months after
the initial site visit.
e. Before leaving the clinic, make sure:
i. The staff understands the information presented.
ii. All required data fields and paperwork for MDH is complete.
iii. The clinic received clear and sufficient assessment, CQI, outreach, and reference materials.
iv. The staff is aware of the follow-up contact in three to six months.
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INCENTIVES
Incentives
1. Incentives are used to motivate providers or immunization staff to develop more effective immunization delivery systems and ultimately improve immunization coverage levels:
a. Incentives promote change and reward achievement. They should be used to assist or
motivate a provider to make practice-based changes and to recognize improved performance. Incentives should focus on quality improvement progress rather than simply
outcomes such as high coverage rates.
b. The purpose of incentives is to motivate and encourage all staff to accept improving
immunization coverage levels as part of their job. Public recognition of positive changes, as well as acknowledging high performing practices, is encouraged.
c. All incentives are recommended. None are required and there are no required reportable elements of the Incentives AFIX component to MDH.
d. Incentives may be informal or formal. Informal incentives can be as simple as providing contact information for local, state, and federal immunization resources, providing
educational materials, or sending website links to immunization-themed videos and
webinars. Formal incentives may be as elaborate as nominating clinic staff members for
awards, or developing a local immunization award.
e. Consider the following examples of incentives. Note that it is important to consider
that provider type, size, and location can influence whether incentives are effective,
relevant, and genuinely motivating to the provider:
i. Informal incentive examples:
A. Free materials.
B. Educational in-services for staff.
C. Ongoing immunization updates.
D. Assistance with developing an immunization quality improvement plan
for the clinic.
E. Letters of recommendation.
ii. Formal incentive examples:
A. Certificates of participation, improvement, and collaboration.
B. Promotion of clinics/offices as “Immunization Champions” or role models.
C. Recognition of clinics/offices with significant improvement or high cov-
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erage levels at local or state conferences, educational seminars, and/or
professional meetings.
D. Recognition of clinics in various state and local professional newsletters
and journals.
f. Formal incentives – awards:
A. National:
a. The CDC Childhood Immunization Champion Award recognizes local
immunization champions for their outstanding work in the area of
childhood immunization. This award goes to an individual, not a clinic or organization. Site visitors should encourage clinic staff to nominate a champion and can also nominate a champion, themselves. A
CDC Immunization Champion will be selected from each of the 50
states and the District of Columbia. Awardees will be announced
during National Infant Immunization Week (NIIW) every year. Find
out more at the CDC Childhood Immunization Champion Web page
(http://www.health.state.mn.us/divs/idepc/immunize/champaward.
html).
B. Statewide:
a. These awards are Minnesota-specific and should be mentioned during the site visit to encourage provider immunization improvement:
i. Coverage awards:
1. These annual awards are given to clinics that have
high immunization rates among their pediatric and
adolescent patients. Both counties and clinics receive
awards for high rates based on population criteria.
Find out more at the Immunization Awards (http://
www.health.state.mn.us/divs/idepc/immunize/champaward.html) Web page.
ii. Giebink:
1. The G. Scott Giebink Award for Excellence in Immunization is given annually to an organization that exhibits leadership, good strategy, and strong advocacy for
immunization. Find out more at the G. Scott Giebink
Excellence in Immunization Award (http://www.
health.state.mn.us/divs/idepc/immunize/giebink.
html) Web page.
C. Regional:
a. MIIC regional entities are encouraged to develop their own formal
awards and incentives.
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2. Incentives summary:
a. Select a set of formal and informal incentives to offer to clinics throughout the AFIX
process.
b. There are no reportable requirements for site visitors or MIIC Regional Entities to report to MDH for this component of AFIX.
Incentives |
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INFORMATION
E X CHANGE
Information eXchange
1. Information eXchange is the component of AFIX aimed at following up with providers to monitor and support progress toward implementing the QI strategies discussed during Feedback.
This follow-up is necessary to ensure that quality improvement in immunization standards and
practices is happening at the provider level.
2. The follow-up process ensures that providers have the necessary resources and information
to improve the quality of their immunization services and are completing continuous quality
improvement.
3. Every provider that receives an AFIX visit gets an initial follow-up no later than six months
following the Feedback session. The purpose of this follow-up is to discuss and document a
provider’s progress in implementing the agreed upon QI strategies and to provide any clarifications and technical assistance.
a. Requirements for eXchange:
i. Run MIIC Assessment Reports to get current coverage rates for the same age
group(s) in the clinic population used for the Feedback visit. Keep a record of
the new rates and the change in rates since the Feedback visit. Site visitors can
use the “Custom Reports” function in the MIIC Assessment feature to get rates
for the age group from the Feedback visit.
ii. Contact the clinic to schedule a time for follow-up. The follow-up discussion can
be in the form of another face-to-face visit or a webinar and conference call.
iii. During the follow-up discussion, review the rates from the Feedback visit and
compare them to current rates. Also, ask about progress made on implementing the QI activities. Document the following elements of the follow-up communication for reporting and for future reference:
A. Progress in implementing QI activities:
a. Progress should be documented as follows on the “Assessment,
Feedback, Incentive, and Information eXchange (AFIX) Follow-Up
Form” on the AFIX Resources (http://www.health.state.mn.us/
divs/idepc/immunize/registry/afix.html) Web page:
i. Fully implemented (100% complete).
ii. Progress to full implementation (> 50% complete).
iii. Partially implemented (< 50% complete).
iv. No implementation (0%).
Information eXchange |
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b. For progress reported at less than 100% complete, request an
estimated due date for 100% completion. Inform the provider of
the subsequent follow-up process to check on 100% completion
status.
i. Subsequent follow-up contact can be via email, conference call, or in-person.
ii. Once the clinic has reported 100% implementation, resubmit the follow-up form to MDH.
c. Send Follow-Up Form to MDH after follow up contact is complete.
B. Comparison of current immunization rates with rates from Feedback
visit:
a. Required reportable rates:
i. 4 DTaP.
ii. 3 IPV (Polio).
iii. 1 MMR.
iv. 3 Hib.
v. 3 HepB.
vi. 1 VAR.
vii. 4 PCV13.
viii. 2-3 RV (MN specific).
ix. Hep A (MN Specific).
x. Coverage level results (series 4:3:1:3:3:1:4).
b. Adolescent Vaccine Coverage Level Results:
i. 1 Tdap.
ii. 1 MCV4.
iii. 1 HPV.
iv. 3 HPV.
iv. Send the provider any discussed MIIC or immunization resources, user guidance
documents, and prepared slides or documents.
v. Send MDH all required documentation after follow-up:
A. Completed Follow-Up Form.
B. New Immunization Assessment reports.
C. Any other notes or important details relevant to clinic improvement
activities the site visitor wishes to include for context or reference.
b. Multiple clinic eXchange:
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i. Covering multiple clinics with one follow-up visit may be allowed after consultation with MDH. If you are planning to meet with one clinic manager or QI
specialist in charge of multiple sites, please schedule a discussion with the AFIX
Coordinator at MDH. This approach may not be appropriate in all cases. The
AFIX Coordinator will work with each region or site visitor that wishes to take
this approach on a case-by-case basis.
4. Information eXchange summary:
a. Run MIIC Assessment Reports to get current coverage rates for the same age group(s)
in the clinic population used for the Feedback visit. Keep a record of the new rates
and the change in rates since the Feedback visit. Keep a copy of the new Assessment
Reports to send to the clinic and to MDH.
b. Contact the clinic to discuss progress made in implementing the agreed upon QI strategies and other developments for improving their immunization coverage rates and
services. This contact can be face-to-face or via webinar/conference call.
c. If requested, provide further guidance and technical assistance on using MIIC to
achieve QI goals.
d. Document the follow-up contact and the clinic’s progress in implementing QI activities
using the Follow-Up Form. Send that completed form, along with the re-run Assessment Reports, to MDH.
e. Send the clinic the new coverage rates, a copy of the Follow-Up Form, and any other
discussed or requested immunization resources.
f. If a provider has not 100% implemented their QI activities, subsequent follow-up contact is needed. This contact can take place via email, conference call, or face-to-face.
Once the clinic has reported 100% implementation, resubmit the Follow-Up Form to
MDH.
Information eXchange |
27
AFIX PROGRAM
28 | AFIX Program
AFIX PROGRAM
PROGRAM
RESOURCES
Program Resources
1. MDH:
a. AFIX Resources (http://www.health.state.mn.us/divs/idepc/immunize/registry/afix.
html) Web page.
b. Immunization Assessment: MIIC User Guidance and Training Resources (http://www.
health.state.mn.us/divs/idepc/immunize/registry/hp/trainassess.html) Web page.
c. MIIC Regions and Regional Coordinators (http://www.health.state.mn.us/divs/idepc/
immunize/registry/map.html) Web page.
d. AFIX Coordinator Sudha Setty, MPH:
i. [email protected].
ii. 651-201-5551.
2. CDC:
a. AFIX (Assessment, Feedback, Incentives, and eXchange) (http://www.cdc.gov/vaccines/
programs/afix/index.html?s_cid=cs_748) website.
b. AFIX Program Policies and Procedures for Awardees) (http://www.cdc.gov/vaccines/
programs/afix/standards.html) Web page.
3. National QI resources:
a. The Community Guide’s Increasing Appropriate Vaccination (http://www.thecommunityguide.org/vaccines/index.html) website.
b. Public Health Quality Improvement eXchange (https://www.phqix.org/) website.
Program Resources |
29