216718 Preliminary results of AFIX-Plus

Monday, November 8, 2010

John Fontanesi, PhD , General Internal Medicine, Family and Preventive Medicine, School of Medicine, University of California San Diego, San Diego, CA
Lori Quick, RN, MSN, CNS , Immunization Program, Colorado Department of Public Health & Environment, Durango, CO
Sierra Jue-Leong , General Internal Medicine, School of Medicine, University of California San Diego, San Diego, CA
Audit and feedback is an effective but time consuming and costly method for improving preventive services in provider practices. Examining new models that encourage greater provider participation improves practice competency and provides greater opportunity for true partnership between those charged with protecting the public's health and those who provide the actual services.

Peer-reviewed chart analysis of missed opportunities to vaccinate. The specific protocol is as follows: 1. Each eligible full- or part-time provider able to order vaccinations under their own license is included 2. Each provider has 5 charts reviewed per month 3. Chart selection is random selection of children seen by that provider within the last 30 days 4. Missed opportunities to vaccinate, and which antigens were missed, are entered into either an EXCEL-based template or an online template that: a. Calculates missed opportunity rates b. Translates that data into statistical process control charts to monitor progress 5. Each missed opportunity is reviewed by the QI committee/and or Medical Director to explore and collect root causes 6. Root cause for each missed opportunity is entered into either an EXCEL-based template or an online template that generates a Parieto chart of common causes 7. Clinic uses supplied common causes/common solutions documents to identify interventions titrated to cause(s) of missed opportunity occurring at their facility 8. Information on what was tried and what worked is shared with the VFC field staff who compile, improve, and disseminate

To date 7 clinics have been enrolled in Phase I and are performing peer-reviewed chart analysis of missed opportunities to vaccinate. COCASA base rates have been collected on all participating sites but have not been analyzed. Phase II is implementation for the State of Colorado.

AFIX Plus offers the potential to improve vaccination practices while altering the relationship between public health and private providers.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Protection of the public in relation to communicable diseases including prevention or control

Learning Objectives:
Participants in the session will discuss the overarching purpose of AFIX Plus: to change the role of public health field staff from that of “auditors” to “facilitators” of quality in partnership with physician offices. Preventive services target childhood vaccination practices, medication reconciliation, dental screening, and developmental assessments in VFC provider offices. The strategies include: having provider sites conduct their own internal quality improvement activities; using monthly assessments of missed opportunities to provide targeted preventive services; online supporting protocols, tools, and training for provider sites; and training public health field staff to function as quality improvement facilitators.

Keywords: Immunizations, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am the Director for the Center for Management Science in Health which oversees quality improvement in health related settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.