1. Arizona Immunization Program Office AFIX and ASIIS “A Great Partnership” Andie Denious, MS. RN Immunization Services Manager Jennifer Ralston Roll, BA Assessment Coordinator Arizona Immunization Program Office

2. Assessment: Measurement of immunization coverage levels Feedback: Providing the assessment results Incentive: Rewards or recognition for high coverage levels eXchange: Sharing assessment results and strategies for improvement What is AFIX?

3. Arizona Immunization Program Office Arizona State Immunization Information System –Statewide registry of immunization records for children birth through 18 years of age –Statewide reporting law implemented 1/1/1998 –Currently 2.4+ million individuals (322,993  36 months of age) –20.9+ million immunizations What is ASIIS?

4. Arizona Immunization Program Office AFIX Staff Visit and assess immunization coverage levels VFC providers throughout Arizona –~750+ VFC provider sites Most visits are combined with VFC quality assessment visits (80%+ in 2004). Conduct assessments of the “Daniel T. Cloud Award” nominees

5. Arizona Immunization Program Office Providers were requested to pull 35 charts of two-year old patients prior to the visit Charts were reviewed on-site Immunization histories were written down by AFIX staff AFIX Before ASIIS

6. Arizona Immunization Program Office AFIX Before ASIIS #2 The handwritten immunization information was taken back to the Immunization Program Office where data entry to CASA was completed Written CASA results were compiled, analyzed and mailed to the provider 2+ weeks following the visit

7. Arizona Immunization Program Office AFIX Before ASIIS #3 The process was time-consuming, involving additional data entry time once AFIX staff returned to the office Because data entry was completed after AFIX staff left the provider’s office, staff were not able to double-check patient charts

8. Arizona Immunization Program Office AFIX Before ASIIS #4 Written assessment results were mailed to the provider 2+ weeks following the visit Because of the time delay between the AFIX visit and the delivery of the feedback report, providers were less interested in assessment results

9. Arizona Immunization Program Office Immunization records of 24-35 month olds for the provider site to be visited are exported from the ASIIS web application prior to the visit The provider’s records are imported to the Clinic Assessment Software Application (CASA). AFIX After ASIIS

10. Arizona Immunization Program Office

11. A Missing Immunizations (MI) list is generated from CASA The MI list is sent to the provider with a request to pull the files of those children for review at the AFIX visit AFIX After ASIIS, #2

12. Arizona Immunization Program Office Upon review of the MI charts in the provider office, additional immunization dates are entered in CASA onsite via laptop Immunization dates missing from ASIIS that are found in the provider charts are reported to ASIIS staff for entry into the registry AFIX After ASIIS, #3

13. Arizona Immunization Program Office AFIX staff provide preliminary feedback to the provider before leaving the office A final “missing immunizations” report is generated for review after chart data is added AFIX After ASIIS, #4

14. Arizona Immunization Program Office AFIX After ASIIS, #5 The provider is able to ask questions while AFIX staff displays and explains CASA reports. A follow-up letter with CASA reports and graphs is sent to the provider within 2 weeks following the visit.

15. Arizona Immunization Program Office Display of Individual Provider’s Levels

16. Arizona Immunization Program Office Provider Coverage Levels Area /Specialty 67% 4:3:1:3:3 coverage levels by 24 Months of Age

17. Arizona Immunization Program Office Conclusions “AFIX After ASIIS” –Benefits providers –Requires less provider staff time in AFIX process –Provider knows the specific charts to pull Fewer charts to pull More congenial, participatory process

18. Arizona Immunization Program Office Conclusions, cont. –Feedback at the time of the assessment enables providers to more easily understand and accept results Providers view “real-time” CASA results Providers can ask questions and get answers immediately AFIX staff able to reference the CASA results as questions arise

19. Arizona Immunization Program Office Definitely, A Great Partnership! “AFIX After ASIIS”

20. Arizona Immunization Program Office Geneva Alvarado Georgina Salazar Melissa Murrieta (Tucson) Jennifer Ralston Roll, Manager The Arizona All-Star AFIX Team

21. Arizona Immunization Program Office Questions? Arizona Immunization Program Office 602-364-3630 or Jennifer Ralston Roll, Assessment Coordinator 602-364-3632 rollj@azdhs.gov