Establishing Goals During Feedback Sessions - AFIX Evaluation Brent Spear Immunization Program Manager Iowa Department of Public Health

AFIX Visit Process Combination AFIX/VFC Visits Staffing DPS Nurse Clinicians Number of visits 125 per nurse Average 60% of providers

Prioritizing Provider Site Visits Providers who have not received a visit the previous year Providers who had less than 75% immunization rate last year Providers who had a storage and handling issue within the last year Providers who were newly enrolled the previous year Utilize tracking spreadsheet for prioritization

Data Source Iowa’s Immunization Registry Information System (IRIS) Data extracted from IRIS and imported into CoCASA Non-IRIS User Billing data obtained electronically from provider using CPT codes and then imported into CoCASA

Age Cohorts Pediatric Adolescent Children up-to-date by 24 months of age Includes children 24-35 months of age/born in 2007 Adolescent Children 13-15 years of age/born 1994-1996

Data Verification Primary Data Extraction Second Data Extraction Send CoCASA reports to provider to verify and review data Missing Immunization Report Invalid Dose Report Provider updates individual patient records in IRIS Second Data Extraction Data utilized at site visit Billing data-CPT codes received from non-IRIS users imported into CoCASA

Onsite CoCASA Data Cleanup Natural Disease Varicella (must have date of disease to enter into CoCASA) 24 months of age or older at time of first visit Immunization given was influenza only, or specialty clinic (school based Tdap clinic) MOGE Must document date

MOGE A patient that no longer receives immunization services from a healthcare provider due to one of the following: Medical record was transferred to another provider Documentation from another provider that states the patient is under their care Patient or guardian states that the patient is now being seen by another provider for immunization services Clinic’s reminder/recall notice is returned with a forwarding address outside of the clinics service area

MOGE Lost to follow-up A minimum of 3 separate attempts, using 2 different methods of contact, must be documented (e.g., letter, phone call, home visit, etc.) At least one of the above must be documented in the patient’s medical record and include the date(s) of the event(s). Documentation of multiple missed appointments is not adequate to meet the MOGE definition.

Feedback Session Print CoCASA Reports on site following data cleanup/individual patient record review Include at least two individuals in session One person who has authority to implement change in clinic process Focus on missed opportunities and clinic vaccination process vs. up-to-date rate

Reports Childhood Adolescent Summary Reports (includes missed opportunity) Single Antigen Report Missing Immunization Report Invalid Doses Report Adolescent Adolescent Coverage Report Invalid Dose Reports

Vaccine Series Pediatric – 24 month of age 4 DTaP, 3 Polio, 1 MMR , 3 Hib, 3 Hep B, 1 Var, 4 PCV (4,3,1,3,3,1,4) 4 DTaP, 3 Polio, 1 MMR, 2 Hib, 3 Hep B, 1 Var, 4 PCV (4,3,1,2,3,1,4) Adolescent – 13-15 years of age 3 Hep B, 1 Meng, 2 MMR, 1 Td or 1 Tdap, 2 Var (3,1,2,1,2) 3 HPV

Goal Setting Brainstorm with providers to set AFIX goals Goals based on clinic vaccination process vs. up-to-date rate Providers determine goals to improve immunization practices Goals are outlined in the Quality Written Plan Achievable Provider’s “Buy In” Limited to no more than 3 focused goals

Evaluation - Follow-Up Provider is contacted 3 - 6 months following the site visit Contact is made by phone Discuss the goals set at the site visit (feedback on results) Determine if goals were implemented Barrier Rationale Offer additional consultation/resources as necessary

Evaluation Process 2009 Evaluation Components Primary Evaluation AFIX methods/process Quality of site visit Secondary Evaluation Feedback and goal setting Implementation of goals

Contact Information Brent Spear Iowa Department of Public Health Lucas State Office Building 321 East 12th Street Des Moines, IA 50139-0075 515-281-4923 1-800-831-6293 bspear@idph.state.ia.us