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

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

3. 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

4. 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

5. Age Cohorts Pediatric Adolescent
Children up-to-date by 24 months of age
Includes children months of age/born in 2007
Adolescent
Children years of age/born

6. 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

7. 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

8. 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

9. 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.

10. 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

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

12. 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 – years of age
3 Hep B, 1 Meng, 2 MMR, 1 Td or 1 Tdap, 2 Var
(3,1,2,1,2)
3 HPV

13. 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

14. Evaluation - Follow-Up
Provider is contacted 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

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

16. Contact Information
Brent Spear
Iowa Department of Public Health
Lucas State Office Building
321 East 12th Street
Des Moines, IA