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AFIX Quarterly Conference Call Minutes

January 30, 2013

Awardee Attendance

Present: Alaska, Arizona, Arkansas, California, Chicago, Colorado, Connecticut, District of Columbia, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, New York City, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Philadelphia, Puerto Rico, San Antonio, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virgin Islands, Virginia, Virgin Islands, Washington, West Virginia, Wisconsin, Wyoming

 

Summary

Comprehensive Clinic Assessment Software Application (CoCASA)

  • CoCASA v8.1

AFIX

  • POB’s Expectations for the AFIX Program (CY 2013)
  • AFIX Program Updates from POB
  • Sharing AFIX Information and Best Practices among Awardees

2013 AFIX Quarterly Call Schedule

  • Dates: April 17, July 17, October 16

 

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Minutes

Comprehensive Clinic Assessment Software Application (CoCASA)

CoCASA v8.1

  • Overview of the changes to the AFIX Evaluation Tab
    • Several screen shots were presented to provide an overview of the AFIX relocation in tabs as well as explain the process for using CoCASA version 8.1 for AFIX site visits.
    • For 2013, two different questionnaires are available in CoCASA version 8.1. A new VFC Questionnaire has been setup for VFC visits which excludes AFIX Assessment parameters. The old VFC/AFIX Set up Questionnaire is to be used for setting up AFIX assessment parameters as done in CoCASA version 7.1. This older questionnaire has not changed in appearance or content, however, data entry will be limited to AFIX visit parameters. This questionnaire can be accessed under Utilities using the old password:  CDCVSQ.
  • AFIX visit information should be entered using the following steps:
    • First access the VFC/AFIX Questionnaire setup using the CDCVSQ password and creating a 2013 Setup with your AFIX Assessment parameters. This step is completed once every year.
    • Go to Assessment setup and set up the individual assessments using this tab.
    • Import the data from your registry or manually enter the data in the Data Entry tab.
    • Run the coverage rate reports.
    • Enter the AFIX site visit data (% coverage) from the reports. This entry should be done in the tab named “2013 AFIX/ pre 2013 VFC-AFIX Evaluation”.
    • The User Guide is currently being prepared and will provide more detailed instructions about this. The Guide will be posted on the CoCASA website no later than mid-February.

AFIX

POB’s Expectations for the AFIX Program (CY 2013)

  • No changes or updates to AFIX recommendations or standards of practice.
    • POB has not provided updates for AFIX during CY 2013 due to the increased workload resulting from the OIG report. Updates for AFIX will be provided for use in CY 2014.
    • Within CDC, we coordinate the VFC and AFIX programs separately with different objectives, staffing, and guidance for each program. Each of the programs has a different purpose; VFC is the Quality Assurance program focused on ensuring the viability and proper storage and handling of vaccines through meeting VFC Program Requirements. AFIX on the other hand, is the Quality Improvement program with the mission of providing QI services for VFC providers to help increase and sustain childhood and adolescent coverage rates.
    • For AFIX, it is important to spend time on building healthy collaborative partnerships with providers, on education, and providing tools that can help improve the quality of services and ensure that VFC eligible children and adolescents receive the proper vaccines at the right age to reduce vaccine preventable diseases.
  • The following is the AFIX Objective for the 5 year project period (2013-2017). This objective will remain the same for the project duration, however, the required activities and performance measures for this objective may change. IPOM Objective B3: “Work with VFC providers on quality improvement processes to increase coverage levels and decrease missed opportunities using AFIX components, as appropriate, and move toward use of IIS as primary source of data for provider coverage level assessment by the end of the project period”.
    • This objective can be explained as follows:
    • Work with VFC enrolled providers using AFIX as a QI process to improve the quality of health services at provider offices resulting in an increase and maintenance of childhood and adolescent coverage rates and a decrease in missed opportunities.
    • Use IIS as the primary source of data for provider coverage level assessments.
      • By the end of this project period, all programs will be expected to use only the registry to run their AFIX assessment reports for coverage and missed opportunities.
      • The current standard method of pulling charts and entering data into CoCASA to generate assessment reports will no longer be acceptable by AFIX standards. Also, the option of importing registry data into CoCASA for assessment reports will not be acceptable.
      • The registry AFIX assessment reports will be standardized and you’ll all be able to generate them using your registries. More work is needed on this front and CDC will be dedicating more time during our upcoming quarterly call to discuss AFIX and the use of immunization registries. During that call, I’ll be accompanied by our registry support branch.
      • The AFIX objective does not require that you use IIS as the primary source of data for any other AFIX component including: qualitative assessment, feedback, follow up, or incentives. All other elements of AFIX visits will be captured in a separate tool to be provided by CDC.
  • Annual Report/AFIX Tables for 2013/ Project Officer site visit information
    POB’s expectation is that all Awardees will be working towards meeting the above mentioned objective. The implementation will involve:
    • Completing the list of activities proposed and approved in the grant application for CY2013.
    • Completing the number of AFIX visits proposed in the VFC/AFIX Tables for CY2013. The visits for AFIX can be completed separately or jointly with VFC visits. This is determined by immunization programs based on resources.
    • POB will be reviewing 3 sources of information to understand the work completed; the AFIX Annual Report, VFC/AFIX Tables, and Project Officers’ site visit reports.
      • Annual report – this report is reviewed to collect aggregate data on provider coverage rates for children and adolescents (this data will be collected for immunization series and individual antigens), to collect the number of AFIX visits completed, review the assessment tools used, the feedback methods used. In addition, data will provide information about increased use of IIS for assessments.
      • AFIX Tables for 2013 – this is a reference tool to compare completed vs. proposed site visits. POB’s expectation is that the nature and number of proposed visits and completed ones match.
      • Project officer site visit information – the information collected through PO site visits provides additional information about the list of activities implemented as well as highlights challenges faced during implementation. The challenges are important to know so we can coordinate the program taking them into account and providing assistance if requested.

AFIX Program Updates from POB

  • Standard Policies and Procedures Guide – this document will provide guidance on all elements of the program with an increased focus on the following:
    • Fostering QI at provider offices
    • The use of AFIX as a QI Program/ the nature of AFIX in light of other QI initiatives like HEDIS.
    • AFIX follow up
  • Changes in the Guide – these elements will no longer be available in their current definition and/or use:
    • The Hybrid assessment method will no longer be acceptable as an assessment method per CDC’s standards.
    • Qualitative assessments will no longer be a stand-alone method. AFIX assessments are quantitative and qualitative in nature (provider coverage rates and missed opportunities (quantitative data) as well as observed information (qualitative data).
    • The “X” in AFIX will represent the exchange of information between immunization programs and providers in the form of follow up on implementing QI measures.
    • POB will provide tools based on this guide that can be used during site visits; a site visit checklist, a qualitative assessment questionnaire, a sample QI plan. These tools will be prepared in partnership with AFIX Advisory Group members.
    • This document will be reviewed by Awardees prior to its release. The review will be coordinated through AIM.
  • A tool to enable recording and tracking AFIX provider visit information.
    • Change over time in provider coverage rates and missed opportunities
    • Feedback process
    • Follow up process
  • The above mentioned tool may be a modification to CoCASA or a stand-alone online tool or both. This is being discussed internally and worked out. This tool will be ready for testing later in the year and we will have at least 2 months to test this product prior to its release. Awardees will take part in the beta testing and this task will be coordinated through AIM.

Sharing AFIX Information and Best Practices among Awardees

Rhode Island’s AFIX Program (Sue Duggan-Ball, QA Coordinator)

  • CoCASA is minimally used for AFIX. They use it mainly to record VFC site visits and to submit the annual VFC Management Survey.
  • The assessment process is initiated through the use of their child health registry (KIDSNET). To date, KIDSNET has only contained childhood vaccination information; however, the children in this database who have turned 13 years old are now adolescents and RI begin reporting adolescent coverage rates to CDC in 2012.
  • Steps taken:
    • A practice is called and the visit is scheduled for 6-8 weeks out. Every provider is visited every other year regardless of their need, rates, distance, etc.
    • HEALTH prints the KIDSNET missing vaccines report, Invalid Dose report and Coverage Rate report for the provider who has a visit scheduled. The reports are mailed to the provider‘s office to check the names missing vaccines and update the records in KIDSNET to account for immunizations that may have been accidentally left out. The provider has 2 weeks to check the missing immunizations report and return a copy of the report with hard copies (proof) of vaccination histories.  HEALTH then updates KIDSNET with any missing data submitted. This process is named data reconciliation.
    • The three reports are printed again, now displaying complete practice data, showing accurate coverage rates. During the visit, HEALTH presents the rates and provides suggestions on how to improve coverage rates and reduce missed opportunities. A summary of this visit and the recommendation is handed to providers for reference and action.
    • Providers are encouraged to print the missing vaccines report in their practices on a monthly basis and independently submit missing data to KIDSNET for data reconciliation. Providers will, in the future, have capability to make the data entries/corrections directly into KIDSNET.
    • There is currently no 3-6 month follow up with providers to check on whether they implemented the QI recommendations or not. The program’s resources and staffing capabilities don’t enable them to complete an effective follow up.  In 2013, HEALTH will make quick visits to practices, not receiving a comprehensive VFC/AFIX visit to measure response to recommendations made at the prior comprehensive visit.
    • HEALTH tracks change over time by keeping annual spreadsheets with records of coverage rates for all provider visits completed.  The immunization rates are entered into CoCASA.

2013 Quarterly Call Schedule

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