Programs & Tools:

VFC-AFIX Quarterly Conference Call Minutes
October 14, 2009

Grantee Attendance

Present: AK, GA,TX, MD, ND, ID, MA, VT, NY, WY, IL, SC,OH, CO,IA, KY, MS, PA, MT, MO, MI, NE, AR, LA, AL, TN, OK, WA, AZ, OR, RI, NC, CA, VA, NYS, VT, UT, San Antonio, NM, MN, FL, KS, NJ, DC

Minutes

VFC Web Page Update and Provider Tool Kit (Jennifer Mullen)

VFC Webpage Parent's Section Update

• CDC is planning to revise the content on the "For Parents" section of the CDC VFC website at: http://www.cdc.gov/vaccines/programs/vfc/parents/default.htm.
  Long term, we may choose to make changes in other sections of the site as well, but for now we are just focused on the content for parents.
• The goal of revising this section of the site is to make sure that the content addresses common parents' questions about accessing the VFC program. We'll provide as much specificity as we can from the federal level, knowing that there is a great deal of variability among grantees in terms of how VFC is implemented.
• New CDC web content that addresses parents' questions about VFC will support your efforts by hopefully addressing parents' questions before they contact you for more information.
• We are just beginning the process of developing new content for the site. We wanted to come to you at this early stage in the process to hear from you about what kind of content you think parents would find most useful on the CDC VFC site. As I mentioned, we are planning to develop new content, and there may be opportunities to develop new resources that could help address areas where parents often get confused or need more information. For example, one idea we are exploring is to create a tool to help parents gather information they need to determine if their child meets the "underinsured" criteria. This includes gathering information from their child's insurance company and healthcare provider. You may have additional ideas of tools or resources that parents would find useful.
  

Questions for the Grantees:

• Have you conducted any research you could share with us about the most common questions parents have about accessing the VFC program?
• What are the most common questions and areas of confusion that you hear from parents about how to access the VFC program?
• What are the "Top 10" things you want parents to know about the VFC program (from a federal level)?
• Are there any specific content areas that you think the CDC VFC website should provide for parents? If so, what are they?
• What resources for parents would you like to see on the CDC VFC website that would answer parents' questions and clear up areas of confusion about how to access the program?
• Have you developed any tools you could share with us to help parents determine whether their child meets the underinsured eligibility criteria?

If you have any thoughts about the above questions, please feel free to contact Jennifer Mullen.

Provider Tool Kit

• CDC has partnered with the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) to develop a new resource to help providers strengthen communication and trust with parents in their practices and have more productive conversations with parents who have questions and concerns about vaccines.
• Provider Resources for Vaccine Conversations with Parents will be available shortly at http://www.cdc.gov/vaccines/conversations/
• This resource was developed through extensive formative research, including:
  • Literature review
  • Development, testing, and revision of draft materials
  • Input from subject matter experts
  • Formative research with parents at multiple points during materials development
• Materials in Provider Resources for Vaccine Conversations with Parents include:
  • Communication strategies for having more productive conversations about immunizations
  • Current vaccine safety information, including answers to common questions and summaries of research
  • Fact sheets on specific vaccine-preventable diseases and the vaccines that prevent them
• All materials are free, and can be downloaded and reproduced.
• Many pieces in the toolkit can be used to facilitate dialogue with parents, or be can be provided as handouts when time is limited or parents are seeking additional information to take home.
  

VFC Topics (Nancy Felon)

VFC Site Visit Questionnaire 2010
It was posted on website in September. The vast majority of grantees should NOT start using the Questionnaire until January 1, 2010. The new questionnaire will be available in the next release of CoCASA. The only significant change is the addition of borrowing question (#9) which is a new way to gather information on borrowing of vaccine between difference sources (VFC and private).

Public Health Prevention Service Fellow and VFC Inpatient Facility Project

• The VFC program will be hosting a Public Health Prevention Service (PHPS) fellow in our branch from October 26 through April 9. A task that we have proposed for the fellow to work on is coordination of a project on VFC enrollment and site visits in delivery hospitals.
• There is a perinatal hepatitis B grant requirement to try to enroll delivery hospitals in VFC to provide a universal birth dose of hepatitis B vaccine to all eligible newborns
• The VFC enrollment, storage and handling, and site visit guidance and documents are meant for provider office settings and don’t always fit well in a birthing hospital or other inpatient context
• We would like to form a small workgroup of 6 to 8 grantees, made up of 3 to 4 VFC coordinators and 3 to 4 perinatal hepatitis B coordinators (preferably from different projects but both coordinators would like to participate please let me know) to meet by teleconference periodically and work on:
  
  
  1. developing guidance for enrolling hospitals in VFC including how they can run data for their profiles
  2. redesigning the VFC site visit questionnaire for a delivery hospital visit
  3. once developed, field testing the materials in a few hospitals
  4. roll out an expanded pilot test with additional grantees

Proposed Timeline
November: Kick-off meeting = Introductions, purpose, goals, federal requirements, and process for developing guidance, assigning tasks.
December - Feb/March: develop guidance for enrollment/running profiles in hospitals
March/April - May: develop a VFC site visit questionnaire for hospital visits
May: develop a common process or tool for field testing the new guidance/tool
June: field test the new guidance/tool in some hospitals
May/June: Update at Vaccine University
July: Update on quarterly calls

Soliciting volunteers:
Volunteers for the Hep B positions were solicited last week during the Perinatal Hepatitis B Coordinators Quarterly Conference call. If a VFC coordinator is interested in being on this committee, please contact Nancy Fenlon by October 23.

VFC Compliance Site Visit
Over the past several months different issues related to the VFC program have come to CDC’s attention that reminded CDC of the importance of frequent VFC compliance visits to enrolled VFC providers to assure the integrity of the VFC program.

These issues ranged from not requiring annual provider enrollment, high number of unvisited providers, and a large vaccine loss due to improper storage that, according to published reports, may have affected over 20,000 individuals. The current VFC requirement is for grantees to conduct VFC Site Visits to minimum of 25% of providers annually. Please remember VFC Site visit are compliance visits that include administering section one of CDC’s VFC Site Visit Questionnaire. In the locations where these issues were identified, the grantees were conducting VFC compliance visits to between 25% and 30% of the program’s total VFC enrolled and active providers.
CDC used the 2008 VFC Management Survey to identify grantees that were conducting VFC Compliance Site Visits to 50% or more of their enrolled providers and grantees that were conducting VFC Compliance Site Visits to less than 50% of their VFC-enrolled providers. We found that 37 (or 60%) of the grantees were conducting VFC Compliance Site Visits to 50% or more of their enrolled and active VFC providers. Twenty-four grantees were conducting VFC Compliance Site Visits to less than 50% of their enrolled and active VFC providers.

The percent of VFC Compliance Site Visits reported ranged from a high of 100% to a low of 11%. In addition, 17 of the 24 grantees that reported VFC Compliance Site Visits to less than 50% of their enrolled and active VFC providers visited a greater percent of public providers than their private providers even though a greater number of private providers than public providers were enrolled in the grantees’ VFC program. In some cases, based data from the 2007 and 2008 VFC Management Surveys, it appears that some of these grantees visited all their public sites at least once within that 24 month period. While scheduling VFC compliance site visits in this way may enable a grantee to meet the existing CDC requirement of visiting a minimum of 25% of active and enrolled VFC providers, it may not address the guidance the public and private providers be represented proportionately in the total number of providers visited.

ISD leadership supports increasing the minimum visit requirement to help assure that CDC and the grantees are providing adequate oversight and offering any needed technical assistance to enrolled providers to assure the integrity of the VFC program. Over the course of the next 6-8 months, VFC program staff will be contacting grantees that visit 50% or more of their enrolled providers to identify strategies that have enabled them to reach this level of provider interaction. In addition, CDC will be requesting the opportunity to make observational VFC compliance site visits with a small number of grantees to observe the interaction between VFC staff and enrolled providers.

During the same time, CDC will be contacting grantees that reported visiting less than 50% of their enrolled providers to learn about their about their program structure and any challenges that might need to be overcome in order to visit a greater percentage of active VFC-enrolled providers. CDC will also request the opportunity to make observational VFC compliance site visits to a small number of these grantees to observe the interaction between VFC staff and enrolled providers. Additionally, the site visit questionnaire that is used by the project officers during their annual site visits to grantees will be revised to including questions about funding and use of staff working in the VFC program.

The information we gather from these visits will be compiled and presented during Vaccine University in May/June 2010. Other methods to disseminate the findings will be developed as well. Any change to the minimum percent of sites visited would become effective in 2011. The timing of CDC’s work and distribution of the findings will allow grantees to make use of this information when preparing their 2011 grant applications.

The VFC Management Survey is the main source of VFC data that CDC uses to evaluate the overall VFC program and individual grantee VFC activities. All grantees should understand how to accurately complete and submit this important data collection tool in a timely manner. It is anticipated that as a result of this project, CDC may revise the VFC Management Survey to make it a more responsive tool to the needs the grantees and CDC. This would be a long-term multi-year project because of a variety of implications (including time, cost, and data comparisons) that such revisions would have on Section One of CDC’s Site Visit Questionnaire and CoCASA.

AFIX Topics (Nathan Crawford)

Nathan encouraged grantees to use the AFIX and CoCASA resources available on the CDC websites here: http://www.cdc.gov/vaccines/programs/afix/default.htm
http://www.cdc.gov/vaccines/programs/cocasa/default.htm

As described in an all-grantee message several weeks ago, the Task Force on Community Preventive Services has reaffirmed their recommendation of AFIX based on strong evidence of effectiveness. Nathan described for the group several important characteristics of the AFIX programs found to be effective by the Task Force:

• Use of follow-up after Feedback
• A focus on missed opportunities
• Face-to-face feedback; written feedback alone insufficient
• Ongoing regular feedback (more than once a year)
  

CoCASA 5.0 (Pam Jones & Nathan Crawford)

Internal testing should begin next week and once that is completed outside testers will be needed. Please let Nathan or Pam Jones know if you are willing and able to test the new version of CoCASA. Nathan’s e-mail is ncrawford2@cdc.gov and Pam can be reached at pjones7@cdc.gov.

CoCASA version 5.0 has over 30 enhancements or system fixes. Some of these fixes include:

• Comparison report that will allow users to use multiple sets of criteria on a single assessment.
• Users can move a VFC visit
• VFC Questionnaire changes (borrowing)
• Add new VFC Noncompliance Summary Report
• VFC Report – Add Region as an option

VFC/AFIX Topics (Nancy Felon)

Vaccine University 2010
Vaccine University continues in the hotel planning stage, a decision on the hotel site should occur in December 2009. It would appear that the most likely date for Vaccine University is early June 2010.

2010 Quarterly Conference Call Schedule

The VFC/AFIX Quarterly Conference Calls will be held on the following dates in 2010:

• January 13, 2010
• April 7, 2010
• July 21, 2010
• October 20, 2010
  

VMBIP Update (Julie Orta/Brad Prescott/Nathan Crawford)

Brad and Julie gave a brief update on the status of various VMBIP activities. Brad discussed the VTrckS delay and CDC’s use of that time to reevaluate the release timeline/process and the functionality of release 1. He also described some of the VPOP evaluation results.

Julie thanked those grantees involved in the Grantee Advisory Committee (GAC) Contact Center Planning workgroup and described the valuable work that group continues to do.

Finally, Nathan updated the group on the status of the various GAC workgroups. With the exception of the Contact Center Planning workgroup, all other GAC workgroups are no longer meeting. The GAC itself, however, has chosen to continue meeting on a monthly basis throughout the delay.

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