Assessment
Feedback Incentives eXchange (AFIX)
An Overview
of AFIX Contents of this page:
Related
page:
AFIX
is a quality improvement strategy to raise immunization
coverage levels and improve standards of practices
at the provider level.
The acronym for this four-part dynamic strategy
stands for
Assessment
of immunization coverage of public and private
providers, Feedback
of diagnostic information to improve service delivery,
Incentives
to recognize and reward improved performance, and
eXchange
of information among providers.
The
AFIX approach provides a quality assurance measure
for public and private immunization providers, presents
an excellent educational opportunity, encourages
private and public partnerships, and increases awareness
among immunization providers.
The
assessment and feedback portions of the process are
data-driven. The data help determine provider performance
and act as a catalyst to improve and maintain coverage
levels. Assessment of performance enables providers
to determine how well they are doing through systematic,
routine examination of client records. The data collected
through these assessments can then be used to diagnose
potential problems relating to service delivery and
office policies.
AFIX
starts with assessment. Presenting and discussing
the assessment information is known as feedback.
How feedback is done is key to the success of the
process. Using the assessment data during the feedback
session will help target practice areas that need
to be improved. Strategies for improvement will then
be specific to the practice, and their effectiveness
can be measured during subsequent assessments.
The incentive and exchange phases of the AFIX process
may include methods that stimulate competition among
provider sites, encourage provider participation
and mutual support, recognize successful solutions,
and promote the exchange of results and ideas.
History
of AFIX
In order to raise coverage levels to achieve national
immunization goals, the Georgia Department of Public
Health implemented a statewide program in 1986 that
consisted of annual assessments of immunization records
at its public health clinics. Information was fed
back to clinic providers and their staff who, in
turn, developed their own solutions to improve coverage.Incentives
included rank order listings of clinics by coverage
level, awards for sites with the highest levels,
and presentations by successful clinics at annual
immunization meetings. Other successful strategies
included coordinating with WIC, conducting reminder/recall
phone activities, and providing performance feedback
to nursing staff. As a result of these efforts, immunization
coverage levels in Georgia public clinics increased
from 40% to 91% between 1986 and 2001. This intervention
has become a national model program to improve immunization
rates.
Effectiveness
of AFIX
AFIX is widely supported as an effective strategy
to improve vaccination rates. Many states have shown
gradual and consistent improvement in their public
sector coverage levels. Assessment and feedback of
public and private provider sites are recommended
in the Standards of Pediatric Immunization Practices
issued by the National Vaccine Advisory Committee
(NVAC) as well as the Advisory Committee on Immunization
Practices (ACIP) in a statement endorsing the AFIX
process and recommending its use by all public and
private providers. The purpose of AFIX is to move
health care personnel from a state of unawareness
about the problem (low immunization rates in their
practice) to one in which they are:
-
aware, concerned and knowledgeable
- motivated
to change
-
ready to try new behaviors/strategies
-
capable of sustaining these new behaviors.
The
benefits of measurement and feedback are not confined
to public clinics. In a private sector study of pediatric
practices conducted by CDC and the AAP, the median
up-to-date coverage for 4:3:1 at 24 months of age
increased from 78% to 87% in one year. Similar improvements
were seen over a 5 year period in community /migrant
health centers that participated in a continuous
quality improvement initiative; health centers in
10 states increased their levels for the 4:3:1 immunization
series from 54% to 84% between 1996 and 2000. The
research suggests that implementation of feedback
strategies to improve vaccination rates can influence
provider practices in other preventive services such
as anemia and lead screening. Publications describing
implementation, outcomes, and research issues of
AFIX are available on this website.
The
Need for AFIX
Although vaccine-preventable diseases are at their
lowest point ever, variations in coverage levels
exist in all age groups; “pockets” of
under-immunized populations can be found in many
urban and rural areas, particularly in those below
the poverty level. Since nearly 98% of American-born
infants begin well-child care in the U.S., it makes
sense for public health to focus on providers. Provider-based
strategies, such as AFIX, focus on sustainable improvements
in service delivery. One provider who sees many clients
can effect long lasting improvements in immunization
practice. In addition, it has been said that only
those who provide care can, in the end, change care.
Thus, it is vital to direct interventions to improve
service delivery towards health care providers.
Blend
of Art and Science
The science of AFIX utilizes data collection and
analysis of the assessment data. The art of AFIX
challenges the provider staff as well as the assessment
staff to interpret, communicate, plan, and implement
strategies that improve immunization coverage.
In
summary, AFIX is a quality assurance tool that consists
of assessing the provider’s vaccination
coverage levels, feeding back that information
along with recommending strategies for improvement,
providing incentives to the provider to
improve vaccination levels, and exchanging
information among the providers within the community
about performance and best-practices. This quality
assurance measure is a proven and reliable tool for
improving vaccination coverage levels in provider
offices.
The AFIX approach incorporates four key elements
to improve immunization service delivery:
-
Assessment
of immunization coverage of public and private
providers
- Feedback
of diagnostic information to improve service delivery
- Incentives
to recognize and reward improved performance
-
eXchange
of information among providers
For
Detailed Information:
Core
Elements of AFIX Training and Implementation
(print
only version (.pdf)
(text-only
version)
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| This
page last modified on November 12, 2003 |
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