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AFIX: Helpful Hints

Assessment Tips

Assessment requires not only the ability to interpret assessment findings but also the ability to use observational skills to determine particular office processes that may be facilitating the administration of immunizations (strengths) or obstructing immunization administration (areas of opportunity).

Both measured and observed information should be presented to the provider.

A significant amount of work is required to prepare for an assessment and must be completed before arriving at the provider’s office. When you are finished with your assessment make sure that you leave the work area clean and neat and leave the charts in a neat pile or re-file as agreed upon with the office staff.

Measured Information (Quantitative Data):

What are your assessment findings?

• Coverage Levels
• Missed Opportunities
• Late Starts
• Vaild vs. Invalid Contraindications
• Drop-offs

Observed Information (Qualitative Data):

What did you observe in the office?

• Immunization information displayed for patients?
• Current ACIP schedule available to staff?
• Staff questioning parents on immunization status or reviewing immunization histories?
• Other barriers to immunizations

What did you observe in the record review?

• Immunizations recorded in standardized place and method?
• Records well organized and legible?
• Immunization status assessed and documented at acute care encounters?

Preparing for the Assessment

Feedback Tips

Providing feedback to a provider and office staff is a combination of art and science. Possessing the knowledge and ability to analyze reports and condense the information into a simple and brief message is essential. In a feedback session, you must be able to facilitate a discussion to motivate the practice to make changes to improve coverage.

1. Be Prepared
   • Organize your findings
   • Outline your session
   • What information will you share with the office?
   • Focus on AFIX process vs. coverage level
   • Begin and end on a positive note
2. Focus on 2-4 priority areas
   • Share with the provider and office staff strengths related to immunization delivery in the practice
   • Introduce 2 to 4 areas of opportunity to improve coverage level
   • Focus on areas that will provide the greatest benefit to the provider
   • Priority areas must match provider’s priority
3. Establish a two way conversation
   • Find out what the provider and staff think are the factor affecting the immunization coverage levels.
   • What can they do improve or change these factors?
   • Are these changes reasonable to implement?
   • Who will take responsibility to make these changes?
4. Use your interpersonal skills
   • Maintain a positive attitude (non-judgmental)
   • Connect with the staff- start to develop a relationship with office
   • Confirm your understanding of what staff has said
   • Gather your thoughts before responding

Incentive Tips

Incentives are techniques used to motivate individuals or organizations to change behaviors. Incentives are the "I" in AFIX and can range from inexpensive and simple to costly and complex. It is up to you to determine which incentives would be most effective for each provider.

Factors that may influence the effectiveness of Incentives:

1. Sources of Motivation
   a. Intrinsic process; motivated by fun
   b. Instrumental; motivated by rewards
   c. Self concept external; motivated by reputation
   d. Self concept internal; motivated by challenge
   e. Goal internalized; motivated by cause
2. Office Environment
3. Priority level of immunizations in overall practice

Incentives can be categorized as informal or formal:

Informal incentives:

Informal Incentives can be low cost and simple and focus on interventions at individual providers and can also be part of the feedback session. Some examples of Informal incentives are:

• Immunization Resource Materials
• The most current VIS forms
• ACIP schedule
• Patient education material
• Web Site Information
• Your Knowledge and Experience
• Assistance in developing a realistic quality improvement plan to improve immunization coverage levels

Formal incentives:

Historically, this form of incentive was promoted by the AFIX strategy in the form of public recognition of improved immunization coverage levels. Formal incentives are generally more complex and expensive than informal incentives.
Some examples of formal incentives are:

• Plaques
• Award Luncheons
• News articles written about best practices and high performing providers
• Tuition/paid registration to educational conferences

Exchange Tips

"Use Every Opportunity to eXchange Information"

Exchanging information successfully requires you to be knowledgeable about best practices related to improving immunization coverage levels and to be able to assist the office in identification of actions that would improve immunization coverage levels.

Exchange of information must be included in the feedback session to assist the provider and office to develop a realistic quality improvement plan to improve immunization coverage levels. Exchange of Information like Incentives can and should be presented both in an informal and formal manner:

Informal exchange of information:

• Discuss during feedback session what changes could be made in practice to assist in improving immunization coverage level
• Utilize your knowledge of what other practices with similar populations have done to improve coverage levels and what activities were successful. Also, it is important to discuss activities that were unsuccessful and why.

Formal exchange of information:

Historically, exchange of information has been presented as peer to peer provider discussion. This mentoring interaction between an "immunization champion" and a provider attempting to improve immunization coverage levels is considered the "gold standard" for exchange of information.

Since it may take years to develop and implement the gold standard of an "Immunization Champion" exchanging information with other providers, you should take every opportunity to exchange information on improving immunization coverage levels with providers and office staff.

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