Programs & Tools:

VFC-AFIX Quarterly Conference Call Minutes
July 12, 2006

Participants:

CDC/NCIRD: Nancy Fenlon, Amy Kirsch, Holly Groom, Julie Orta

Grantees: AL, AZ, CA,CO, FL, GA, HI, IA, ID, IL, KS, KY, LA, MA, MI, MN, MS, MT, NE, NC, ND, NE, NH, NJ, NM, NY City, NY State, OH, OK, OR, PA, Philadelphia, San Antonio, TN, TX, UT, VA, Virgin Islands, VT, Washington DC, WV, WY

VFC-AFIX Evaluation Reminders

Slide numbers referenced below are from the handout provided in the conference call announcements. Please contact Amy Kirsch (aok8@cdc.gov) if you did not receive a copy.

1. Importing legacy CASA data into CoCASA

   • The only reason to import legacy CASA data into CoCASA is if your program wants to analyze CASA data in CoCASA. You are able to document visits and enter assessment results in the VFC-AFIX Evaluation module of CoCASA without importing CASA data. (slide 3)

2. Documenting the purpose of a site visit in the VFC/AFIX Evaluation module of CoCASA

   • The key item to remember is that for an AFIX visit to occur, all components of AFIX must be implemented. For that reason, the decision was made to use the Feedback date for both the Assessment date and the Feedback date to ensure all components are implemented. The same date should be used even if the assessment was conducted on a different date in person or by other methods such as registry data.

   • In version 2.0 of CoCASA, instead of “Assessment Visit” and “Feedback Visit”, you will have one option to record “AFIX Visits.” Based on conversations following the conference call, instructions on this item are slightly different than in the slide handouts. (slide 8) Please use the date the Feedback visit was conducted as the date entered for both Feedback and Assessment visits. We ask that you use this date as this will signify that the AFIX visit has been completed since feedback has been conducted.

   • "VFC site visit" should only be selected as the purpose of visit when a VFC Site Visit Questionnaire is completed. If no questionnaire is completed, then this is not a VFC site visit. (slide 11)



3. Completing the VFC Management Survey

   • After all data have been entered into CoCASA (or your program’s alternative evaluation database), the VFC Management Survey can be completed (slide 12)

   • It is important to remember that Table 1 of the survey, where you enter the total number of enrolled and active VFC providers, is used as the denominator for all VFC activities. For example, if your program has 100 enrolled and active VFC providers entered into table 1, then it is not possible for your program to have visited 150 providers for VFC site visits (in table 3 of the survey). Please be sure to review these survey tables for potential data inconsistencies before submitting final survey data. (slides 13-15)

   • You are asked to report coverage rates in the VFC Management Survey. Please only select one series to report in the survey (431331 or 43133, etc). This series is the one your program has determined to be your official series, and should be the series used to assess all practices in a calendar year. Once you have entered the official series results into the survey you are finished with this section of the survey. Leave ALL other series tables blank. (slide 15-17). It is possible that your program uses standard assessments for some practices, and hybrid assessments for other practices. In this case, it is acceptable to report both standard and hybrid assessment results into the survey.

   • The number of provider sites who received AFIX visits (either as AFIX only or as VFC/AFIX Combined visits) should be the same as the number of provider sites that have a documented assessment result or coverage level entered into the coverage results tables. There may be situations where a provider received an AFIX visit but a coverage result was not calculated (due to small sample of children). In these situations there may be a slight discrepancy between number of provider sites receiving AFIX visits and number or sites with reported coverage results. However, these differences should not be substantial. (slides 20-24)

   • Educational visits should be documented as the Purpose of Visit only when education was the primary Purpose of the Visit. If education was provided to a practice during an AFIX or VFC visit, as is standard practice, then educational visit should NOT be selected as a Purpose of Visit for this date. (slides 26-30)

   • Please remember that all data can be entered into CoCASA v1.4; however, for the completion of the VFC Management Survey due March 1, 2007, please use CoCASA v2.0. Upgrading to version 2.0 is critical for the accurate completion of the VFC Management Survey in march of 2007 as the reports in the VFC/AFIX Evaluation Module will be changed to match the data requests in the VFC Management Survey. If you do not upgrade to version 2.0 before completing the survey, the data generated from version 1.4 will not match the data requested on the survey.

4. Changes to CoCASA 2.0
   

   After the conference call concluded, CDC staff met and discussed additional changes to CoCASA to clarify reporting. The items included below summarize the changes to the VFC/AFIX Evaluation Module. Some items were discussed on the call; others were not so please read carefully.

• There will be some changes made to the VFC/AFIX Evaluation Module screen that may affect the way you document your visits. The changes outlined here are only those changes being made to the Purpose of Visit screen section in CoCASA 1.4. Most of these changes are being made in order to get more accurate counts of the number of visits being made to providers. These modified options will provide us with the true number of visits, yet still allow users to record other types of contact with provider sites.

• Purpose of Visit will be changed to Purpose of Contact with Provider

• Visit Date will be changed to Date of Contact with Provider

• VFC Follow-up Visit will be removed

• Assessment Visit will be changed to AFIX Visit

• Feedback Visit will be removed

• AFIX Qualitative Visit will be added (for those providers with small samples of children)

• Other VFC related visit will be changed to VFC Follow-up Contact. The open-ended text box will remain so you can enter the reason for the follow-up contact (i.e. phone call or visit to the office)

• Other AFIX related visit will be changed to AFIX Follow-up Contact. The open-ended text box will remain so you can enter the reason for the follow-up contact (i.e. phone call or visit to the office.

• AFIX Qualitative Visit and AFIX Visit will both be counted as AFIX visits in the CoCASA Core Activities report.

• VFC and AFIX Follow-up Contacts will be available as a separate CoCASA report.

Questions and Answers

Q. What is the definition of enrolled and active providers?
A. Enrolled providers are providers who have signed a VFC provider agreement (enrollment) form and active enrolled providers are enrolled providers who have received VFC vaccine within the current reporting year.

Q. Do you have to select both Assessment and Feedback as the purpose of visit in order for the visit to be counted as an AFIX visit?
A. No, once you select Assessment as the purpose of visit, then the visit is automatically considered an AFIX visit. UPDATE: In CoCASA version 2.0 “Assessment Visit” will be revised to be “AFIX Visit” so this connection will be more transparent. If the assessment (A) and feedback, incentives and exchange (FIX) activities were conducted on separate days, then the date of the recorded visit should be the date the FIX activities took place (rather than the date of the A activity).

Q. In our program we use separate assessment methodologies for private and public practices. We use standard assessments for public and hybrid assessment for private. Is it okay to document these visits separately in the coverage results section of the VFC Management Survey?
A. Yes, you should report the coverage level for the official series assessed in your public practice, as well as enter the results from the hybrid assessments (above or below the pre-determined threshold) conducted in the private practices.

Q. We assessed practices using the 431 series from January to April, and then changed to the 431331 series. Which series should we report in the VFC Management Survey?
A. You should report the 431 series for all practices assessed in the current reporting year (2006) so that you can report coverage for one series for the full year. What this means is that you will need to re-analyze practices visited from April to present date to determine coverage for the 431 series. Practices visited for the remainder of the year should be assessed for both the 431 and 431331 series. When you report the coverage results in the 2006 VFC Management Survey, report only on the 431 series. You will still have your assessments for the 431331 series from April to December and can use these as a baseline for comparison in 2007. While not always convenient, it is best for programs to change the official series being assessed at the beginning of a reporting year so as to avoid having to conduct multiple series assessments.

Q. If we visit a practice that has less than 10 children in the age cohort being assessed, should we still use CoCASA?
A. That is up to the program to decide. You can either do a qualitative assessment of the practice (since AFIX Qualitative Visit will be a new option in the Purpose of Contact screen), and provide this feedback to the provider, or you can do a regular AFIX assessment which generates a coverage level. (Qualitative assessments involve reviewing medical charts on a case by case basis and do not generate a coverage level because the number of records included is so small.) It is up to your program to determine what you are most comfortable doing. A qualitative assessment can be just as helpful as a regular AFIX assessment and in CoCASA version 2.0, you will be able to specifically enter this visit as an AFIX Qualitative Visit in the software.

Q. In the past, if we have visited a provider with less than 10 age-eligible children, then we have entered the purpose of visit as Other AFIX. Is this okay?
A. For those visits your program has already documented as Other AFIX, you will need to go back and re-classify them as an AFIX Qualitative Visit when CoCASA 2.0 is released. The Purpose of Visit screen and options are going to change slightly in CoCASA 2.0 (see above). There will be a new option under Purpose of Visit (AFIX Qualitative Visit) where you can capture AFIX visits to providers with small samples of children. It would be best to categorize these visits in this category so that they are counted as AFIX visits. Contact Amy Kirsch (aok8@cdc.gov) for additional information and/or assistance with reclassifying these visits after CoCASA 2.0 is released.

Q. How will we distinguish the type of contact being made to the provider (phone vs. physical visit) in the new AFIX Follow up Contact?
A. The open-ended text field will allow you to enter an explanation of exactly what took place during this provider contact. A separate report in CoCASA will allow the user to print out the details of every Follow-up Contact that takes place.

Q. In the VFC Management Survey will we be required to enter the number of follow-up contacts that occur in the reporting year?
A. No, this field is meant for you to keep track of all your activities. We will not ask for any summary reports of these contacts or activities at this point in time.

Q. What type of activities can be entered in the AFIX Follow-up Contact field?
A. Do not enter any activities that are a part of your standard AFIX protocol. For example, if you send a follow-up letter to each provider site where you conduct an AFIX visit, then this is not a separate activity that should be recorded in the software.

When you call or visit a provider several weeks after the feedback session to follow-up on a quality improvement action item, then this activity should be reported as an “AFIX Follow-up Contact” with the provider.

Q. Will you provide rollovers for all the Purpose of Contact fields that will be in CoCASA 2.0?
A. Yes, we will provide rollovers (definitions on the software screen) for each field to help clarify any confusion on how to record the different types of contact being made with providers. If you still have questions about how to enter data, please be sure to contact us and ask. It is easier to confirm appropriate use of these fields now, rather than wait and have to recode visits several months down the road.

Q. When will CoCASA 2.0 be released?
A. Based on the number of changes that resulted from the July 12th conference call, the projected release date has been moved to October 30th.

Q. Now that more discussion about adolescent immunization coverage is taking place will there also be more grant guidance provided to grantees on inclusion of adolescent assessments? Will there be more funding to include adolescent assessments in our AFIX activities?
A. There is no plan to increase funding for including adolescent activities. And while there is increased interest in assessing adolescent coverage, we don’t recommend you start including this age group until you are confident that your program has achieved the Level I AFIX Standards.

Q. Is the Adolescent Coverage Report in CoCASA being modified to more accurately assess adolescent coverage levels?
A. Yes, the Adolescent Coverage Report in CoCASA is being expanded to improve programs’ abilities to assess and report on adolescent coverage.

Announcements

• CoCASA call, hosted by Stephanie Sanchez in MI, will take place on August 2 at 2:30pm (EST).

• Rural States call has been temporarily suspended due to low attendance on the May 2006 call (2 people). Please contact Nancy Fenlon (ncf1@cdc.gov) if you are interested in resuming these calls. The calls are open to any program that has an interest in addressing immunization issues specific to rural areas. Contact Nancy by August 15th if you are interested in participating in these calls.

• Nancy Fenlon is now the point-person and resident expert for VFC programmatic issues. Please contact her if you have questions related to your VFC program. There are 2 main upcoming VFC documents in the works:
  

  1. Q&A Document- FAQs for VFC. Document is divided into 6 sections and includes topics such as: Vaccine administration, Storage and Handling, and Enrollment. Legal counsel is reviewing edits to the document. Expect a mid-August release date. The document will be sent in an all-grantee message and will also be circulated to AFIX and VFC email lists.

  2. VFC Operations Guide: ISD and CMS have been working together to update the guide. Hoping for a late fall 2006 or early 2007 release. More updates to come.

Next Call: Wednesday October 11, 2006 2:00 pm -3:30 pm EST

 Return to VFC-AFIX Quarterly Conference Call Minutes main page

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