Assessment
Feedback Incentives eXchange (AFIX)
Assessment
Methods
Immunization providers have a tendency to overestimate their practice
coverage levels. Accurate assessments at the provider level, however,
can identify overall coverage and reveal possible service delivery problems
in the practice. Understanding and accepting the assessment results
are the first steps to implementing changes in policies and practices
that will improve patient care.
The
objective of a good assessment is to help providers identify obstacles
to immunization series completion and get their “buy-in” to make needed
changes. In the real world,
the selection of an appropriate assessment method depends on
-
how
accessible the immunization data are
-
how
easy it is to implement the method
-
the
time and staff constraints at the provider and the local level
-
the
number, size, and type of practices to be assessed
-
the
availability of resources to support the assessment data
The
three types of Assessment Methods supported by CDC fall into two categories:
Chart Based Assessments and Registry Based Assessments. Each
method has advantages and weaknesses (basically a trade-off between speed
and diagnostic information) that must be weighed
before selecting the “right” option for your program. The
three Assessment Methods are described below within their respective category.
Chart-based
Assessment
-
Standard Assessment
The Standard method for conducting an assessment offers two options.
Ideally, all records in the selected age group would be included in
the assessment. This complete review of all records in the specified
age range will provide the most accurate assessment results. If the
total number of patients in the specified age range is equal to or less
than 50, a total review is the best option.
When
the total number of patients in the specified age range is greater
than 50, a Standard Assessment can be conducted using a randomly selected
sample of patient charts. An estimated vaccination coverage level
based on the information obtained from the charts can be calculated.
The Standard
Assessment method provides immunization coverage levels for the assessed
provider site as well as diagnostic information on patients with missed
opportunities, late starts, etc.
-
Hybrid Assessment
The Hybrid Assessment method may also be used for conducting assessments.
This method is available using the principles of Lot
Quality Assurance (LQA) sampling
and involves reviewing exactly 30 charts. The Hybrid
method can only identify whether a provider’s coverage is above
or below a selected threshold level rather than calculate an estimated
immunization coverage level.
Coverage
levels can not be determined using the Hybrid Assessment method. Individual
medical charts should be reviewed with the provider in an effort to
highlight immunization practices that might improve coverage levels.
Diagnostic information regarding missed opportunities, late starts,
drop-offs, etc can only be determined by using individual medical
charts.
Consult the Hybrid
CASA Methodology for more information.
Registry-based
Assessments
A
registry based assessment utilizes data from an immunization registry.
This method generally assesses a pre-defined population rather than
a sample of that population. The immunization data can be analyzed with
available assessment functions built into the registry (if available)
or the data can be exported from the registry and imported into CoCASA
for analysis.
The Comprehensive Clinic Assessment Software
Application (CoCASA) is a tool for assessing immunization practices within
a clinic, private practice, or any other environment where immunizations
are provided. CoCASA has data entry and import capabilities.
Immunization
coverage assessments are essential for vaccination programs because they
indicate how well immunization recommendations are being implemented. Assessments
also provide early indicators of the presence of significant barriers
to immunization and stimulate the development of improvement plans.
In order to expand the benefits of AFIX
to the private sector, which now vaccinates nearly 80% of children in
the US, the National Immunization Program (NIP) launched an initiative
to incorporate assessment and feedback activities during Vaccines For
Children (VFC) provider site visits. This initiative links two highly
successful programs - AFIX and VFC - and focuses on increasing quality
assurance activities within provider offices enrolled in the VFC program.
VFC
is a federal program that purchases vaccines for eligible children who
meet one of the following requirements: enrolled in Medicaid; no insurance;
Native American or Alaska Native; or underinsured. All states are participating
in this program, which enjoys broad physician support. Over
44,000 provider sites participate in the program, primarily in the private
sector. The VFC program benefits
providers as well as children by reducing cost as a barrier to immunization
and encouraging kids to stay in a medical home.
VFC
provider site visits are conducted to review compliance with VFC eligibility
requirements and to evaluate vaccine storage and handling procedures.
These VFC site visits provide an excellent opportunity to introduce and
include assessment and feedback of immunization service delivery practices.
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This
page last modified on January 3, 2006. |
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