Assessment Feedback Incentives eXchange (AFIX)

Assessment is the cornerstone of the AFIX process. Assessment refers to the evaluation of medical records to ascertain the immunization level for a defined group of people.  This step, along with feedback of the results, is essential because most providers overestimate their practice’s immunization rates. Accurate assessments done in provider settings can identify overall coverage levels and pinpoint problem areas that the provider may not have known existed.  It enables providers and their staff to make data-based decisions on how to improve performance.  

The results from an assessment can be used to guide strategies for improving immunization service delivery and office policies. Continuous, ongoing assessments of performance are also essential in order to effectively monitor change in provider behaviors and practices. Assessment increases awareness. 

The purpose of an assessment is to:

1. Diagnose service delivery problems
2. Identify useful changes in policy and practice 
3. Monitor and refine interventions.

CDC has developed an assessment software known as CoCASA (Comprehensive Clinic Assessment Software Application). CoCASA is widely used and is instrumental for efficient and effective assessments in provider offices. CoCASA can be downloaded from the NIP website or obtained on CD-Rom or diskette from NIP. The time necessary for the assessment depends upon which assessment method is selected and the quality of the recordkeeping practices at the provider office.

CoCASA provides detailed reports on the specific diagnosis of the problem, for example, whether children start their series on time, whether and when patients drop out of the system, and whether vaccines are given simultaneously. CoCASA also can help to raise awareness regarding issues such as record keeping and documentation and the need for reminder and recall systems.

In order to conduct an accurate, reliable assessment, issues such as how immunizations are documented, what type of record selection will be used, how to determine sample size and selection, and the development of assessment working definitions need to be addressed prior to the actual assessment process.  Working definitions for “active clients” and children in the Moved or Going Elsewhere (MOGE) category, for example, should be established and agreed upon if comparisons are to be made to other provider sites.  In general, standardized data collection allows for more accurate comparability among provider types within and between states. CDC has outlined several assessment methods to assist public and private providers in assessing their immunization coverage levels. For technical details on planning and conducting provider assessments, please refer to Assessment Methods.