Programs & Tools:

AFIX: Overview

What is AFIX?

At a glance:

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 the healthcare provider's vaccination coverage levels and immunization practices,
Feedback of results to the provider along with recommended strategies to improve coverage levels,
Incentives to recognize and reward improved performance, and
eXchange of healthcare information and resources necessary to facilitate improvement.

More...

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:

1. aware, concerned and knowledgeable
2. motivated to change
3. ready to try new behaviors/strategies
4. capable of sustaining these new behaviors.

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. Consult the AFIX Publications page for more on the descriptions of implementation, outcomes, and research.

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. Consult the National Immunization Survey for coverage levels by year. 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.

Related Resources

• National Immunization Conference (NIC)
• VFC/AFIX Grantee Conference Call Minutes
• Core Elements of AFIX Training and Implementation
• The AFIX Standards Guide
• 2008-2012 Immunization Program Operations Manual (IPOM)
• CoCASA website
• VFC website

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