AFIX Guide to the Core Elements for Training and Implementation

AFIX has traditionally been conducted to assess immunization delivery systems for children. However, several states are applying the AFIX process to assess adolescent and adult populations.

This Core Elements document, generalizes the AFIX process so that it can be applied to any age group. When differences between populations do exist with respect to the AFIX process, this document clearly identifies the difference and provides helpful strategies for modifying the AFIX methodology.

Core Elements Guide

• Core Elements for AFIX Training and Implementation [757KB - 81 pages]
  • Introduction
  • Acknowledgements
  • Assessment (“A”)
    • Methodology
    • Preparation for Visit
    • The Visit
    • Organize and Analyze Data
  • Feedback (“F”)
    • Preparing for Feedback Session
    • Methods of Conducting Feedback Session
    • Concluding a Feedback Session
    • After Conclusion of Feedback Session
  • Incentives (“I”)
    • Informal Incentives
    • Formal Incentives
    • Funding and Partnering for Incentives
  • eXchange of Information (“X”)
  • Comparison of Immunization Coverage Levels
  • Successful Processes/Systems Implemented by Other Practices
  • Ideas for Removing Barriers
  • Encouraging Ownership of This Initiative
  • Offer Additional Education Opportunities
  • Resources
  • Final Advice
  • Appendix A – List of High Risk Conditions
  • Appendix B – Hybrid Assessment Method
  • Appendix C – Examples of Pre-Assessment Forms and Letters
  • Appendix D – Public Health Implications of the Health Insurance Portability and Accountability Act (HIPAA)
  • Appendix E – Examples of Confidentiality Information
  • Appendix F – Methods for Selecting a Random Sample
  • Appendix G – Using Registries for Immunization Assessment
  • Appendix H – Examples and Tips on Partnering
  • Appendix I – Graphical Representation of Immunization Coverage Levels Between Practices
  • Appendix J – Examples of Vaccine Administration Records for Medical Records
  • Appendix K – Additional Resources
  • Appendix L – Glossary of Terms

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What is the Core Elements Guide?

The CDC Task Force on Community Preventive Services has endorsed the AFIX methodology as an effective quality improvement activity to improve immunization coverage levels in persons of all ages. With this endorsement, CDC convened a work group consisting of local, state, and federal participants. A subcommittee of the Clinic Provider Assessment Work Group (CPAWG) developed this document and the CDC AFIX committee recommends these core elements be used as guidelines when providing AFIX education and training in any health care setting, whether public or private. One activity that the group determined to be a priority was the development of these guidelines to ensure AFIX activities are conducted in a standardized fashion. The use of these core elements should assist any health care provider to improve immunization practices. CPAWG continues to meet bi-annually to develop an agenda of priority activities on which to focus.

To ensure proper use of the core elements, training sessions to conduct AFIX visits are essential. The core elements will provide guidance in:

• Training key staff to conduct AFIX visits
• Creating AFIX process protocols

This document is intended to be used by individuals and immunization programs that plan to utilize the AFIX methodology. Individual users will find this methodology to be flexible for their specific needs while statewide programs can use these same concepts in their settings, as well. AFIX users need to be reminded that facilitating immunization practice (behavior) changes in the health care provider offices requires skillful collaboration. In all cases, health care providers should be encouraged to take ownership of the initiative by being active participants in making decisions through all phases of the process, from Assessment to eXchange. The use of AFIX has been demonstrated to change immunization practice behaviors and improve outcomes in any health care setting.

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