HPV AFIX Site Visits: Overview Sarah Born Adolescent Coordinator May 12, 2016

What is AFIX? AFIX is a QI process for clinics to learn about at improve their immunization practices and rates. It stands for: Assessment Feedback Incentives eXchange The purpose of AFIX is to assist and support health care personnel by identifying low immunization rates, opportunities for improving immunization delivery practices, and ensuring that providers are; 1. Aware of and knowledgeable about their immunization rates and missed opportunities to vaccinate 2. Motivated to incorporate changes to their current practices 3. Ready to try new immunization service strategies 4. Capable of sustaining these new behaviors.

Assessment Assessment of the health care provider's vaccination coverage levels and immunization practices. Meet with VFC clinic staff Review clinic-specific Wisconsin Immunization Registry (WIR) data Review questionnaire

Feedback Feedback of results to the provider along with recommended strategies to improve processes, immunization practices, and coverage levels. Go over strengths & weaknesses Discuss resource packet AFIX, WIR, CDC Discuss 2-3 quality improvement strategies

Incentives Incentives to recognize and reward improved performance HPV Toolkit CDC 2015 Pink Book Silver Award: HPV coverage level >70% Gold Award: HPV Coverage levels >80%

Exchange eXchange of information which is also known as follow up with providers to monitor and support progress towards implementing quality improvement strategies and improving vaccination coverage levels. Send recap email following site visit Provide informal follow-up at 3 months Provide formal follow-up 6 months

HPV afix: Where Are We Today? Clinics contacted Over 700 VFC clinics around Wisconsin Site Visits* Completed: 160 clinics Upcoming: 20 clinics Goal: 200 clinics by end of May 2016 *As of April 20th, 2016

Six Month Follow-up: HPV 1 Coverage Rate Changes in Patients Aged 11–18 Years 4.7% 6.2% 3.8% 3.8% --4% .6% 1.6% --.8% 13.1% Clinic 1 patient population: 273 pre intervention, 194 post-intervention Clinic 2 patient population: 1760 pre intervention, 1762 post-intervention Clinic 3 patient population: 1055 pre intervention, 1041 post-intervention Clinic 4 patient population: 633 pre intervention, 648 post-intervention Clinic 5 patient population: 1731 pre intervention, 1724 post-intervention Clinic 6 patient population: 480 pre intervention, 505 post-intervention Clinic 7 patient population: 254 pre intervention, 258 post-intervention Clinic 8 patient population: 148 pre intervention, 53 post-intervention Clinic 9 patient population: 164 pre intervention, 132 post-intervention Clinic 10 patient population: 131 pre intervention, 119 post-intervention Clinic 11 patient population: 122 pre intervention, 97 post-intervention Clinic 12 patient population: 212 pre intervention, 142 post-intervention Clinic 13 patient population: 1943 pre intervention, 1332 post-intervention Clinic 14 patient population: 723 pre intervention, 765 post-intervention

Six Month Follow-up: HPV 3 Coverage Rate Changes in Patients Aged 11–18 Years 6.2% --1.4% 4.4% 1.8% 4.7% 1.2% .7% 6.5% 1.1% 1.9% 1.4% 4.4% 5.5% 3.2% 7.3% .3% .5%

Six Month Follow-up: Missed Opportunity Rate Changes in Patients Aged 11–18 Years -1% 4.9% -.5% Negative=less patients with a missed opportunity

Challenges Scheduling Non responses Clinics choosing to opt out Connecting with the right person Site Visits Inactivating clients Issues with EMR’s and them not syncing with WIR Staff education - creating a unified message Lack of providers/support staff at meetings

Successes Site visits going smoothly- clinic staff on board with HPV QI! Common strategies selected: Implementing reminder/recall system Inactivating patients Using CDC HPV posters and handouts Strengthening provider recommendation Three and six month follow-ups very promising

QUESTIONS? Taylor Larson, M.P.H. HPV Immunization Outreach Specialist Wisconsin Immunization Program 1 W. Wilson St. Room 1150 Madison, WI 53701 608-266-3128 – Phone 608-266-7089 - FAX Kailynn Mitchell HPV Immunization Outreach Specialist Wisconsin Immunization Program 1 W. Wilson St. Room 1150 Madison, WI 53701 608-266-9823 – Phone 608-266-7089 – FAX