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

2. 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.

3. 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

4. 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

5. 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%

6. 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 following site visit
Provide informal follow-up at 3 months
Provide formal follow-up 6 months

7. 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

8. 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

9. 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%

10. 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

11. 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

12. 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

13. QUESTIONS?
Taylor Larson, M.P.H. HPV Immunization Outreach Specialist Wisconsin Immunization Program 1 W. Wilson St. Room 1150 Madison, WI – Phone FAX
Kailynn Mitchell HPV Immunization Outreach Specialist Wisconsin Immunization Program 1 W. Wilson St. Room 1150 Madison, WI – Phone – FAX