An Innovative Approach for Improving Childhood Immunization Rates in Crook, Deschutes, and Jefferson Counties

AFIX is a widely supported, data-informed program that is an effective and recommended strategy for improving immunization rates and practices at the provider level. AFIX is based on systematic review of scientific literature and the recommendations of the CDC-appointed Task Force on Community Preventive Services. As recognized by the Task Force, routine assessment and feedback on vaccination rates obtained at the provider site is one of the most effective strategies for achieving high, sustainable vaccination coverage. The DCHS Immunization Program implemented the AFIX project regionally in partnership with Crook and Jefferson County Health Departments. Participating clinics are assisted in reviewing and discussing their immunization data (quantitative and qualitative). From this, root causes were identified, and evidence-based strategies were selected based on analysis of the data and the issues identified by the group. The clinics implement chosen strategies and receive follow-up and assistance by the local AFIX project coordinator (DCHS Immunization Program coordinator). Each clinic implemented six evidence-based strategies over the course of the project, or around two strategies per year. A workgroup was created by the Community advisory Council and included representation from our largest pediatric clinic (COPA) and a smaller clinic (La Pine Community Health Clinic). There was also county health department representation. They reviewed immunization data. The data review was used to facilitate discussion on the barriers clinics experience, the roots of these barriers (root cause analysis), and brainstorm possible interventions (brainstorming). The CDC’s AFIX Program was recommended as it is an existing, evidence-based program implemented at the provider level. This was important as research shows that providers are trusted by parents most when making vaccine decisions for their children. Also, the clinic participants were receptive to the idea of a county coordinator facilitating the program and working with their clinics to implement strategies to improve immunization services and monitor progress. Strategies included, but were not limited to the following: • Using best practices and policies to support quality immunization services • Implementing 15-month well-child visits • Pre-scheduling next appointments while the patient is still at the clinic • Providing appointment reminders • Regularly identifying patients who are due or past due for shots and calling them to schedule an appointment • Rescheduling patients who do not show for appointments • Continuing to provide clinic data on immunization rates and sharing the data with clinic staff • Forecasting shots on every visit (well-child or not) to determine which vaccinations are due • Standardizing and educating on data entry in the ALERT immunization information system • Regularly inactivating patients in ALERT who are no longer being seen at the clinic • Hosting a regional evening educational event with national speakers who discussed the importance and historical relevance of immunization • Hosting a best practice meeting twice annually with immunization champions from the clinics, discussing successes and challenges, providing ALERT assessment report and data interpretation training, and identifying opportunities for improvement • Giving a monetary award after 1 year of project participation for the clinic, which can be used for internal immunization education and advancement Some clinics developed their own innovative approaches to increase vaccination rates. Examples of these include the following: • Creating a packet with information on the schedule and importance of immunizations. The packet was given to parents at the 2-week appointment for newborns. • Creating and accepting an application for funding for a “diaper incentive.” When parents came in for their child’s immunizations, they also received diapers. In addition, to help encourage 15-month well-child visits, the CCO in central Oregon, PacificSource, changed its reimbursement policy to include the 15-month well-child visit. More information about the program can be found on the CDC website: https://www.cdc.gov/vaccines/programs/afix/index.html.

Immunization data from the clinic were reviewed regularly. Clinics run their immunization assessment report every 6 months, and they use the information to identify successes and opportunities for improvement.