SMaRT AFIX Organization/Facility User Guide (v. July 2018)

Organization/Facility User Guide

The Assessment, Feedback, Incentives, and eXchange (AFIX) program is a continuous quality improvement process that uses research to help improve immunization rates and practices at the immunization provider level. The main purpose of AFIX is to assist and support health care personnel by identifying low immunization rates, providing opportunities to improve immunization delivery practices, and ensuring that providers are:

1. Knowledgeable about their immunization rates and aware of their missed opportunities to vaccinate,
2. Motivated to incorporate changes to their current practices,
3. Ready to try new immunization service strategies, and
4. Capable of sustaining these new behaviors.

For more information about the CDC's AFIX program, visit the AFIX website page.

The STC | SMaRT AFIX online tool is an application that provides a uniform, standardized user interface for provider-level assessment activities. SMaRT AFIX enhances an IIS's capability to provide:

• Standardized vaccination coverage assessments for children and adolescents served by providers participating in the Vaccines for Children (VFC) program
• An efficient mechanism to report AFIX results to the CDC

The SMaRT AFIX application provides data for Childhood and Adolescent assessments, as established by the CDC. The Childhood Cohort covers patients aged 24 through 35 months, assessed at 24 months. The Adolescent Cohort covers patients aged 13 through 17 years, assessed as of the date of assessment (the current system date). SMaRT AFIX also allows for custom reporting on all ages from birth to 19 years of age.

This Organization/Facility User Guide outlines the instructions for using the application and is divided into the following sections:

• Browser Recommendations
• Single Sign-On (SSO)
• Menu and Icons
• Overview (Dashboard)
• Childhood Cohort Reports
• Adolescent Cohort Reports
• Custom Reports
• Manage Reports

Information for AFIX Coordinators and AFIX users is covered in the AFIX User/AFIX Coordinator User Guide.

SMaRT AFIX Components

SMaRT AFIX includes the following components, although access may be limited by user access level:

• Master Rate Comparison - This allows the AFIX Coordinator and AFIX users to view a list of providers ranked based on Childhood or Adolescent coverage rates so that they can prioritize and target AFIX visits. A VFC PIN is used to link the provider in the IIS with the provider in the AFIX online tool. Other filtering options are available so that providers can be prioritized based on criteria such as practice size or location.
• Export to CDC's AFIX Online Tool - This allows for efficient reporting of AFIX results to the CDC's AFIX Online Tool and will automate the input of coverage rate data.
• Interactive Coverage Dashboard - This allows for quick comprehension of coverage rate data at a glance with easily understood graphics, including filters and options for selection of data visualization options.
• Patient Lists - Users can generate patient lists for active status management, invalid doses, or missed opportunities.

SMaRT AFIX Terms

The following terms are specific to STC | SMaRT AFIX:

• Up-to-Date (UTD) - Patients counted as up-to-date in the summary graph have received the appropriate number of doses of all included antigens by the age of 24 months (childhood) or by the time of assessment (adolescent)
• Late Up-to-Date (Late UTD) (Childhood Cohort Only) - This refers to a patient who was not up to date at the compliance age, but became up to date after the compliance date and before the assessment date. The patient is only counted once, regardless of how many vaccines are late up to date. This is not a count of how many late up-to-date vaccines were administered. Patients counted as late up-to-date in the summary graph have received the appropriate number of doses of all included antigens under either the Up-to-Date or Late Up-to-Date guidelines. This measure is not part of the Adolescent Cohort as the compliance date and the assessment date are identical and there is no gap in time. For the summary graph, the patient is only flagged Late UTD if they are either UTD or Late UTD for all antigens
• Missed Opportunity - This occurs when a vaccination was due at the time of a patient's last visit and the patient did receive a vaccine, but not all of the vaccines due were administered by the provider. The patient is counted as a missed opportunity if at least one vaccination qualifies as a missed opportunity. However, the patient is only counted once on the summary graph, no matter how many vaccinations are missed. Parent refusals are also counted as missed opportunities.
• Active Patients for a Facility - A patient shows a status of Active for the assessed facility in their IIS if they have initiated a past vaccine received by that patient and/or created or edited the patient's demographics. Coverage rates are determined by all active patients for a facility, not simply the patients owned by the facility. Note for states using IWeb: A patient can have an Active status among numerous facilities, but the patient is only owned by one facility. Facilities can inactivate patients so that they are not included in their cohort coverage rates.
• Active Patients Owned by a Facility (for states using IWeb) - Ownership in IWeb occurs when an organization/facility performs a qualifying event for a patient by creating a new patient or conducting the most recent vaccination encounter, unless the location denies ownership or is blocked from taking ownership. A patient can only be owned by one facility at any point in time. In the Custom Reports section in STC | SMaRT AFIX, evaluating the patient population by ownership only returns the smallest patient population for a provider. The provider sees only patients to whom they provided the most recent vaccination, or patients they themselves entered into the registry, if there are no associated vaccinations.