Examining Adolescent Assessment, Feedback, Incentive, and Exchange (AFIX) in North Carolina (AFIX)

Examining Adolescent Assessment, Feedback, Incentive, and Exchange (AFIX)

The North Carolina Immunization Branch will evaluate the use of the CDC program to improve adolescent vaccination practices (called Assessment, Feedback, Incentives, and eXchanges, or AFIX). This evaluation is the first of its kind in the nation and may have a profound impact on prevention.

AFIX has four major components: 1) Assessment of a provider's current immunization practices and vaccination levels, 2) Feedback of the assessment results and strategies to improve coverage levels, 3) Incentives to improve coverage levels, and 4) eXchange of information and resources necessary to facilitate improvement.

This program will evaluate the effectiveness of AFIX visits on affecting provider practices to increase adolescent (age 11-18) immunization. Visits include discussion of that practice's immunization rates and strategies for improving rates. The investigators will compare the changes, from baseline to 5 months, in immunization for practices receiving virtual visits (webinars), in-person visits, and no visits (control group). Thirty practices will be randomly assigned to each intervention type. The main outcomes of this study are practice-wide uptake rates of several adolescent vaccines (Tdap, HPV, and MCV4) as well as pre- and post-AFIX visit surveys focusing on recall tactics utilized by each practice. Data will be collected on practices with at least 200 adolescent patients (note: there is no patient-level data collected in this study).

Study Overview

• Status: Completed
• Conditions: Immunization; Adolescent Health Services
• Intervention / Treatment: Other: Assessment , Feedback, Incentives, and eXchange Program

• Study Type: Interventional
• Enrollment (Actual): 91
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27599
      • Cervical Cancer-Free North Carolina
    • Raleigh, North Carolina, United States, 27699
      • North Carolina Immunization Branch

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Pediatric and/or family practices participating in the North Carolina Immunization Program
• A minimum of 200 active adolescent patients

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; This arm includes 30 health centers in North Carolina with at least 200 adolescent (age 11-18) patients. Practices in this arm were randomly assigned to receive no AFIX visit.
Experimental: AFIX In-Person Visit; This arm includes 30 health centers in North Carolina with at least 200 adolescent (age 11-18) patients. These practices received an in-person AFIX visit from a North Carolina Immunization Branch employee. Intervention: Other: Assessment , Feedback, Incentives, and eXchange Program	Other: Assessment , Feedback, Incentives, and eXchange Program; The NC Immunization Branch uses Adolescent AFIX (Assessment, Feedback, Incentives and eXchange) Program, a quality improvement strategy developed by the CDC to improve the immunization practices and vaccination coverage levels of public and private health care providers. It has four main components: 1) Assessment of a provider's current immunization practices and vaccination levels, 2) Feedback of the assessment results and strategies to improve coverage levels, 3) Incentives to improve coverage levels, and 4) eXchange of information and resources necessary to facilitate improvement.
Experimental: AFIX Webinar Visit; This arm includes 31 health centers in North Carolina with at least 200 adolescent (age 11-18) patients. These practices received a webinar during which a North Carolina Immunization Branch employee completed the components of an AFIX visit. Intervention: Other: Assessment , Feedback, Incentives, and eXchange Program	Other: Assessment , Feedback, Incentives, and eXchange Program; The NC Immunization Branch uses Adolescent AFIX (Assessment, Feedback, Incentives and eXchange) Program, a quality improvement strategy developed by the CDC to improve the immunization practices and vaccination coverage levels of public and private health care providers. It has four main components: 1) Assessment of a provider's current immunization practices and vaccination levels, 2) Feedback of the assessment results and strategies to improve coverage levels, 3) Incentives to improve coverage levels, and 4) eXchange of information and resources necessary to facilitate improvement.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Vaccination Rate: HPV vaccine initiation among 11-12 year olds	We will gather practice-specific rates of coverage for adolescents (age 11-12) for the first dose of human papillomavirus (HPV) vaccine at baseline and 5 months follow-up.	Baseline and 5 months follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Vaccination Rate: HPV vaccine initiation among 13-18 year olds	We will gather practice-specific rates of coverage for adolescents (age 13-18) for the first dose of human papillomavirus (HPV) vaccine at baseline and 5 months follow-up.	Baseline and 5 months follow-up
Change in Vaccination Rate: Tdap vaccine among 11-12 year olds	We will gather practice-specific rates of coverage for adolescents (age 11-12) for tetanus, diphtheria, and pertussis booster (Tdap) at baseline and 5 months follow-up.	Baseline and 5 months follow-up
Change in Vaccination Rate: Tdap vaccine among 13-18 year olds	We will gather practice-specific rates of coverage for adolescents (age 13-18) for tetanus, diphtheria, and pertussis booster (Tdap) at baseline and 5 months follow-up.	Baseline and 5 months follow-up
Change in Vaccination Rate: Meningitis vaccine among 11-12 year olds	We will gather practice-specific rates of coverage for adolescents (age 11-12) for meningococcal conjugate (i.e., meningitis vaccine) at baseline and 5 months follow-up.	Baseline and 5 months follow-up
Change in Vaccination Rate: Meningitis vaccine among 13-18 year olds	We will gather practice-specific rates of coverage for adolescents (age 13-18) for meningococcal conjugate (i.e., meningitis vaccine) at baseline and 5 months follow-up.	Baseline and 5 months follow-up
Change in Vaccination Rate: HPV vaccine completion among 11-12 year olds	We will gather practice-specific rates of coverage for adolescents (age 11-12) for the third and final dose of human papillomavirus (HPV) vaccine at baseline and 5 months follow-up.	Baseline and 5 months follow-up
Change in Vaccination Rate: HPV vaccine completion among 13-18 year olds	We will gather practice-specific rates of coverage for adolescents (age 13-18) for the third and final dose of human papillomavirus (HPV) vaccine at baseline and 5 months follow-up.	Baseline and 5 months follow-up

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Vaccination Rate: MMR among 11-12 year olds	We will gather practice-specific rates of coverage for adolescents (ages 11-12) for measles, mumps, and rubella (MMR) vaccine at baseline and 5 months follow-up. This is a childhood vaccine that is not targeted for adolescents; however the intervention may impact MMR coverage.	Baseline and 5 months follow-up
Change in Vaccination Rate: MMR among 13-18 year olds	We will gather practice-specific rates of coverage for adolescents (ages 13-18) for measles, mumps, and rubella (MMR) vaccine at baseline and 5 months follow-up. This is a childhood vaccine that is not targeted for adolescents; however the intervention may impact MMR coverage.	Baseline and 5 months follow-up
Change in Vaccination Rate: Hepatitis B vaccine among 11-12 year olds	We will gather practice-specific rates of coverage for adolescents (ages 11-12) for hepatitis B vaccine at baseline and 5 months follow-up. This is a childhood vaccine that is not targeted for adolescents; however the intervention may impact hepatitis B vaccine coverage.	Baseline and 5 months follow-up
Change in Vaccination Rate: Hepatitis B vaccine among 13-18 year olds	We will gather practice-specific rates of coverage for adolescents (ages 13-18) for hepatitis B vaccine at baseline and 5 months follow-up. This is a childhood vaccine that is not targeted for adolescents; however the intervention may impact hepatitis B vaccine coverage.	Baseline and 5 months follow-up
Change in Vaccination Rate: Varicella vaccine among 11-12 year olds	We will gather practice-specific rates of coverage for adolescents (ages 11-12) for varicella vaccine at baseline and 5 months follow-up. This is a childhood vaccine that is not targeted for adolescents; however the intervention may impact varicella vaccine coverage.	Baseline and 5 months follow-up
Change in Vaccination Rate: Varicella vaccine among 13-18 year olds	We will gather practice-specific rates of coverage for adolescents (ages 13-18) for varicella vaccine at baseline and 5 months follow-up. This is a childhood vaccine that is not targeted for adolescents; however the intervention may impact varicella vaccine coverage.	Baseline and 5 months follow-up

Collaborators and Investigators

• Sponsor: University of North Carolina, Chapel Hill
• Collaborators: North Carolina Division of Public Health
• Investigators: Principal Investigator: Amanda Dayton, MA, DPH/WCH/Immunization; Principal Investigator: Amy Grimshaw, MS, MSW, DPH/WCH/Immunization; Study Director: Noel T Brewer, PhD, University of North Carolina, Chapel Hill

Publications and helpful links

General Publications

• Gilkey MB, Dayton AM, Moss JL, Sparks AC, Grimshaw AH, Bowling JM, Brewer NT. Increasing provision of adolescent vaccines in primary care: a randomized controlled trial. Pediatrics. 2014 Aug;134(2):e346-53. doi: 10.1542/peds.2013-4257. Epub 2014 Jul 7.
• Gilkey MB, Moss JL, Roberts AJ, Dayton AM, Grimshaw AH, Brewer NT. Comparing in-person and webinar delivery of an immunization quality improvement program: a process evaluation of the adolescent AFIX trial. Implement Sci. 2014 Feb 18;9:21. doi: 10.1186/1748-5908-9-21.

Study record dates

Study Major Dates

• Study Start: April 1, 2011
• Primary Completion (Actual): December 1, 2012
• Study Completion (Actual): December 1, 2012

Study Registration Dates

• First Submitted: February 24, 2012
• First Submitted That Met QC Criteria: February 29, 2012
• First Posted (Estimate): March 6, 2012

Study Record Updates

• Last Update Posted (Estimate): December 18, 2013
• Last Update Submitted That Met QC Criteria: December 16, 2013
• Last Verified: December 1, 2013

More Information

Terms related to this study

• Keywords: Measles-Mumps-Rubella Vaccine; Hepatitis B Vaccines; Papillomavirus Vaccines; Meningococcal Vaccines; Chickenpox Vaccine; Diphtheria-Tetanus-Pertussis Vaccine
• Other Study ID Numbers: 2011-3