26755 Bureau of Communicable Diseases, Wisconsin Division of Public Health, Wisconsin Department of Health Services, Madison, WI, USA.
Public Health Rep. 2021 Sep-Oct;136(5):603-608. doi: 10.1177/0033354920974661. Epub 2021 Feb 9.
Assessment, Feedback, Incentives, and eXchange (AFIX) is a quality improvement model used to increase childhood and adolescent immunization rates in the United States. We evaluated implementation of a similar quality improvement model to boost adult immunization rates.
During November 2016 through May 2017, adult immunization outreach specialists conducted 124 in-person visits to clinics in Wisconsin that immunize adults, submit immunization information to the Wisconsin Immunization Registry (WIR), and agreed to participate in adult AFIX. Outreach specialists ran immunization assessment reports using the WIR and showed a paper copy of the report during the visit. Health care providers were encouraged to implement at least 1 of 18 strategies (eg, reminder-and-recall intervention, giving adult immunization resources to patients) to increase adult immunization rates. Outreach specialists conducted follow-up with health care providers at 3, 6, and 9-18 months after the initial visit to encourage strategy implementation. We compared AFIX sites with control clinics on practice type, geographic location, and clinic size.
Clinics that participated in adult AFIX had a significantly larger increase in median adult immunization rates for completion of the human papillomavirus vaccine series at the 9- to 18-month follow-up than control clinics did (10.4% vs 7.7%; = .02). The median immunization rate for 13-valent pneumococcal conjugate vaccine/23-valent pneumococcal polysaccharide vaccine completed in series was higher, but not significantly so, among adult AFIX clinics than among control clinics (12.6% vs 10.7%; = .18).
Adult AFIX resulted in increased awareness about adult immunization recommendations and may be a useful tool for increasing adult immunization rates.
评估、反馈、激励和交换（AFIX）是一种用于提高美国儿童和青少年免疫接种率的质量改进模型。我们评估了实施类似的质量改进模型以提高成人免疫接种率的情况。
在 2016 年 11 月至 2017 年 5 月期间，成人免疫接种外展专家对威斯康星州的 124 家为成年人进行免疫接种、向威斯康星免疫登记处（WIR）提交免疫接种信息并同意参与成人 AFIX 的诊所进行了 124 次现场访问。外展专家使用 WIR 运行免疫评估报告，并在访问期间展示报告的纸质副本。鼓励医疗保健提供者实施至少 18 种策略中的 1 种（例如，提醒和召回干预，为患者提供成人免疫资源）以提高成人免疫接种率。外展专家在初始访问后的 3、6 和 9-18 个月对医疗保健提供者进行后续跟进，以鼓励策略的实施。我们比较了参与成人 AFIX 的诊所与对照组诊所在实践类型、地理位置和诊所规模方面的情况。
在 9 至 18 个月的随访中，参与成人 AFIX 的诊所完成人乳头瘤病毒疫苗系列的中位数成人免疫接种率明显高于对照组（10.4%比 7.7%； =.02）。在成人 AFIX 诊所中，13 价肺炎球菌结合疫苗/23 价肺炎球菌多糖疫苗系列完成的疫苗接种率更高，但差异无统计学意义（12.6%比 10.7%； =.18）。
成人 AFIX 提高了对成人免疫接种建议的认识，可能是提高成人免疫接种率的有用工具。
