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

Study Overview
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Brief Summary
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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).

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

Conditions
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Adolescent Health Services, Immunization

Intervention / Treatment
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* Other: Assessment , Feedback, Incentives, and eXchange Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pediatric and/or family practices participating in the North Carolina Immunization Program A minimum of 200 active adolescent patients
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>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<br>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<br>* 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.<br>|
| Experimental: AFIX Webinar Visit<br>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<br>* 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.<br>|

What is the study measuring?
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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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diphtheria-Tetanus-Pertussis Vaccine, Measles-Mumps-Rubella Vaccine, Meningococcal Vaccines, Hepatitis B Vaccines, Chickenpox Vaccine, Papillomavirus Vaccines