About 30% of children in Central Oregon do not receive the Advisory Committee on Immunization Practices (ACIP) recommended vaccine by age two. This leaves the child and community at increased risk for disease outbreaks. Two-year-old rates have improved in Central Oregon over the last three years as the result of the Regional AFIX project in the Spring of 2016. While clinics have worked to improve the rates, two-year-old immunization rates still lag behind the federal Health People 2020 goal of 80% to control the spread of disease. The 2017 rate in Jefferson County was 71%, Crook County was 70%, and Deschutes County was 69%. The higher the density of immunized people in the community, the less likelihood of disease transmission. Infants are especially susceptible to disease, as the immunity they receive from their mother wanes over the first year of life. Infants and young children who have not received all of the recommended vaccines and are exposed to infection may not have a strong enough immune system to fight the disease. This increases the risk of hospitalization and mortality.
"The AFIX Project has helped Mosaic focus on additional ways to improve our childhood immunization rates. Reviewing strategies as a team and keep it as a priority helped us identify additional strategies we may have otherwise overlooked. Working in the AFIX Project created this focus, led to operational improvement, and encouraged collaboration with our Pediatric clinics because they are AFIX partners." Maria Hatcliff, RN, MPH, Quality Improvement Manager, Mosaic Medical
-
The project is attempting to achieve the following:1. Increase immunization rates of Crook, Deschutes, and Jefferson County two-years-olds by implementing the AFIX Program in Vaccine for Children (VFC) enrolled clinics who see two-year-old children and younger.
2. Engage additional providers in the AFIX Program in Central Oregon.
3. Coordinate with partners to improve awareness of the importance of immunizations to protect our communities.
In September and October 2019, thirteen Feedback Meetings were conducted with clinics (4 in Crook, 7 in Deschutes, 2 in Jefferson).
Immunization Coalition Meetings are focused on education about improving childhood immunization coverage and flu prevention. For example, on October 1, 2019, Holly Groom, MPH presented on Vaccine Safety Research. Due to COVID-19, future meetings will be held remotely.
The COVID-19 Pandemic has necessitated a shift in project activities. Further Feedback Meetings were planned with clinics for April that had to be postponed per CDC recommendations. As clinics began to regain some semblance of normal operations in June, check-in with each clinic was made to ensure plans were in place to catch children up who were due or past due for immunizations.
Based on clinic data collected in August, it is evident that clinics are working really hard on immunization coverage. Rates averaged around 70% for 2-year-olds. Adolescent data was more variable across clinics. Education and strategy implementation for improved adolescent immunization coverage across the region will continue to be a priority for this project.
-
The Central Oregon Regional Immunization Rate Improvement Project is currently in progress, and lessons are still coming in.- AFIX is an evidence-based program that works in Central Oregon. It has shown improvements in immunization rates.
- To supplement quality improvement efforts being conducted by individual clinics and organizations, Best Practice and Immunization Coalition Meetings are planned and facilitated to reinforce quality immunization service practices and maintain motivation to make immunizations a priority for clinics.
- Because the COVID-19 pandemic impacted this project starting in March 2020, some of the project activities have been canceled or modified for safety, and because clinic and health department priorities shifted due to COVID-19.
AFIX is an evidence-based program that stands for Assessment, Feedback, Incentives, and eXchange. An “Assessment” of clinic immunization rates is generated by the Oregon Immunization Program and the data is presented and discussed at a “Feedback” meeting facilitated by the Project Coordinator and/or State Immunization Program Staff.
The clinic staff chooses 2 evidence-based strategies for implementation in their clinic over the course of each year of the project. An Immunization Champion for each clinic works to ensure that chosen strategies are implemented and progress is monitored. The current program was implemented with 15 clinics, and the clinics implemented the 15-month well-child visits which were approved by Pacific Source.
There was an 8.4% average rate increase across the original 10 participating clinics (66.1% to 74.5%), and a 6.0% average rate increase across clinics initiated during and after year 2 (67.9% to 73.9%).
The program assures coordination between AFIX, Boost, and a messaging campaign. The program has been highlighted at State Conferences and the National Immunization Conference. Partners include Mosaic Medical, St. Charles Healthcare, along with other medical providers.