Immunization Program

Percent of provider offices enrolled in Connecticut Vaccine Program (CVP) who have received an AFIX visit - ARCHIVED. AFIX program ended


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Story Behind the Curve

This page is not being updated because the AFIX program has ended. 

AFIX (Assessment, Feedback, Incentives, and eXchange) is a continuous quality improvement (QI) process developed by the Centers for Disease Control and Prevention (CDC) to raise immunization coverage levels, reduce missed opportunities to vaccinate, and improve standards of practice at the local level. AFIX stands for:

  • Assessment of the healthcare provider's vaccination coverage levels and immunization practices.
  • Feedback of results to the provider along with recommended quality improvement strategies to improve processes, immunization practices, and coverage levels.
  • Incentives to recognize and reward improved performance.
  • eXchange of information with providers to follow-up on their progress towards quality improvement in immunization services and improvement in immunization coverage levels.

AFIX site visits are performed by Connecticut Immunization Program staff. The visit is an opportunity for education, outreach, and consensus toward improved immunization services and the attained benefits of QI. The AFIX components can assist practices in meeting immunization coverage goals.

During 2018, 20.0% of provider offices that vaccinate young children received a site visit, which is above the target of 25%.


DPH Immunization Partners

Government: Centers for Disease Control and Prevention, CT Department of Social Services/Community Health Network (CHN), CT Department of Children and Families, CT Local Health Departments/Districts, Tribal Governments, Health Departments from other states, Emergency Response and Public Health Preparedness

Organizations and Coalitions: Connecticut Vaccine Advisory Council (CVAC), Connecticut Chapter of the American Academy of Pediatrics (AAP) Foundation for Children, CT American Lung Association, American Immunization Registry Association (AIRA), Every Child By Two, Association of Immunization Managers (AIM), American Cancer Society

Business and Industry: Pharmaceutical companies that produce vaccines, Immunization Information System (IIS) vendors, electronic health record (EHR) vendors, insurance companies

Health Care: Private and public providers, community health centers, school based health centers, hospitals

Education: Daycares, schools and colleges, Board of Nursing, State Department of Education, Yale School of Public Health

Community Services: CT Department of Social Services, Community Health Network (CHN), Local WIC Offices, tribal services, services for immigrants and refugees, homeless shelters and programs, domestic violence shelters and programs, Hispanic Health Council, Maternal Infant Outreach Program - City of Hartford Health and Human Services (MIOP) , Family Strides, Head Start, Healthy Start, Nurturing Families, Connections, Mom’s Project, Positive Parenting, Project Mother Care, Reach out and Read, Birth to Three, libraries, churches, Community Health Center Family Wellness Center/New Britain, Weston Women’s League, Human Resources Agency of New Britain (HRA), Family and Children’s Agency (FCA) of Norwalk, Spanish Speaking Center, United Way

The Public: Parents and the general public

What Works

The Community Preventive Services Task Force recommends assessment and feedback for vaccination providers on the basis of strong evidence of effectiveness in increasing vaccination rates. The Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997-2007) combined with more recent evidence (1 study, search period 2007-February 2012). The following are some of the citations from the review:

Jacob V, Chattopadhyay SK, Hopkins DP, Murphy Morgan J, Pitan AA, Clymer JM, the Community Preventive Services Task Force. Increasing coverage of appropriate vaccinations: a Community Guide systematic economic review. Adobe PDF File [PDF - 440 kB] Am J Prev Med 2016;50(6):797–808.

Bordley WC, Chelminski A, Margolis PA, Kraus R, Szilagyi PG, Vann JJ. The effect of audit and feedback on immunization delivery: A systematic review. Am J Prev Med 2000; 18(4):343-50.

Brousseau N, Sauvageau C, Ouakki M, Audet D, Kiely M, Couture C, Pare A, Deceuninck G. Feasibility and impact of providing feedback to vaccinating medical clinics: evaluating a public health intervention. BMC Public Health 2010;10:750.

Hambidge SJ, Davidson AJ, Phibbs SL, Chandramouli V, Zerbe G, LeBaron CW, et al. Strategies to improve immunization rates and well-child care in a disadvantaged population: a cluster randomized controlled trial. Archives of Pediatrics & Adolescent Medicine 2004; 158:162-9.

Sabnis SS, Pomeranz AJ, Amateau MM. The effect of education, feedback, and provider prompts on the rate of missed vaccine opportunities in a community health center. Clinical Pediatrics 2003;42 (2):147-5.

Action Plan

Immunization Program staff will continue to conduct AFIX site visits in accordance with CDC guidelines. Long term plans include expanding the current methodology to include more age groups.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy