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IQIP: New Immunization Quality Improvement Program

ByJoshua Foust
This is a partner post from the Colorado Department of Public Health & Environment.

Immunization Quality Improvement for Providers (IQIP) is the new Quality Improvement (QI) program from the Centers for Disease Control and Prevention (CDC) that replaced the Assessment, Feedback, Incentive, eXchange (AFIX) program.  In 1995, the Senate instructed CDC to “ensure that all states/awardees receiving immunization infrastructure/operational grant funds conduct annual provider assessments in all public-sector clinics using a CDC-approved methodology (AFIX). In 1999, the National Vaccine Advisory Committee (NVAC) recommended that all public and private immunization providers, should have vaccination coverage assessed annually and that private providers should be assisted by state and local health departments.  In 2018, recommendations from CDC scientific and program staff led to a refinement of CDC’s approach to provider-level immunization QI efforts. Those recommendations resulted in the transition from AFIX to IQIP.

IQIP’s mission is to promote and support the implementation of provider-level quality improvement strategies designed to help increase on-time vaccination of children and adolescents. The focus of the IQIP consultant (a Public Health Nurse Consultant from the Colorado Department of Public Health and Environment’s Immunization Branch) is to assist providers in identifying areas where improvement of immunization delivery services will lead to the increase of on-time vaccination and increased vaccine uptake by patients. The strategies chosen by the provider’s care team can align with strategies that are already the focus of the QI team, or the team is free to choose another strategy. The hope of the IQIP program is that each provider will choose a team member to be the IQIP/QI coordinator who will work closely with the care team and the IQIP Consultant to implement the chosen strategies.

IQIP has three broad strategies that provider teams can choose: leveraging the Colorado Immunization Information System (CIIS), scheduling the next visit before the patient leaves the clinic, and/or strongly recommending all ACIP recommended vaccines (focusing on HPV vaccine if the provider cares for adolescent patients). Providers are asked to choose at least one of the strategies to focus on, but are allowed to choose all 3 strategies, if desired.  CDC has allowed awardees (CDPHE) to develop a “custom” strategy. At this time, CDPHE has not developed a custom strategy, because providers have verbalized a desire to focus on the IQIP developed strategies. This could change in the future based on provider feedback.

IQIP Consultants maintain contact with provider designated IQIP coordinators throughout the 12-month IQIP process, providing support, education, and information to assist the clinic in successfully implementing the chosen strategies thereby improving vaccine up-take.  Providers receive coverage data at the onset of the 12-month process and at the end as an evaluation of year-over-year coverage data that will focus on the percentage of patients vaccinated, and not the coverage percentages.

CDC requires that 25% of all Vaccines for Children (VFC) enrolled providers participate in an immunization QI program annually, which for Colorado is approximately 145 IQIP visits per year. However, only those providers who actively provide immunization data to the Colorado Immunization Information System (CIIS) are considered for an IQIP visit. The IQIP coordinator works closely with the VFC Compliance Site Visit team in an attempt to minimize clinic interruptions by numerous Immunization Branch personnel throughout the year. Colorado’s IQIP team are focusing on multi-site health systems for 2019-2020, in order to minimize the number of interruptions to the clinic workday.

Finally, as AFIX moves on to IQIP, CDPHE would like to acknowledge the following clinics that took part in AFIX during 2019. Each clinic left their mark in immunization quality improvement. Congratulations to all the following winners!

  • Gold Awards:
    • Arkansas Valley Family Practice
    • Banner Health-Railroad Clinic
    • Brush Family Medicine
  • Silver Award:
    • Kaiser Permanente-Parkside Medical Offices
  • Bronze Awards:
    • Denver Health School-based Health Centers
    • Kaiser Permanente-Greeley Medical Offices
    • Kaiser Permanente-Loveland Medical Offices
    • Larimer County Public Health Immunization Program

For more information on the IQIP program, contact Deb Zambrano at Debra.Zambrano@state.co.us or 303.692.2258.