Immunization Assessment, Feedback, Incentive, and eXchange (AFIX) Program

OverviewAbstract image of children holding hands

AFIX (Assessment, Feedback, Incentive, and eXchange) is the evidence-based, continuous quality improvement process used by the Centers for Disease Control and Prevention (CDC) to improve immunization practices and increase immunization coverage rates. AFIX is a quality improvement program for health care providers. The goal of AFIX is to increase vaccination of children and adolescents with all vaccine recommendations by the advisory committee for immunization practices (ACIP), by reducing missed opportunities to vaccinate and improve immunization delivery practices at the provider level. The Immunization Program strives to meet the Healthy People 2020 AFIX goal of increasing the percentage of providers who have had vaccination coverage levels among children in their practice population measured within the past year.

What are health care providers saying about participating in the AFIX program?

"I can't believe it has been three months! Your visit has definitely raised awareness among the team."

"I think the most valued thing we did was improving the education of providers and nursing staff to the recommendations and indications."

"I learned a lot on what I can do with my patients to help keep them informed about the HPV (vaccine)."


What is the AFIX process?

AFIX is similar to the Plan-Study-Act-Do quality improvement cycle, but it is specific to increasing immunization coverage rates in a health care practice.

Assessment: Immunization staff use the Wisconsin Immunization Registry (WIR)  to generate vaccine coverage rates for the clinic/practice and review the effectiveness of the provider's immunization delivery practices through a discussion which is guided by a questionnaire. 

Feedback: A meeting to discuss vaccine coverage rates and strategies to improve upon those rates. Program staff will work with the providers to identify barriers and collaborate to develop customized evidence-based, quality improvement strategies.

Incentive: Recognition of those providers that reach their goals.

eXchange: A check-in is scheduled three to six months following the initial feedback meeting to monitor progress and offer support.

I am a health care provider interested in participating in AFIX for my practice, how do I get involved?

If you are a Vaccines for Children (VFC) provider and are interested in participating in the AFIX program, please contact your regional office staff representative.

If you are not a part of the VFC program and are interested in participating in AFIX, please contact Sarah Born.  

What other AFIX resources are available?

CDC's AFIX webpage includes an overview and resources.

Suggestions for improving your Immunization Practices (PDF) from the Immunization Action Coalition.

An overview of the AFIX questionnaire can be found on CDC's website.

The Community Guide links to the evidence-based quality improvement strategies suggested in the AFIX questionnaire.

Overview of the quality improvement process from the American Academy of Family Physicians (AAFP).

Provider resources for adolescent immunizations from the CDC.

Staff from the Wisconsin Immunization Program presented a poster at the 2016 National Immunization Conference that focused on efforts around increasing HPV vaccination coverage (PPT) levels. An additional poster about efforts to increase adult vaccine coverage (PDF) levels was presented by Immunization Program staff at the 2017 National Adult and Influenza Immunization Summit.


Last Revised: September 26, 2017