MOBI 2015 One Month Followup Program * MOBI TIES Trainer Name * Trainer Email * Site Name * Presentation Date * Date of follow-up * Name and title of practice staff person providing information Did the person attend the presentation? (to ensure the highest quality of results, the person answering these questions should have attended the training) * Yes No What change did the practice commit to on their PDSA worksheet? Did the practice return their PDSA Worksheet to the trainer? * Yes No Please ask them to fax the form to the trainer or the Ohio AAP office (614) 846-4025. BEST PRACTICES FOR OFFICE OPERATIONS 1. Did the practice have an AFIX measurement before the presentation? * No Will consider Interested Not enough kids (for TIES, adolescents) Yes Can the practice expand on their decision not to have an AFIX measurement? Provide them with information on getting an AFIX. Are they willing to share their AFIX rate with us so we can assist in helping them improve their rates? 2. Is the practice a Vaccines for Children (VFC) provider. Yes No Is there anything else the MOBI/TIES Program could do to improve this? 3. How often does the practice provide a current Vaccine Information Statement (VIS) to parents prior to an immunization? * Never Rarely Sometimes Frequently Almost Always Is there anything the MOBI/TIES office could do to improve this? (Reinforce that it is Federal Law to provide VIS for every immunization) 4. Has the practice updated their vaccine policies/procedures since the training? * Yes No Don't have a policy If yes, when was it last updated and how frequently does this normally occur? If the practice does not have a policy, please answer why? 5. How often does the practice use the ImpactSIIS Registry to look up immunizations? * Never Rarely Sometimes Frequently Almost Always Is there anything else the MOBI/TIES office could do to improve this? 6. How often does the practice check immunization status at every visit? * Never Rarely Sometimes Frequently Almost Always Is there anything else the MOBI/TIES office could to do improve this? BEST PRACTICES FOR INCREASING VACCINE RATES 7. How often does the practice use an immunization REMINDER system? * Never Rarely Sometimes Frequently Almost Always Is there anything else the MOBI/TIES office could do to improve this? 8. How often does the practice use an immunization RECALL system? * Never Rarely Sometimes Frequently Almost Always Is there anything else the MOBI/TIES office could do to improve this? 9. Does the practice have a "go to" person for vaccine questions? Yes No Is there anything else the MOBI/TIES office could do to improve this? 10. How often does the practice give all vaccines that are due, regardless of the number of injections? * Never Rarely Sometimes Frequently Almost Always Is there anything else the MOBI/TIES office can do to improve this? 11. How often does the practice allow shots to be given to children or adolescents with minor illnesses like colds, diarrhea or low-grade fever? * Never Rarely Sometimes Frequently Almost Always Is there anything else the MOBI/TIES office could do to improve this? 12. How often does the practice allow patients to come in the same day for immunization-only nurses visits? * Never Rarely Sometimes Frequently Almost Always Is there anything else the MOBI/TIES office could do to improve this? 13. How often does the practice give age-appropriate vaccines even when no vaccine record is available? * Never Rarely Sometimes Frequently Almost Always Is there anything else the MOBI/TIES office could do to improve this? 14. How often does the practice use combination vaccines? * Never Rarely Sometimes Frequently Almost Always Is there anything else the MOBI/TIES office could do to improve this? VACCINE OBSTACLES 15. What would the practice say are the biggest obstacles to increasing your immunization coverage rates? (check all that apply) Time commitment Cost Staffing Parental Refusal No same-day immunization-only visits Nurses not authorized to immune if due Physician's decision I don't know N/A - we have incorporated the strategy(yes) into our practice Other Please include any other comments here. CONTINUING EDUCATION CERTIFICATES Choose one to determine which continuing education certificate should be issued. MOBI - September 10, 2014 - September 9, 2015 MOBI - September 10, 2015 - September 9, 2016 TIES - September 10, 2015 - September 9, 2016 MOBI 14-15: How will the trainer provide certificates to this practice? I will provide attendees with a link to download and print the certificates themselves. I will provide (or have already provided) attendees with paper copies in the mail. I'd like Ohio AAP to email attendees a link to download and print the certificates themselves. Provide the following information to the practice:Go to this link to download the continuing education certificate for your MOBI training. Participants may print and fill out the certificate for 1.0 Prescribed credits from the AAFP. ONA also accepts this as 1 contact hour. Note: only those who attended the presentation, signed the attendance sheet and completed an evaluation may claim the continuing education credit. Click here to download and print paper copies. Enter the contact person's email address below and an email will automatically be sent with a link and instructions on how to download the certificates. Enter only ONE email address below. MOBI 15-16: How will the trainer provide certificates to this practice? * I will provide attendees with a link to download and print the certificates themselves. I will provide (or have already provided) attendees with paper copies in the mail. I'd like Ohio AAP to email attendees a link to download and print the certificates themselves. Click here to download and print paper copies. Provide the following information the practice:Go to this link to download the continuing education certificate for your MOBI training. Participants may print and fill out the certificate for 1.0 Prescribed credits from the AAFP. ONA also accepts this as 1 contact hour. Note: only those who attended the presentation, signed the attendance sheet and completed an evaluation may claim the continuing education credit. Enter the contact person's email address below and an email will automatically be sent with a link and instructions on how to download the certificates. Enter only ONE email address below. TIES 15-16: How will the trainer provide certificates to this practice? * I will provide attendees with a link to download and print the certificates themselves. I will provide (or have already provided) attendees with paper copies in the mail. I'd like Ohio AAP to email attendees a link to download and print the certificates themselves. Click here to download and print paper copies. Provide the following information to the practice:Go to this link to download the continuing education certificate for your TIES training. Participants may print and fill out the certificate for 1.0 Prescribed credits from the AAFP. ONA also accepts this as 1 contact hour. Note: only those who attended the presentation, signed the attendance sheet and completed an evaluation may claim the continuing education credit. Enter the contact person's email address below and an email will automatically be sent with a link and instructions on how to download the certificates. Enter only ONE email address below. If you are human, leave this field blank.
