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Increasing Pneumococcal Vaccination Rates Among Residents of Long-Term–Care Facilities: Provider-Based Improvement Strategies Implemented by Peer-Review Organizations in Four Western States

Published online by Cambridge University Press:  02 January 2015

Kurt B. Stevenson ,
John W. McMahon Sr ,
Jan Harris ,
J. Richard Hillman  and
Steven D. Helgerson
Kurt B. Stevenson*
Affiliation:
PRO-West, Boise, Idaho
John W. McMahon Sr
Affiliation:
Mountain-Pacific Quality Health Foundation, Helena, Montana
Jan Harris
Affiliation:
PRO-West, Anchorage, Alaska
J. Richard Hillman
Affiliation:
Mountain-Pacific Quality Health Foundation, Cheyenne, Wyoming
Steven D. Helgerson
Affiliation:
Mountain-Pacific Quality Health Foundation, Helena, Montana Mountain-Pacific Quality Health Foundation, Cheyenne, Wyoming
*
PRO-West, 720 Park Blvd, Suite 120, Boise, ID 83712-7756
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Abstract

Objective:

To evaluate collaborative efforts and intervention strategies by peer-review organizations (PROs) and long-term-care facilities (LTCFs) for improving pneumococcal vaccination rates among residents of LTCFs.

Design:

Prospective, before-after quality improvement project.

Setting:

133 LTCFs in Alaska, Idaho, Montana, and Wyoming.

Patients:

All residents of participating LTCFs.

Methods:

Baseline pneumococcal vaccination rates were determined by medical-record review, self-reporting by patient or family members, and review of Medicare claims information. Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF.

Results:

133 LTCFs with 7,623 residents from Alaska, Idaho, Montana, and Wyoming participated in this quality-improvement project. This accounted for 41% (133/321) of the potential nursing homes and resident population in the participating states. Baseline overall vaccination rates were 40% (3,050/7,589). The overall vaccination rate improved to 75% (5,720/7,623, P<.001). The number of facilities meeting the Healthy People 2000 vaccination goal of 80% improved from 18% (24/133) to 62% (83/133, P<.001). Initial use of chart stickers and implementation of standing orders led to similar increases in vaccination rates, but the standing-order strategy required commitment of fewer PRO resources at a statewide level. Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70% in facilities enforcing a standing-order policy.

Conclusions:

Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates. Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives. Standing orders appear to be one intervention effective in sustaining successful vaccination efforts. Regardless of the specific interventions employed, PROs played a significant role in facilitating vaccination program development and intervention implementation.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 11 , November 2000 , pp. 705 - 710
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1.Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(RR-8):1–24.Google Scholar
2.Marrie, TJ, Slayter, KL. Nursing home-acquired pneumonia: treatment options. Drugs Aging 1996;8:338–348.Google Scholar
3.Quick, RE, Hoge, CW, Hamilton, DJ, Whitney, CJ, Borges, M, Kobayashi, JM. Underutilization of pneumococcal vaccine in nursing homes in Washington State: report of a serotype-specific outbreak and a survey. Am J Med 1993;94:149–152.Google Scholar
4.Nuorti, JP, Butler, JC, Crutcher, JM, Guevara, R, Welch, D, Holder, P, et al. An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents. N Engl J Med 1998;338:1861–1868.CrossRefGoogle ScholarPubMed
5.Centers for Disease Control and Prevention. Outbreaks of pneumococcal pneumonia among unvaccinated residents in chronic-care facilities— Massachusetts, October 1995, Oklahoma, February 1996, and Maryland, May-June 1996. MMWR 1997;46:60–62.Google Scholar
6.Simberkoff, MS, Cross, AP, Al-Ibrahim, M, Batch, AL, Geiseler, PJ, Nadler, J, et al. Efficacy of pneumococcal vaccine in high-risk Patients results of a Veterans Administration Cooperative Study. N Engl J Med 1986;315:1318–1327.Google Scholar
7.Ortqvist, A, Hedlund, J, Burman, LAElbel, E, Hofer, M, Leinonen, M, et al. Randomised trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Swedish Pneumococcal Vaccination Study Group. Lancet 1998;351:399–403.CrossRefGoogle Scholar
8.Broome, CV. Efficacy of pneumococcal polysaccharide vaccines. Rev Infect Dis 1981;3(suppl):S82–S96.Google Scholar
9.Fine, MJ, Smith, MA, Carson, CAMeffe, F, Sankey, SS, Weissfeld LA et al. Efficacy of pneumococcal vaccination in adults. A meta-analysis of randomized clinical trials. Arch Intern Med 1994;154:2666–2677.CrossRefGoogle Scholar
10.Farr, BM, Johnston, BL, Cobb, DK, Fisch, MJ, Germanson, TP, Adal KA et al. Preventing pneumococcal bacteremia in patients at risk. Results of a matched case-control study. Arch Intern Med 1995;155:2336–2340.Google Scholar
11.Shapiro, ED, Berg, AT, Austrian, R, Schroeder, D, Parcellis, V, Margolis, A, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991;325:1453–1460.Google Scholar
12.Shapiro, ED, Clemens, JD. A controlled evaluation of the protective efficacy of pneumococcal vaccine for patients at high risk of serious pneumococcal infections. Ann Intern Med 1984;101:325–330.Google Scholar
13.Centers for Disease Control and Prevention. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: US Department of Health and Human Services, Public Health Service; 1991. DHHS Publication No. (PHS) 91-50213.Google Scholar
14.Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination levels among adults >65 years—United States, 1997. MMWR 1998;47:797–802.65+years—United+States,+1997.+MMWR1998;47:797–802.>Google Scholar
15.Greby, SM, Singleton, JA, Sneller, VP, Strikas, RAWilliams, WW. Pneumococcal and influenza vaccination coverage in nursing homes. In: US abstracts From the 32nd National Immunization Conference; July 1998; Atlanta, GA.Google Scholar
16.Nichol, KL, Grimm, MB, Peterson, DC. Immunizations in long-term care facilities: policies and practice. J Am Geriatr Soc 1996;44:349–355.Google Scholar
17.McArthur, MA, Simor, AE, Campbell, B, McGeer, A. Influenza and pneumococcal vaccination and tuberculin skin testing programs in long-term care facilities: where do we stand? Infect Control Hosp Epidemiol 1995;16:18–24.Google Scholar
18.Warren, SS, Nguyen-Van-Tam, JS, Pearson, JC, Madeley, RJ. Practices and policies for influenza immunization in old people's homes in Nottingham (UK) during the 1992-1993 season: potential for improvement. J Public Health Med 1995;17:392–396.Google Scholar
19.Nichol, KL. Ten-year durability and success of an organized program to increase influenza and pneumococcal vaccination rates among high-risk adults. Am J Med 1998;105:385–392.CrossRefGoogle ScholarPubMed
20.Centers for Disease Control and Prevention. Use of standing orders programs to increase adult vaccination rates. Recommendations of the Advisory Committee on Immunization Practices. MMWR 2000;49(RR-1):15.Google Scholar
21.Centers for Disease Control and Prevention. Vaccine-preventable diseases: improving vaccination coverage in children, adolescents, and adults. A report on recommendations of the Task Force on Community Preventive Services. MMWR 1999;48(RR-8):1–15.Google Scholar
22.Setia, U, Serventi, I, Lorenz, P. Factors affecting the use of influenza vaccine in the institutionalized elderly. J Am Geriatr Soc 1985;33:856–858.CrossRefGoogle ScholarPubMed
23.Health Care Financing Administration. Evidence Report and Evidence-Based Recommendations: Interventions That Increase the Utilization of Medicare-Funded Preventive Services for Persons age 65 and Older. Baltimore, MD: US Department of Health and Human Services, Health Care Financing Administration; 1999. HCFA Publication No. HCFA-02151.Google Scholar
24.Centers for Disease Control and Prevention. Increasing pneumococcal vaccination rates—United States, 1993. MMWR 1995;44:741–744.Google Scholar
25.Health Care Financing Administration. Change Request 1103 to Sections 3157 and 3660.7. In: Medicare Intermediary Manual. Part 3, Claims. 2000.Google Scholar
26.Facts and Trends. The Nursing Facility Sourcebook—1998. Washington, DC: American Health Care Association; 1998.Google Scholar
27.Sisk, JE, Moskowitz, AJ, Whang, W, Lin, JD, Fedson, DS, McBean, AM, et al. Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA 1997;278:1333–1339.Google Scholar