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Characteristics of Long-Term–Care Facility Residents Associated With Receipt of Influenza and Pneumococcal Vaccinations

Published online by Cambridge University Press:  02 January 2015

Barbara Bardenheier ,
Abigail Shefer ,
Linda McKibben ,
Henry Roberts  and
Dale Bratzler
Barbara Bardenheier*
Affiliation:
Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Abigail Shefer
Affiliation:
Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Linda McKibben
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Henry Roberts
Affiliation:
Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Dale Bratzler
Affiliation:
Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma
*
Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-52, Atlanta, GA 30333
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Abstract

Background:

Studies have found residency in long-term–care facilities (LTCFs) a risk factor for influenza and pneumonia and have demonstrated that vaccinations against these diseases reduce the risk of disease. However, rates are below Healthy People 2010 goals of 90% for LTCFs. During 1999–2002, a multi-state demonstration project was conducted in LTCFs to implement standing orders programs for immunizations.

Objective:

Identify nursing home resident–specific characteristics associated with vaccination coverage at baseline.

Methods:

Facility-level data were collected from self-reported surveys of selected nursing homes in 14 states and from the On-line Survey and Certification Reporting System. Resident-level data, including demographics and physical functioning, were obtained from the Centers for Medicare & Medicaid Services' Minimum Data Set; 2000–2001 vaccination status was obtained by chart review. Influenza vaccination status reflected a single season, whereas pneumococcal vaccination status reflected vaccination in the past. Multilevel analysis was used to control for facility-level variation.

Results:

Of 22,188 residents sampled in 249 LTCFs, complete data were obtained for 20,516 (92%). The average coverage for immunizations was 58.5% ± 0.7% for influenza and 34.6% ± 0.3% for pneumococcal. On bivariate analyses, residents with cognitive, psychiatric, or neurologic problems were more likely to be vaccinated; those with accidental injuries, unstable conditions, or cancer were less likely to receive either vaccine. On multilevel analysis, the strongest resident characteristics associated with receipt of immunizations, controlling facility variation, were cognitive deficits and psychiatric illness.

Conclusion:

The variation in baseline vaccination coverage associated with LTCF resident characteristics supports the need for strategies to increase vaccination coverage in LTCFs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 11 , November 2004 , pp. 946 - 954
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1. Bradley, SF. Prevention of influenza in long-term-care facilities: Long-Term-Care Committee of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1999;20:629–637.CrossRefGoogle ScholarPubMed
2. Muder, RR. Approach to the problem of pneumonia in long-term care facilities. Compr Ther 2000;26:255–262.Google Scholar
3. Marrie, TJ. Pneumonia in the elderly. Curr Opin Pulm Med 1996;2:192–197.CrossRefGoogle ScholarPubMed
4. Arden, NH. Control of influenza in the long-term-care facility: a review of established approaches and newer options. Infect Control Hosp Epidemiol 2000;21:59–64.CrossRefGoogle ScholarPubMed
5. Carroll, NV, Delafuente, JC, McClure, KL, Weakley, DF, Khan, ZM, Cox, FM. Economic burden of influenza-like illness in long-term-care facilities. Am J Health Syst Pharm 2001;58:1133–1138.Google Scholar
6. Bridges, CB, Fukuda, K, Uyeki, TM, Cox, NJ, Singleton, JA. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2002;51:1–31.Google Scholar
7. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997;46:1–24.Google Scholar
8. McElhaney, JE, Beattie, BL, Devine, R, Grynoch, R, Toth, EL, Bleackley, RC. Age-related decline in interleukin 2 production in response to influenza vaccine. J Am Geriatr Soc 1990;38:652–658.CrossRefGoogle ScholarPubMed
9. Patriarca, PA, Weber, JA, Parker, RA, et al. Risk factors for outbreaks of influenza in nursing homes: a case-control study. Am J Epidemiol 1986;124:114–119.CrossRefGoogle ScholarPubMed
10. Buikema, A, Singleton, J, Sneller, V, Strikas, R. Influenza and pneumococcal vaccination in nursing homes, U.S., 1995-1999. Presented at the National Immunization Conference; May 29, 2001; Atlanta, GA.Google Scholar
11. Influenza and pneumococcal vaccination levels among persons aged > or = 65 years: United States, 2001. MMWR 2002;51:1019–1024.+or+=+65+years:+United+States,+2001.+MMWR+2002;51:1019–1024.>Google Scholar
12. Centers for Medicare & Medicaid Services. State Operations Manual. Baltimore, MD: Centers for Medicare & Medicaid Services; 1999.Google Scholar
13. Institute of Medicine. Improving the Quality of Long-Term Care. Washington, DC: National Academy Press; 2001.Google Scholar
14. Fries, BE, Schneider, DP, Foley, WJ, Gavazzi, M, Burke, R, Cornelius, E. Refining a case-mix measure for nursing homes: resource utilization groups (RUG-III). Med Care 1994;32:668–685.Google Scholar
15. AV, Diez-Roux. A glossary for multilevel analysis. J Epidemiol Community Health 2002;56:588–594.Google Scholar
16. KM, Chan-Tack. Influenza and pneumococcal immunization rates among a high-risk population. South Med J 2001;94:323–324.Google Scholar
17. Klein, RS, Adachi, N. An effective hospital-based pneumococcal immunization program. Arch Intern Med 1986;146:327–329.CrossRefGoogle ScholarPubMed
18. Morton, MR, Spruill, WJ, Cooper, JW. Pharmacist impact on pneumococcal vaccination rates in long-term-care facilities. Am J Hosp Pharm 1988;45:73.Google Scholar
19. Reuben, DB, Shekelle, PG, Wenger, NS. Quality of care for older persons at the dawn of the third millennium. J Am Geriatr Soc 2003; 5LS346–S350.Google Scholar
20. LaVeist, TA, Rolley, NC, Diala, C. Prevalence and patterns of discrimination among U.S. health care consumers. Int J Health Serv 2003; 33:331–344.CrossRefGoogle ScholarPubMed
21. Sabbagh, MN, Silverberg, N, Majeed, B, et al. Length of stay in skilled nursing facilities is longer for patients with dementia. J Alzheimers Dis 2003;5:57–63.Google Scholar
22. Racial/ethnic disparities in influenza and pneumococcal vaccination levels among persons aged < or =65 years: United States, 1989-2001. MMWR 2003;52:958–962.Google Scholar
23. Influenza and pneumococcal vaccination levels among persons aged > or = 65 years: United States, 1999. MMWR 2001;50:532–537.+or+=+65+years:+United+States,+1999.+MMWR+2001;50:532–537.>Google Scholar
24. Race-specific differences in influenza vaccination levels among Medicare beneficiaries: United States, 1993. MMWR 1995;44:24-27, 33.Google Scholar
25. Cui, XW, Nagao, MM, Effler, PV. Influenza and pneumococcal vaccination coverage levels among Hawaii statewide long-term-care facilities. Infect Control Hosp Epidemiol 2001;22:519–521.Google Scholar
26. Use of standing orders programs to increase adult vaccination rates. MMWR 2000;49:15–26.Google Scholar
27. Sisk, JE, Moskowitz, AJ, Whang, W, et al. Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA 1997;278:1333–1339.CrossRefGoogle ScholarPubMed
28. Nichol, KL, Wuorenma, J, von Sternberg, T. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Arch Intern Med 1998;158:1769–1776.Google Scholar