Advertisement
Original Study| Volume 11, ISSUE 1, P59-69, January 2010

Download started.

Ok

Influenza Immunization Coverage Among Residents of Long-Term Care Facilities Certified by CMS, 2005–2006: The Newest MDS Quality Indicator

Published:December 11, 2009DOI:https://doi.org/10.1016/j.jamda.2009.09.011

      Background

      In October 2005, the Centers for Medicare and Medicaid Services (CMS) required that long-term care (LTC) facilities certified by CMS offer each resident annual influenza vaccination. Subsequently, vaccination status was added to resident assessments collected beginning in the influenza season, 2005–2006. This is the first year immunization coverage can be reported based on a census of LTC residents.

      Objectives

      Report influenza immunization coverage for LTC residents by state, resident, and facility characteristics. Identify uses of the data and areas in need of improvement.

      Methods

      Analysis of CMS' Minimum Data Set of 1,851,676 residents in nursing homes from October 1 through December 31 but who could have been discharged between January 1 and March 31 merged with data for 14,493 non–hospital-based facilities from the Online Survey and Certification Assessment Reporting System.

      Results

      Overall, 83% of residents were offered the vaccine and 72% had received the vaccine. Almost 10% refused to receive the vaccine, 14% were not offered the vaccine, 1% were ineligible, and 3% were missing vaccination status. Vaccination coverage varied significantly among states (range: 49% to 87%). Fewer African Americans and Hispanics than whites were offered the vaccine (79% and 79% versus 84%, respectively) and received it (65% and 66% versus 73%, respectively); more African Americans refused the vaccine (12%) than residents of other races and/or ethnicities. Residents of Medicaid-certified-only facilities had higher levels of vaccination than residents of other facilities (82% versus ≤73%).

      Conclusion

      MDS immunization data can be used as surveillance to work with states to improve coverage. Further research to examine racial disparities in vaccination among LTC residents is needed.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Disease Control and Prevention
        Recommendations of the Immunization Practices Advisory Committee Prevention and Control of Influenza.
        MMWR Morb Mortal Wkly Rep. 1988; 37: 361-373
        • Institute of Medicine
        Improving the Quality of Care in Nursing Homes.
        National Academy Press, Washington, DC1986
        • Institute of Medicine
        Improving the quality of long-term care.
        National Academy Press, Washington, DC2001
      1. The National Quality Forum. National Voluntary Consensus Standards for Nursing Home Care. The National Quality Forum. Available at: http://www.qualityforum.org/Publications/2008/12/National_Voluntary_Consensus_Standards_for_Influenza_and_Pneumococcal_Immunizations.aspx. Accessed November 24, 2004.

        • Bardenheier B.
        • Shefer A.
        • Tiggle R.
        • et al.
        Nursing home resident and facility characteristics associated with pneumococcal vaccination: National Nursing Home Survey, 1995–1999.
        J Am Geriatr Soc. 2005; 53: 1543-1551
        • Institute of Medicine
        Improving the Quality of Long-Term Care.
        National Academy Press, Washington, DC2001
      2. Centers for Disease Control and Prevention. Link Plus. National Center for Chronic Disease Prevention and Health Promotion. Available at: http://www.cdc.gov/cancer/npcr/tools/registryplus/lp.htm?s_cid=q307Cancer_LinkPlus. Accessed July 2, 2009.

        • US Department of Health and Human Services
        Healthy People 2010. 2nd ed. With understanding and improving health and objectives for improving health (2 vols.).
        U.S. Department of Health and Human Services, Washington, DC2001
        • Lu P.J.
        • Euler G.L.
        • Mootrey G.T.
        • et al.
        State-specific influenza vaccination coverage among adults aged > or = 18 years—United States, 2003–04 and 2005–06 influenza seasons.
        MMWR Morb Mortal Wkly Rep. 2007; 56: 953-959
        • Mac D.R.
        • Baken L.
        • Nelson A.
        • Nichol K.L.
        Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients.
        Am J Prev Med. 1999; 16: 173-177
      3. Centers for Medicare & Medicaid Services. New 9th Scope of Work Task. Centers for Medicare & Medicaid Services. Available at: http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter08–32.pdf. Accessed June 12, 2009.

        • Bardenheier B.
        • Shefer A.
        • Mckibben L.
        • et al.
        Characteristics of long-term-care facility residents associated with receipt of influenza and pneumococcal vaccinations.
        Infect Control Hosp Epidemiol. 2004; 25: 946-954
        • Marsteller J.A.
        • Tiggle R.
        • Remsburg R.
        • et al.
        Influenza immunization in nursing homes: Who does not get immunized and whose status is unknown?.
        Infect Control Hosp Epidemiol. 2006; 27: 388-396
      4. Bardenheier B, Wortley PM, Shefer A. Influenza vaccine among African-American and white nursing home residents: Is there a gap? J Am Geriatr Soc. In press.

        • Shimabukuro T.T.
        • Wortley P.M.
        • Bardenheier B.
        • et al.
        Survey of state practices during the 2004–2005 influenza vaccine shortage.
        Public Health Rep. 2007; 122: 311-318
        • Bardenheier B.H.
        • Strikas R.
        • Kempe A.
        • et al.
        Influenza vaccine supply, 2005–2006: Did we come up short?.
        BMC Health Serv Res. 2007; 7: 66
        • Decker F.
        Nursing home performance in resident care in the United States: Is it only a matter of for-profit versus not-for-profit?.
        Health Econ Policy Law. 2008; 3: 115-140
        • Task Force on Community Preventive Services
        Recommendations regarding interventions to improve vaccination coverage in children, adolescents, and adults.
        Am J Prev Med. 2000; 18: 92-96
        • Health Care Financing Administration
        Evidence report and evidence-based recommendations: Interventions that increase the utilization of Medicare-funded preventive service for persons age 65 and older.
        US Department of Health and Human Services, Health Care Financing Administration, Washington, DC1999 (Report HCFA publication no. HCFA-02151)
        • Zimmerman D.R.
        • Karon S.L.
        • Arling G.
        • et al.
        Development and testing of nursing home quality indicators.
        Health Care Financ Rev. 1995; 16: 107-127
        • Hawes C.
        • Morris J.N.
        • Phillips C.D.
        • et al.
        Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS).
        Gerontologist. 1995; 35: 172-178