Objectives
Determine whether a comprehensive approach to implementing national consensus guidelines
for nursing home acquired pneumonia (NHAP), including influenza and pneumococcal vaccination,
improves resident subject and staff vaccination rates.
Methods
Quasi-experimental, mixed-methods multifaceted intervention trial conducted at 16
nursing homes (NHs) from 1 corporation (8 in metropolitan Denver, Colorado; 8 in Kansas
and Missouri) during 3 influenza seasons, October to April 2004 to 2007. Residents
with 2 or more signs and symptoms of systemic lower respiratory tract infection (LRTI)
and NH staff and physicians were eligible. Subjects' NH records were reviewed for
vaccination. Each director of nursing (DON) completed a questionnaire assessing staffing
and the number of direct care staff vaccinated against influenza. DONs and study liaison
nurses were interviewed after the intervention. Bivariate analysis compared vaccination
outcomes and covariates between intervention and control homes, and risk-adjusted
models were fit. Qualitative interview transcripts were analyzed using content coding.
Results
No statistically significant relationship between the intervention and improved resident
vaccination rates was found, so other factors associated with improved rates were
explored. Estimated direct patient care staff vaccination rates were better during
the baseline and improved more in the intervention NHs. Qualitative results suggested
that facility-specific factors and national policy changes impacted vaccination rates.
Conclusions
External factors influence staff and resident vaccination rates, diluting the potential
impact of a comprehensive program to improve care for NHAP on vaccination.
Keywords
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Article info
Footnotes
Supported by a grant from the Agency for Health Care Research and Quality, RO1-HS13608.
Identification
Copyright
Published by Elsevier Inc.
