Characteristics of long-term-care facility residents associated with receipt of influenza and pneumococcal vaccinations
Characteristics of long-term-care facility residents associated with receipt of influenza and pneumococcal vaccinations
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DOI：
10.1086/502325
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发表时间：
2004-11-01
影响因子：
4.5
通讯作者：
Bratzler, D
中科院分区：
文献类型：
--
作者：
Bardenheier, B;Shefer, A;Bratzler, D
背景技术背景：研究发现，长期护理机构（LTCF）的居住是流感和肺炎的一个危险因素，并证明接种这些疾病的疫苗可以降低疾病的风险。然而，LTCF的比率低于健康人群2010年90%的目标。在1999-2002年期间，一个多州的示范项目进行了LTCFs执行常备订单计划免疫接种。目的：确定疗养院居民的具体特点与疫苗接种率在baseline.METHODS：设施级数据收集自报调查选定的疗养院在14个国家和在线调查和认证报告系统。居民水平的数据，包括人口统计学和身体功能，从医疗保险和医疗补助服务中心的最小数据集获得; 2000-2001年的疫苗接种状况通过图表审查获得。流感疫苗接种状况反映了单一季节，而肺炎球菌疫苗接种状况反映了过去的疫苗接种情况。多水平分析被用来控制设施水平variation.Results：在249 LTCF抽样的22,188名居民中，获得了20,516（92%）的完整数据。流感疫苗接种的平均覆盖率为58.5% +/- 0.7%，肺炎球菌疫苗接种的平均覆盖率为34.6% +/- 0.3%。在双变量分析中，有认知、精神或神经问题的居民更有可能接种疫苗;那些有意外伤害、不稳定状况或癌症的人接种疫苗的可能性较小。多层次分析，最强的居民特点与接受免疫接种，控制设施的变化，认知缺陷和精神疾病。结论：在基线疫苗接种覆盖率与LTCF居民特征的变化支持需要的战略，以增加疫苗接种覆盖率在LTCFs。
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.