Association of Standing-Order Policies With Vaccination Rates in Dialysis Clinics: A US-Based Cross-sectional Study
Association of Standing-Order Policies With Vaccination Rates in Dialysis Clinics: A US-Based Cross-sectional Study
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DOI：
10.1053/j.ajkd.2008.12.038
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发表时间：
2009-07-01
影响因子：
13.2
通讯作者：
McClellan, William
中科院分区：
文献类型：
--
作者：
Bond, T. Christopher;Patel, Priti R.;McClellan, William
背景：终末期肾病患者因感染而发病和死亡的风险增加。针对这一患者群体的质量改进工作包括评估可能增加流感、B型肝炎和肺炎球菌疾病疫苗接种率的机构政策和实践。研究设计：向终末期肾病网络6、11和15中的所有透析中心发送疫苗接种实践、信念和态度的调查。在考虑的1，052个透析设施中，683个返回了调查，报告了2005年至2006年的疫苗接种率，并且有20名或更多患者。透析机构的常备订单政策，分类为机构范围内的订单，为每位患者预先打印入院订单结果：流感、B型肝炎和乙型肝炎的疫苗接种率（全部或部分系列）、B型肝炎和肺炎球菌疫苗。测量：患者接种，在中心内或中心外进行。结果：流感疫苗的总体接种率为76% +/- 18%（SD），B肝炎全系列或部分系列疫苗的接种率为73% +/- 22%，B肝炎全系列疫苗的接种率为62% +/- 25%，肺炎球菌疫苗的接种率为44% +/- 34%。与个人订单相比，设施范围内的长期订单和图表订单与流感疫苗接种率无关（0.4%;置信区间分别为-4至5;和1.27%;置信区间分别为-3至5），但与B型肝炎全系列或部分系列的更高疫苗接种率相关（9%;置信区间为3 - 15; 11%置信区间为5 - 17），B型肝炎全系列（11%;置信区间，4至17;和13%;置信区间，7至19），和肺炎球菌疾病（21%;置信区间，14至29;和20%;置信区间，13至27，分别）。局限性：数据是横截面，和疫苗接种中心外的自我reported.Conclusions：现有的设施范围内或图表为基础的顺序程序可能是有效的，促进疫苗接种乙型肝炎B和肺炎球菌疾病。美国肾脏病杂志54：86-94。(c)2009年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background: Patients with end-stage renal disease are at increased risk of morbidity and mortality because of infection. Quality improvement efforts for this patient population include assessment of institutional policies and practices that may increase vaccination rates for influenza, hepatitis B, and pneumococcal disease.Study Design: A survey of vaccination practices, beliefs, and attitudes was sent to all dialysis centers in End-Stage Renal Disease Networks 6, 11, and 15.Setting & Participants: Of 1,052 dialysis facilities considered, 683 returned the survey, reported vaccination rates for 2005 to 2006, and had 20 or more patients.Predictor or Factor: Standing-order policy of the dialysis facility, categorized as facility-wide orders, preprinted admission orders for each patient (chart orders), physician-specific orders, and individual orders.Outcomes: Vaccination rates for influenza, hepatitis B (full or partial series), hepatitis B, and pneumococcal vaccine.Measurements: Patient vaccination, given at or outside the center.Results: Overall vaccination rates were 76% +/- 18% (SD) for influenza, 73% +/- 22% for hepatitis B full or partial series, 62% +/- 25% for hepatitis B full series, and 44% +/- 34% for pneumococcal vaccine. Compared with individual orders, facility-wide standing orders and chart orders were not associated with greater vaccination rates for influenza (0.4%; confidence interval, -4 to 5; and 1.27%; confidence interval, -3 to 5, respectively), but were associated with greater vaccination rates for hepatitis B full or partial series (9%; confidence interval, 3 to 15; and 11% confidence interval, 5 to 17, respectively), hepatitis B full series (11%; confidence interval, 4 to 17; and 13%; confidence interval, 7 to 19, respectively), and pneumococcal disease (21%; confidence interval, 14 to 29; and 20%; confidence interval, 13 to 27, respectively).Limitations: Data are cross-sectional, and vaccinations outside the center were self-reported.Conclusions: Existing facility-wide or chart-based order programs may be effective in promoting vaccination against hepatitis B and pneumococcal disease. Am J Kidney Dis 54:86-94. (c) 2009 by the National Kidney Foundation, Inc.