Race and Ethnicity in Vaccination for Influenza in Vulnerable Elderly (REVIVE)

描述（申请人提供）：免疫接种是减少肺炎球菌肺炎和流感的疾病和死亡的有效策略，但这两种疾病是美国老年人死于可预防疾病的主要原因，特别是在长期护理机构（LTCF）。本研究将描述LTCF全国样本的免疫接种过程和程序，并检查工作人员的知识，态度，关于LTCF居民免疫接种提供的实践和决策。它还将描述种族和族裔信息的收集和记录，并评估居民评估工具上报告的种族的有效性。最后，本研究将探讨种族如何在LTCF居民的免疫接种率中发挥作用。由长期护理、感染控制和种族多样性领域的五名专家组成的技术咨询小组（TAP）将为这项研究提供信息。在他们的指导下，将向LTCF发送一份全国行政调查，以收集人口统计数据，并收集有关设施为居民提供免疫接种和记录居民种族的政策和程序的信息。将对答复国家行政调查的36个地点的分层随机抽样的工作人员进行调查，以探讨他们对养老院居民免疫接种和记录其种族的知识基础、态度和做法。此外，将与LTCF工作人员一起在现场举行焦点小组会议，以收集关于这些做法的深入信息，以及关于有效和公平执行免疫接种和种族识别做法的问题、关切和障碍。在现场，联合委员会项目工作人员还将从医疗记录和MDS中提取关于居民免疫接种和种族的数据，并计算协议率。患者还将被要求自我识别他们的种族遗产，他们的回答将与医疗记录中的信息进行比较。最后，将分析数据，以检查种族和免疫接种之间的关联。这项研究的结果将在为同行评审准备的手稿中描述，该手稿将确定种族可能在LTCF居民的免疫率中发挥作用的原因。 公共卫生相关性：种族和族裔群体之间的免疫接种率差异是有据可查的。然而，种族和族裔文件的有效性仍有待确定。影响患者接受免疫接种的因素也是众所周知的，但对影响工作人员如何、何时以及向谁提供免疫接种的因素知之甚少。本研究的价值在于建立MDS报告的流感状态和种族的有效性，并确定种族是否会影响LTCF居民的免疫率。

DESCRIPTION (provided by applicant): Immunization is an effective strategy to reduce illness and death from pneumococcal pneumonia and influenza, yet these two illnesses are the leading cause of death from preventable disease among older Americans, particularly in Long Term Care Facilities (LTCFs) This study will describe immunization processes and procedures in a national sample of LTCFs and examine staff knowledge, attitudes, practices and decision making regarding LTCF resident immunization delivery. It will also describe the collection and documentation of race and ethnicity information, and evaluate the validity of race reported on the resident assessment instrument. Lastly, this study will examine how race might play a role in the immunization rates of LTCF residents. A Technical Advisory Panel (TAP) comprised of five experts in the areas of long term care, infection control and ethnic diversity will inform the study. Under their guidance, a National Administrative Survey will be sent to LTCFs to collect demographic data and gather information on the policies and procedures facilities have in place to deliver immunizations to residents and document the resident's race. Staff at a stratified random sample of 36 sites responding to the National Administrative Survey will be surveyed to explore their knowledge base, attitudes and practices in relation to the immunization of nursing home residents and the recording of their race. In addition, focus groups will be conducted on-site with LTCF staff to gather in-depth information on these practices as well as the problems, concerns and barriers regarding the effective and equitable implementation of immunization and racial identification practices. While on-site, Joint Commission project staff will also abstract data on resident immunizations and race from both the medical record and MDS, and calculate agreement rates. Patients will also be asked to self-identify their racial heritage and their responses will be compared to the information in the medical record. Finally, data will be analyzed to examine the association between race and immunizations. The results of the study will be described in a manuscript prepared for peer review that will identify reasons race might play a role in the immunization rates of LTCF residents. PUBLIC HEALTH RELEVANCE: The disparity in immunization rates between racial and ethnic groups is well-documented. The validity of documentation of race and ethnicity, however, still needs to be established. Factors that influence patient acceptance of immunizations are also well known, but little is known about factors that influence how, when, and to whom staff offers immunizations. The value of this project is in establishing the validity of influenza status and race reported on the MDS and identifying whether race might influence immunization rates of LTCF residents.