The Impact of Flu and Flu Vaccine on NH Resident Morbitidity

说明(申请人提供)：流感是发病率和死亡率过高的最重要原因之一，对老年人造成不成比例的影响，导致死亡和住院。疗养院居民最有可能承受与流感相关的发病率和死亡率的全部影响。他们的免疫和生理衰老，多种疾病，以及通过封闭的生活区和共同的照顾者而暴露于更大的风险，导致他们的易感性增加。流感是非传染性疾病暴发的主要原因之一，提高这一人群的预防性疫苗接种率的努力取得了不同程度的成功。到目前为止，很少有研究研究流感和预防性疫苗接种对NH居民身体功能下降的影响，这对居民和他们的照顾者来说都是最密切相关的。该提案涉及与预防和护理管理以及患者安全相关的AHRQ研究议程，所有这些都被纳入长期护理质量和质量衡量的更广泛议程。使用与医疗保险登记和住院索赔数据相关联的全美NHS所有NH居民的十年综合纵向居民评估数据(MDS)，以及122个监测城市的CDC流感流行率和严重程度每周数据，我们建议建立一个模型，以估计每个居民疗养院局部流感严重程度和年度疫苗接种覆盖率对功能衰退、感染、体重减轻以及与流感相关和所有原因住院的影响。我们估计和测试疫苗接种对住院率和基于MDS的发病率结果的重要性的建模方法是基于应用于纵向数据的差异差异(DID)模型的扩展，该模型结合了流感暴露的强烈季节性因素。除了对流感和流感疫苗接种对NH居民的影响产生公正的估计外，我们的模型还将做出与临床和政策关注相关的各种其他重要预测，并记录下“季节性调整”CMS公开报告的疗养院质量指标的必要性。

DESCRIPTION (provided by the applicant): Influenza is one of the most important causes of excess morbidity and mortality which disproportionately affects the elderly, leading to death and hospitalization. Nursing home (NH) residents are most likely to bear the full impact of influenza-related morbidity and mortality. Their immune and physiologic senescence, multi-morbidity, and greater exposure risk through close living quarters and shared caregivers contribute to their increased susceptibility. Influenza is one of the leading causes of infectious disease outbreaks in NH and efforts to increase the rates of preventative vaccination of this population have had varying levels of success. To date, few studies have examined the effect of influenza and preventative vaccination on NH residents' decline in physical functioning, something that is most germane to this population for both residents and their caregivers. This proposal addresses the AHRQ research agenda related to prevention and care management as well as patient safety, all framed within the broader agenda of long term care quality and quality measurement. Using ten years of comprehensive, longitudinal resident assessment data (the MDS) on all NH residents in all US NHs linked to Medicare enrollment and hospital claims data as well as to weekly CDC influenza prevalence and severity data in 122 surveillance cities, we propose to build a model to estimate the impact of localized influenza severity and annual vaccination coverage in each resident's nursing home on the rate of functional decline, infection, weight loss and both influenza related and all cause hospitalizations. Our modeling approach to estimation and testing the significance of the vaccination effect on hospitalization rates and our MDS-based morbidity outcomes is based on an extension of the differences-in-differences (DID) model applied to longitudinal data that incorporates the strong seasonal aspects of influenza exposure. In addition to generating unbiased estimates of the effect of influenza and influenza vaccination on NH residents, our model will make various other important predictions relevant to clinical and policy concerns and document the need for "seasonally adjusting" CMS' publicly reported nursing home quality measures.