The Impact of Flu and Flu Vaccine on NH Resident Morbitidity

描述（由申请方提供）：流感是发病率和死亡率过高的最重要原因之一，对老年人的影响不成比例，导致死亡和住院。疗养院（NH）居民最有可能承担流感相关发病率和死亡率的全部影响。他们的免疫和生理衰老、多种发病率以及由于居住区近和共同照顾者而造成的更大的接触风险，都有助于增加他们的易感性。流感是NH传染病爆发的主要原因之一，提高这一人群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，很少有研究考察流感和预防性疫苗接种对NH居民身体机能下降的影响，这对居民及其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，所有这些都是在长期护理质量和质量测量的更广泛议程中制定的。使用10年的全面，纵向居民评估数据（MDS）对所有美国NH的所有NH居民，与医疗保险登记和医院索赔数据以及122个监测城市的每周CDC流感流行率和严重程度数据相关联，我们建议建立一个模型，以估计当地流感严重程度和每个居民养老院的年度疫苗接种覆盖率对功能性流感发生率的影响。下降、感染、体重减轻以及流感相关和所有原因的住院。我们的建模方法来估计和检验疫苗接种对住院率和基于MDS的发病率结局的影响的显著性，是基于应用于纵向数据的差异中的差异（DID）模型的扩展，该模型包含流感暴露的强季节性方面。除了生成流感和流感疫苗接种对NH居民的影响的无偏估计外，我们的模型还将做出与临床和政策问题相关的其他各种重要预测，并记录“季节性调整”CMS公开报告的养老院质量措施的必要性。

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.