title: Influenza vaccinations of Washington state Medicare beneficiaries seen by physiatrists in the outpatient setting in 1994.
abstract: OBJECTIVE
  To compare influenza vaccination billing rates for patients seen by physiatrists with those of four other specialties: neurology, rheumatology, family practice, and internal medicine.
  
  
  METHODS
  Retrospective cohort analysis using Medicare billing data.
  
  
  METHODS
  234,164 Medicare outpatients seen in Washington state between September 1 and December 31, 1994.
  
  
  RESULTS
  Based on Medicare's billing data, only 6 of 99 physiatrists ordered vaccinations, and they immunized only 159 (6%) of the patients seen. An additional 1,109 (42%) patients seen by physiatrists were vaccinated by other physicians. Physiatric patients were less likely to have been vaccinated than those seen by internists, family practitioners, or rheumatologists (p < .002), but equally likely as those seen by neurologists (p = .07). A significantly smaller percentage of physiatrists ordered vaccinations than all other specialties (p < .04). Utilizing pre-existing survey data, the misclassification rate (those immunized but not billed) was estimated at 22% of our original cohort. Thus, approximately 800 patients, one third of those seeing physiatrists, may not have been immunized. We estimated the increase in hospitalization costs to be $117 per nonvaccinated patient (total >$90,000).
  
  
  CONCLUSIONS
  Missed opportunities for vaccination by physiatrists appear to be more frequent than in other specialties and have potentially large health and economic costs.
authors.affiliation: Division of Clinical Standards and Quality, Health Care Financing Administration, Region 10, Seattle, WA 98121, USA.
authors.forename: L
authors.initials: L
authors.lastname: Chan
authors.forename: P M
authors.initials: PM
authors.lastname: Houck
authors.forename: R A
authors.initials: RA
authors.lastname: Rosenblatt
authors.forename: G
authors.initials: G
authors.lastname: Hart
authors.forename: L M
authors.initials: LM
authors.lastname: Baldwin
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs; D006801:Humans; D007252:Influenza Vaccines; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D016345:Medicare Part B / Q000706:statistics & numerical data*; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data; D010810:Physical and Rehabilitation Medicine / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012219:Rheumatology / Q000706:statistics & numerical data; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*; D014861:Washington
chemical_list: D007252:Influenza Vaccines