title: Increasing pneumococcal vaccination rates among residents of long-term--care facilities: provider-based improvement strategies implemented by peer-review organizations in four western states.
abstract: OBJECTIVE
  To evaluate collaborative efforts and intervention strategies by peer-review organizations (PROs) and long-term-care facilities (LTCFs) for improving pneumococcal vaccination rates among residents of LTCFs.
  
  
  METHODS
  Prospective, before-after quality improvement project.
  
  
  METHODS
  133 LTCFs in Alaska, Idaho, Montana, and Wyoming.
  
  
  METHODS
  All residents of participating LTCFs.
  
  
  METHODS
  Baseline pneumococcal vaccination rates were determined by medical-record review, self-reporting by patient or family members, and review of Medicare claims information. Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF.
  
  
  RESULTS
  133 LTCFs with 7,623 residents from Alaska, Idaho, Montana, and Wyoming participated in this quality-improvement project. This accounted for 41% (133/321) of the potential nursing homes and resident population in the participating states. Baseline overall vaccination rates were 40% (3,050/7,589). The overall vaccination rate improved to 75% (5,720/7,623, P<.001). The number of facilities meeting the Healthy People 2000 vaccination goal of 80% improved from 18% (24/133) to 62% (83/133, P<.001). Initial use of chart stickers and implementation of standing orders led to similar increases in vaccination rates, but the standing-order strategy required commitment of fewer PRO resources at a statewide level. Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70% in facilities enforcing a standing-order policy.
  
  
  CONCLUSIONS
  Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates. Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives. Standing orders appear to be one intervention effective in sustaining successful vaccination efforts. Regardless of the specific interventions employed, PROs played a significant role in facilitating vaccination program development and intervention implementation.
authors.affiliation: PRO-West, Boise, Idaho 83712-7756, USA.
authors.forename: K B
authors.initials: KB
authors.lastname: Stevenson
authors.forename: J W
authors.initials: JW
authors.lastname: McMahon
authors.forename: J
authors.initials: J
authors.lastname: Harris
authors.forename: J R
authors.initials: JR
authors.lastname: Hillman
authors.forename: S D
authors.initials: SD
authors.lastname: Helgerson
mesh_terms: D000368:Aged; D000413:Alaska; D006801:Humans; D008134:Long-Term Care; D008499:Medical Records; D015205:Northwestern United States; D009735:Nursing Homes; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011014:Pneumonia / Q000517:prevention & control*; D011366:Professional Review Organizations; D011446:Prospective Studies
chemical_list: D022242:Pneumococcal Vaccines