title: Pneumococcal vaccination: analysis of opportunities in an inner-city hospital.
abstract: BACKGROUND
  Adult pneumococcal vaccination rates for persons at risk of developing pneumococcal disease remain below desired levels. Various sites within the hospital (inpatient medicine wards [IMWs], general medicine clinics [GMCs], and emergency departments [EDs]) have been suggested as venues for administering vaccination. The cost-effectiveness of such sites for delivery of pneumococcal vaccination is not known.
  
  
  OBJECTIVE
  To compare the potential coverage of at-risk patients and cost of pneumococcal vaccination delivered in an ED, GMC, and IMWs.
  
  
  METHODS
  We studied a retrospective cohort of 300 patients with pneumococcal bacteremia who had been hospitalized at Cook County Hospital, an inner-city Chicago public teaching hospital, from January 1994 through December 1998. We measured the presence of risk factors, as defined by the Centers for Disease Control and Prevention, for developing pneumococcal disease prior to index admission for bacteremia; patient use of ED, GMC, and IMWs from 4 weeks to 5 years before index admission; size of target population for vaccination in each site; and cost benefit of a pneumococcal vaccination strategy at each site.
  
  
  RESULTS
  In the 4 weeks to 5 years before index admission, risk factors were present in 209 patients; 182 (87.1%) of the 209 had been in the ED, 104 (49.7%) in an IMW, and 64 (30.6%) in a GMC. The ED showed the greatest potential vaccine coverage, at a cost savings in a best-case scenario; the IMWs showed the best cost-benefit ratio but would provide access to fewer at-risk patients; and a program in the GMC would reach the fewest at-risk patients, with a cost-benefit ratio similar to that of the ED.
  
  
  CONCLUSIONS
  The ED in an inner-city hospital has the potential to vaccinate more patients at risk of pneumococcal bacteremia than a GMC or IMWs, and may do so at a cost savings. A prospective evaluation of such a strategy is warranted.
authors.affiliation: University of Pittsburgh Medical Center, PA, USA.
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
authors.forename: David
authors.initials: D
authors.lastname: Slobodkin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D002641:Chicago / Q000453:epidemiology; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006773:Hospitals, Municipal / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics; D010343:Patient Admission / Q000191:economics; D011008:Pneumococcal Infections / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000191:economics; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D022242:Pneumococcal Vaccines