title: Pneumococcal vaccination in nursing homes: does policy change practice?
abstract: OBJECTIVE
  To describe the impact of a Tennessee Department of Health regulation amendment requiring that all nursing home residents 65 years of age or older demonstrate documentation of pneumococcal vaccination, or documented medical contraindication, or patient refusal.
  
  
  METHODS
  Cross-sectional descriptive study of nursing homes using a mailed self-administered survey instrument.
  
  
  RESULTS
  Of 354 Tennessee nursing homes, 304 homes were targeted for the survey, after excluding hospital-based rehabilitation and skilled care facilities, and facilities with fewer than 50 beds. Pneumococcal immunization rates improved from 32% to 42% from 1998 to 1999, coincident with the new policy. Homes reporting high immunization rates (>/=75%) increased from 21% to 28%. These facilities were more likely to be larger (>100 beds) and urban; to have a computerized or chart-based vaccine record; to have a standing order policy; and high influenza immunization rates. Overall, only 23% of homes reported that the policy was helpful in increasing immunization rates, and only 38% of facilities reported an increase in rates of at least 5%. However, 58% of facilities that found the policy useful improved pneumococcal vaccination rates at least 5% compared with 32% that did not find it useful. No other factors were strongly associated with improved vaccine rates.
  
  
  CONCLUSIONS
  Pneumococcal immunization rates of at least 75% were associated with facility size, location, and record-keeping practices. Pneumococcal vaccination rates improved only modestly between 1998 and 1999, coincident with the health department amendment. Those who found the policy useful had the greatest improvement in rates.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine and Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA.
authors.forename: M Kate
authors.initials: MK
authors.lastname: Dunn
authors.forename: Sumi
authors.initials: S
authors.lastname: Misra
authors.forename: Ralf
authors.initials: R
authors.lastname: Habermann
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D004282:Documentation / Q000592:standards; D005161:Facility Regulation and Control / Q000458:organization & administration*; D019538:Health Care Surveys; D006276:Health Facility Size; D006291:Health Policy; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*; D022242:Pneumococcal Vaccines; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011635:Public Health Administration / Q000592:standards*; D011795:Surveys and Questionnaires; D013714:Tennessee; D014481:United States; D014611:Vaccination / Q000592:standards / Q000706:statistics & numerical data*
chemical_list: D022242:Pneumococcal Vaccines