title: Hospital decision-making regarding the smallpox pre-event vaccination program.
abstract: OBJECTIVE
  To understand the factors underlying the decision by U.S. hospitals to participate or not in the U.S. Smallpox Pre-Event Vaccination Program (SPVP).
  
  
  METHODS
  We conducted semistructured telephone interviews with a convenience sample of 123 hospital decision-makers in nine states between June and November 2003.
  
  
  RESULTS
  Within our sample, 88 hospitals (72%) decided to participate in the SPVP and 35 (28%) decided against doing so. Nearly all hospital decision-makers considered the risk of a smallpox outbreak, risks associated with vaccination, hospital costs, and the reaction of hospital stakeholders. However, these factors often were weighed differently by hospitals that decided to participate compared to those that did not. Fewer than half of all hospitals reported that public health officials played an important role in their decision-making process, but those that did felt the influence of public health officials was positive.
  
  
  CONCLUSIONS
  Strengthening the linkage between the public and private health sectors may help to address some of the barriers to broader participation by hospitals in the SPVP and foster the success of smallpox outbreak response preparedness efforts in the future.
authors.affiliation: Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, USA. kempera@med.umich.edu
authors.forename: Alex R
authors.initials: AR
authors.lastname: Kemper
authors.forename: Anne E
authors.initials: AE
authors.lastname: Cowan
authors.forename: Pamela L Y H
authors.initials: PL
authors.lastname: Ching
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Kennedy
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Gary L
authors.initials: GL
authors.lastname: Freed
mesh_terms: D003159:Community-Institutional Relations; D003659:Decision Making, Organizational; D004196:Disease Outbreaks / Q000191:economics / Q000517:prevention & control*; D006739:Hospital Administration / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D032541:Mass Vaccination / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D012899:Smallpox / Q000453:epidemiology*; D012941:Social Responsibility; D014481:United States