title: [The effect of the introduction of pneumococcal vaccination for adults as a quality measure on vaccination rates in Clalit Health Services].
abstract: BACKGROUND
  The incidence of invasive pneumococcal infections in industrialized countries is above 50/100,000 annuaty in adults over the age of 65 years. The Israel Ministry of Health recommends 23-valent polysaccharide anti-pneumococcaL vaccination for patients with immune suppression or chronic diseases and citizens above the age of 65 years.
  
  
  METHODS
  in 1.1.2008 pneumococcal vaccination for adults was introduced as a quality measure in CLalit Health Services (CHS). At the time of the introduction of pneumococcaL vaccination as a new quality measure in CHS, as one of 70 quality measures in community medicine, the target population included all CHS enrollees over 65 years of age and patients with specific chronic diseases. The relative weight of this quality measure within the set of CHS quality measures was set at 3.19%. The goal for the measure was set at 75%. Pneumococcal vaccination was paired with the influenza vaccination campaign. Mandatory copayment was reduced from NIS 57 to NIS 25 for enroLLees without supplementary medical insurance, and from NIS 11 to NIS 5 for enrollees with supplementary insurance. An alert for performing pneumococcaL vaccination for the target population was introduced into the medical software used by all CHS physicians.
  
  
  RESULTS
  During a period of two years foLLowing the introduction of pneumococcaL vaccination as a quality measure in CHS, approximately 400,000 CHS enrollees within the target population received pneumococcaL vaccination, and the rate of immunization increased 10-fold (with respect to August 2007).
  
  
  CONCLUSIONS
  The introduction of pneumococcal vaccination as a quality measure in CHS, coupled by other managerial and service-related actions, substantially increased the vaccination rates.
authors.affiliation: Chief Physician's Office, Clalit Health Services Headquarters, Tel Aviv, Israel. arcohen@clalit.org.il
authors.forename: Arnon D
authors.initials: AD
authors.lastname: Cohen
authors.forename: Jacob
authors.initials: J
authors.lastname: Dreiher
authors.forename: Margalit
authors.initials: M
authors.lastname: Goldfracht
authors.forename: Orit
authors.initials: O
authors.lastname: Yakovson
authors.forename: Nicky
authors.initials: N
authors.lastname: Lieberman
authors.forename: Dorit
authors.initials: D
authors.lastname: Weiss
authors.forename: Calanit
authors.initials: C
authors.lastname: Kay
authors.forename: Silvia
authors.initials: S
authors.lastname: Fleischmann
authors.forename: Yael
authors.initials: Y
authors.lastname: Rosenbluth
authors.forename: Haim
authors.initials: H
authors.lastname: Bitterman
authors.forename: Ran
authors.initials: R
authors.lastname: Balicer
mesh_terms: D000368:Aged; D017047:Cost Sharing; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D007557:Israel / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000191:economics; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012984:Software; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines