• Barbara Bardenheier, Abigail Shefer, Linda McKibben, Henry Roberts, and Dale Bratzler.
• Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
• Infect Control Hosp Epidemiol. 2004 Nov 1; 25 (11): 946-54.

BackgroundStudies have found residency in long-term-care facilities (LTCFs) a risk factor for influenza and pneumonia and have demonstrated that vaccinations against these diseases reduce the risk of disease. However, rates are below Healthy People 2010 goals of 90% for LTCFs. During 1999-2002, a multi-state demonstration project was conducted in LTCFs to implement standing orders programs for immunizations.ObjectiveIdentify nursing home resident-specific characteristics associated with vaccination coverage at baseline.MethodsFacility-level data were collected from self-reported surveys of selected nursing homes in 14 states and from the On-line Survey and Certification Reporting System. Resident-level data, including demographics and physical functioning, were obtained from the Centers for Medicare & Medicaid Services' Minimum Data Set; 2000-2001 vaccination status was obtained by chart review. Influenza vaccination status reflected a single season, whereas pneumococcal vaccination status reflected vaccination in the past. Multilevel analysis was used to control for facility-level variation.ResultsOf 22,188 residents sampled in 249 LTCFs, complete data were obtained for 20,516 (92%). The average coverage for immunizations was 58.5% +/- 0.7% for influenza and 34.6% +/- 0.3% for pneumococcal. On bivariate analyses, residents with cognitive, psychiatric, or neurologic problems were more likely to be vaccinated; those with accidental injuries, unstable conditions, or cancer were less likely to receive either vaccine. On multilevel analysis, the strongest resident characteristics associated with receipt of immunizations, controlling facility variation, were cognitive deficits and psychiatric illness.ConclusionThe variation in baseline vaccination coverage associated with LTCF resident characteristics supports the need for strategies to increase vaccination coverage in LTCFs.

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