• M Kate Dunn, Sumi Misra, Ralf Habermann, and Marie R Griffin.
• Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine and Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA.
• J Am Med Dir Assoc. 2003 May 1; 4 (3): 135-8.

ObjectiveTo 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.DesignCross-sectional descriptive study of nursing homes using a mailed self-administered survey instrument.ResultsOf 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.ConclusionPneumococcal 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.

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