Hospital-based influenza and pneumococcal vaccination: Sutton's Law applied to prevention.
01 Nov 2000-Infection Control and Hospital Epidemiology (Infect Control Hosp Epidemiol)-Vol. 21, Iss: 11, pp 692-699
TL;DR: This commentary will address the following six issues: the epidemiological rationale for hospitalbased influenza and pneumococcal vaccination; the translation of these epidemiological findings into clinical and public policy; changes in the scientific understanding of the benefits of influenza and pneumoniae vaccination; experience in implementing hospitalbased programs for vaccination; practical issues for hospital-based vaccination; and an enhanced role for infection control practitioners in ensuring that Sutton’s Law for influenza and lung cancer vaccination is followed.
Abstract: Pneumonia and influenza continue to be two of the major causes of hospitalization and death throughout the world. It is fitting that this issue of the Journal is devoted to addressing these important topics. Many of these cases are caused by influenza virus and Streptococcus pneumoniae and could be prevented if the delivery of influenza and pneumococcal vaccines were more effectively targeted to those individuals who are otherwise destined to be hospitalized or to die due to one of these diseases. That persons with vaccine-preventable influenza and pneumococcal infections are still admitted to our hospitals is a sobering reminder that there still is important work to do. Early in their education, virtually all medical students are taught the importance of following Sutton’s Law in formulating a differential diagnosis. Sutton’s Law is based on the remark made by the notorious bank robber, Willie Sutton. When asked why he robbed banks, he replied, “That’s where the money is.” In formulating a differential diagnosis, the student is advised to think first of common problems, not rare diseases. More often than not, diagnosing a common problem is “where the money is.” Sutton’s Law also can be applied to the prevention of influenza and pneumococcal infections. In this instance, the question asked is, “What is the best vaccination strategy for reaching people who, if not vaccinated, will have the greatest likelihood of being hospitalized or dying of these two diseases?” The answer is patients who are being discharged from the hospital. Hospital-based influenza and pneumococcal vaccination is “where the money is.” In this commentary, we will address the following six issues: (1) the epidemiological rationale for hospitalbased influenza and pneumococcal vaccination; (2) the translation of these epidemiological findings into clinical and public policy; (3) changes in the scientific understanding of the benefits of influenza and pneumococcal vaccination; (4) experience in implementing hospitalbased programs for vaccination; (5) practical issues for hospital-based vaccination; and (6) an enhanced role for infection control practitioners in ensuring that Sutton’s Law for influenza and pneumococcal vaccination is followed.
Citations
More filters
TL;DR: The Inpatient Vaccine Program at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center identified and mitigated a dozen workflow considerations and proved flexible enough to adapt to evolving vaccination eligibility.
Abstract: The Inpatient Vaccine Program at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center identified and mitigated a dozen workflow considerations and proved flexible enough to adapt to evolving vaccination eligibility.
5 citations
01 Jun 2004
TL;DR: Investigation of risk factors for death during the influenza season and whether persons at higher risk for dying were also more likely to be vaccinated found disparities in vaccination rates according to risk status point out the need for more effective strategies to ensure that high-risk persons are immunized.
Abstract: We conducted a serial cohort study among elderly members of two and three large managed care organizations for the 1996–1997 and 1997–1998 influenza seasons, respectively, to investigate risk factors for death during the influenza season and whether persons at higher risk for dying were also more likely to be vaccinated. Data were obtained from the clinical and administrative databases of the health plans, and multivariable logistic regression was used to assess the impact of specific risk characteristics on the risk of dying and the likelihood of vaccination while controlling for baseline demographic and health characteristics. There were 82,867 and 158,454 subjects in the two cohorts. Subjects with advanced age (≥85 years), medical co-morbidities, hospitalization during the baseline period and hospitalization for pneumonia or influenza during the vaccination period for each study year were more likely to die during the influenza season. However, subjects with advanced age, certain co-morbidities (renal disease or dementia/stroke), hospitalization during the baseline period or hospitalization for pneumonia or influenza during the vaccination period were also less likely to be vaccinated. These disparities in vaccination rates according to risk status may confound interpretations of ecologic studies assessing temporal trends in vaccination rates and influenza-attributable mortality rates and point out the need for more effective strategies to ensure that high-risk persons are immunized.
4 citations
Dissertation•
10 Dec 2009
TL;DR: In this article, the authors present a review of the literature on e-health adoption and its impact on health outcomes, including the impact of e-Health adoption on health outcomes.
Abstract: ......................................................................................................................................... ii ACKNOWLEDGEMENTS ..................................................................................................................... iii TABLE OF CONTENTS ......................................................................................................................... iv LIST OF TABLES ............................................................................................................................... viii LIST OF FIGURES ................................................................................................................................. x LIST OF APPENDICES .......................................................................................................................... xi EXECUTIVE SUMMARY .......................................................................................................................1 CHAPTER 1: INTRODUCTION ..............................................................................................................7 RESEARCH OBJECTIVES. .......................................................................................................................... 10 CHAPTER 2: LITERATURE REVIEW ..................................................................................................... 11 2.1 E-HEALTH ADOPTION AND IMPACT ON HEALTH OUTCOMES ......................................................... 11 2.1.1 CPOE WITH CDS ......................................................................................................................... 16 2.1.2 CPOE .......................................................................................................................................... 19 2.1.3 CDS ............................................................................................................................................ 20 2.1.4 EHR ............................................................................................................................................ 22 2.1.5 SUMMARY ................................................................................................................................. 24 2.2 E-HEALTH ADOPTION AND RETURN ON INVESTMENT (ROI) ........................................................... 24 2.2.1 CPOE .......................................................................................................................................... 26 2.2.2 EHR ............................................................................................................................................ 27 2.2.3 SUMMARY ................................................................................................................................. 27 2.3 BARRIERS TO E-HEALTH ADOPTION ................................................................................................. 28 2.3.1 SUMMARY ................................................................................................................................. 34 2.4 RESOURCES AND E-HEALTH ADOPTION .......................................................................................... 34 2.4.1 SUMMARY ................................................................................................................................. 37 CHAPTER 3: BARRIERS, DEDICATED RESOURCES AND E-HEALTH ADOPTION ...................................... 38 3.1 RESEARCH DESIGN ........................................................................................................................... 38 3.2 DATA SOURCES ................................................................................................................................. 38 3.3 BACKGROUND .................................................................................................................................. 38 3.3.1 OHA SURVEY .............................................................................................................................. 38
4 citations
Additional excerpts
...CCC, Rehab & Mental Health Hospitals (18)...
[...]
TL;DR: This study compared a standing orders protocol with computerized physician reminders and with routine practice in a prospective trial and found a clear superiority of standing orders over physician reminders, a finding consistent with previous studies and supportive of the ACIP recommendation for healthcare institutions to implement standing orders programs to increase pneumococcal and influenza vaccine coverage of high-risk individuals.
Abstract: The recent outbreak of avian influenza in Asia is a timely reminder of the ever present possibility of a human influenza pandemic in the near future.1 Work continues to develop vaccines effective against emergent influenza strains, but another component of effective prevention and infection control programs is the ability to administer vaccine in a timely and efficient manner. Even in the absence of a pandemic, influenza-associated respiratory and circulatory illness results in more than 200,000 hospitalizations and 36,000 deaths each year in the United States, according to recent estimates.2,3 These numbers suggest that the routine administration of influenza vaccine to targeted populations remains a major challenge. The efficacy of influenza and pneumococcal vaccines in preventing illness is well established,4,5 and during the past decade substantial progress has been made in increasing influenza and pneumococcal vaccination coverage in targeted populations. Estimates of influenza vaccination levels among individuals 65 years and older based on the National Health Interview Survey (NHIS) showed an increase from 33% in 1989 to 66% in the 2001–2002 season.4,6 NHIS estimates for pneumococcal vaccine coverage in this population also increased (from 15% in 1989 to 54% in 2001).6,7 However, influenza vaccination rates in all other targeted adult populations remained well below 50% in the 2001–2002 season, including healthcare workers (38%) and adults 18 to 49 years old with high-risk conditions (23%).4 Influenza vaccination rates among children at increased risk for influenza complications have also been low.4 This year, the Advisory Committee on Immunization Practices (ACIP) extended use of influenza vaccine by recommending vaccination for healthy children 6 to 23 months old and close contacts of children 0 to 23 months old.4 These figures suggest that despite some progress, targeted populations, including many workers and patients of healthcare institutions, still remain vulnerable. In this issue of Infection Control and Hospital Epidemiology, several articles address the challenges we face in further increasing vaccination levels among targeted populations.8-12 The study by Coyle and Currie is a welcome addition to the literature about interventions to increase pneumococcal vaccination rates among hospitalized patients.8 This study compared a standing orders protocol with computerized physician reminders and with routine practice in a prospective trial. The study found a clear superiority of standing orders over physician reminders, a finding consistent with previous studies13 and supportive of the ACIP recommendation for healthcare institutions to implement standing orders programs to increase pneumococcal and influenza vaccine coverage of high-risk individuals.4,5 Two studies examine employee influenza vaccination policies at healthcare institutions.9,10 In a large survey of healthcare institutions in North Carolina, Goldstein et al. found that only 38% reported having formal written policies regarding employee influenza vaccination.9 The lowest rates were found in assisted living facilities and dialysis centers. The authors also noted that barriers to increasing levels of influenza vaccination may differ depending on the type of institution, further emphasizing the need to adapt vaccination interventions to the specific needs of an individual institution. The article by Bryant et al. describes a survey of influenza vaccination policies among several pediatric hospitals.10 The median employee vaccination rate reported by infection control practitioners was 43% in this voluntary survey. A point-prevalence survey of employ-
3 citations
01 Jan 2010
3 citations
References
More filters
TL;DR: For elderly citizens living in the community, vaccination against influenza is associated with reductions in the rate of hospitalization and in deaths from influenza and its complications, as compared with the rates in unvaccinated elderly persons, and vaccination produces direct dollar savings.
Abstract: Background Despite recommendations for annual vaccination against influenza, more than half of elderly Americans do not receive this vaccine. In a serial cohort study, we assessed the efficacy and cost effectiveness of influenza vaccine administered to older persons living in the community. Methods Using administrative data bases, we studied men and women over 64 years of age who were enrolled in a large health maintenance organization in the Minneapolis-St. Paul area. We examined the rate of vaccination and the occurrence of influenza and its complications in each of three seasons: 1990-1991, 1991-1992, and 1992-1993. Outcomes were adjusted for age, sex, diagnoses indicating a high risk, use of medications, and previous use of health care services. Results Each cohort included more than 25,000 persons 65 years of age or older. Immunization rates ranged from 45 percent to 58 percent. Although the vaccine recipients had more coexisting illnesses at base line than those who did not receive the vaccine, duri...
968 citations
Book•
01 Jan 1997
TL;DR: The role of the hospital epidemiologist in protecting the environment laboratory-acquired infections infectious biohazards associated with laboratory animal research nosocomial infections related to patient care support and protection from blood and blood products.
Abstract: Section 1 Perspectives: the control of infections in hospitals - 1750-1950 cost-effectiveness and cost-benefit analysis in infection control the modern infection control practitioner heath care reform and the hospital epidemiologist in the US. Section 2 Management: regulatory, accreditation, and professional agencies influencing infection control programs controversies in isolation policies and practices organizing for infection control with limited resources microbiology: the role of the clinical laboratory health psychology. Section 3 Epidemiology methods: surveillance, reporting and use of computers what to do about high endemic rates of infection epidemics: identification and management design and analytical issues in studies of infectious diseases statistics in infection control studies. Section 4 Special locations: outpatient/out of hospital care issues infection contra issues in same-day surgery extended care facilities. Section 5 Special problems: the threat of antibiotic resistance optimal use of antibiotics multidrug resistant enterococci and the threat of vancomycin-resistant staphylococcus aurous epidemiology of nosocomial tuberculosis. Section 6 Protecting employees: protecting employees from injury and infection management of exposures to infections. Section 7 Environmental issues: hospital environment for high-risk patients environment issues and nosocomial infections the operating theatre: a special environment area disinfection, sterilization and waste disposal the hospital and pollution: role of the hospital epidemiologist in protecting the environment laboratory-acquired infections infectious biohazards associated with laboratory animal research nosocomial infections related to patient care support. Section 8 Preventing specific infections: handwashing, hand disinfestation, and skin disinfestation nosocomial blood stream infections IV-related infections nosocomial pneumonia urinary tract infections surgical infections including burns perioperative antibiotic prophylaxis infection in implantable prosthetic devices nosocomial gastrointestinal infections uncommon infections of the eye prevention and control of nosocomial infections in obstetrics and gynaecology. Section 9 Special patients: infection in the newborn the paediatric patient the elderly solid-organ transplant patients bone marrow transplant patients the AIDS patient protecting recipients from blood and blood products.
765 citations
TL;DR: In this paper, the authors present the results of systematic reviews of the effectiveness, applicability, other effects, economic impact, and barriers to use of selected population-based interventions intended to improve vaccination coverage.
624 citations
559 citations
TL;DR: It is confirmed that healthy senior citizens as well as senior citizens with underlying medical conditions are at risk for the serious complications of influenza and benefit from vaccination.
Abstract: Background: Vaccination rates for healthy senior citizens are lower than those for senior citizens with underlying medical conditions such as chronic heart or lung disease. Uncertainty about the benefits of influenza vaccination for healthy senior citizens may contribute to lower rates of utilization in this group. Objective: To clarify the benefits of influenza vaccination among low-risk senior citizens while concurrently assessing the benefits for intermediate- and high-risk senior citizens. Methods: All elderly members of a large health maintenance organization were included in each of 6 consecutive study cohorts. Subjects were grouped according to risk status: high risk (having heart or lung disease), intermediate risk (having diabetes, renal disease, stroke and/or dementia, or rheumatologic disease), and low risk. Outcomes were compared between vaccinated and unvaccinated subjects after controlling for baseline demographic and health characteristics. Results: There were more than 20 000 subjects in each of the 6 cohorts who provided 147 551 person-periods of observation. The pooled vaccination rate was 60%. There were 101 619 person-periods of observation for low-risk subjects, 15 482 for intermediate-risk, and 30 450 for highrisk subjects. Vaccination over the 6 seasons was associated with an overall reduction of 39% for pneumonia hospitalizations (P,.001), a 32% decrease in hospitalizations for all respiratory conditions (P,.001), and a 27% decrease in hospitalizations for congestive heart failure (P,.001). Immunization was also associated with a 50% reduction in all-cause mortality (P,.001). Within the risk subgroups, vaccine effectiveness was 29%, 32%, and 49% for high-, intermediate-, and low-risk senior citizens for reducing hospitalizations for pneumonia and influenza (for high and low risk, P#.002; for intermediate risk, P = .11). Effectiveness was 19%, 39%, and 33% (for each, P#.008), respectively, for reducing hospitalizations for all respiratory conditions and 49%, 64%, and 55% for reducing deaths from all causes (for each, P,.001). Vaccination was also associated with direct medical care cost savings of $73 per individual vaccinated for all subjects combined (P = .002). Estimates of cost savings within each risk group suggest that vaccination would be cost saving for each subgroup (range of cost savings of $171 per individual vaccinated for high risk to $7 for low risk), although within the subgroups these findings did not reach statistical significance (for each, P$.05). Conclusions: This study confirms that healthy senior citizens as well as senior citizens with underlying medical conditions are at risk for the serious complications of influenza and benefit from vaccination. All individuals 65 years or older should be immunized with this vaccine. Arch Intern Med. 1998;158:1769-1776
470 citations