Bratzler Dale W, Houck Peter M, Jiang Hui, Nsa Wato, Shook Claudette, Moore Lori, Red Lisa
Health Care Quality Improvement Program, Oklahoma Foundation for Medical Quality, Inc, 14000 Quail Springs Pkwy, Suite 400, Oklahoma City, OK 73134, USA.
Arch Intern Med. 2002 Nov 11;162(20):2349-56. doi: 10.1001/archinte.162.20.2349.
Hospitalized elderly patients are at risk for subsequent influenza and pneumococcal disease. Despite this risk, they are often not vaccinated in this setting.
We reviewed the medical records of a national sample of 107 311 fee-for-service Medicare patients, 65 years or older, discharged from April 1, 1998, through March 31, 1999, with a principal diagnosis of acute myocardial infarction, heart failure, pneumonia, or stroke. We linked patient identifiers to Medicare Part B claims to identify influenza and pneumococcal vaccines paid for before, during, or after hospitalization. The main outcome measures were documentation by chart review or paid claim of influenza or pneumococcal vaccination.
Of the 104 976 patients with a single hospitalization, 35 169 (33.5%; 95% confidence interval [CI], 33.2%-33.8%) received pneumococcal vaccination prior to admission, 444 (0.4%; 95% CI, 0.4%-0.5%) were vaccinated in the hospital, and 1076 (1.0%; 95% CI, 1.0%-1.1%) were vaccinated within 30 days of discharge. In the subgroup of 40 488 patients discharged from October through December, 12 782 (31.6%; 95% CI, 31.1%-32.0%) received influenza vaccination prior to admission, 755 (1.9%; 95% CI, 1.7%-2.0%) were vaccinated in the hospital, and 4302 (10.6%; 95% CI, 10.3%-10.9%) were vaccinated after discharge. Of patients who were unvaccinated prior to admission, 97.3% (95% CI, 97.1%-97.5%) did not receive influenza vaccine and 99.4% (95% CI, 99.3%-99.4%) did not receive pneumococcal vaccine before hospital discharge.
National recommendations for inpatient vaccination against influenza and pneumococcal disease are not being followed for the vast majority of eligible Medicare patients admitted to the hospital.
住院老年患者有感染后续流感和肺炎球菌疾病的风险。尽管存在这种风险，但他们在此种情况下往往未接种疫苗。
我们回顾了1998年4月1日至1999年3月31日期间从全国抽取的107311名按服务付费的医疗保险患者（年龄在65岁及以上）的病历，这些患者的主要诊断为急性心肌梗死、心力衰竭、肺炎或中风。我们将患者标识符与医疗保险B部分理赔记录相链接，以确定在住院前、住院期间或出院后支付费用的流感和肺炎球菌疫苗。主要结局指标是通过病历审查或已支付理赔记录来记录流感或肺炎球菌疫苗接种情况。
在104976名单次住院的患者中，35169名（33.5%；95%置信区间[CI]，33.2% - 33.8%）在入院前接种了肺炎球菌疫苗，444名（0.4%；95%CI，0.4% - 0.5%）在住院期间接种，1076名（1.0%；95%CI，1.0% - 1.1%）在出院后30天内接种。在10月至12月出院的40488名患者亚组中，12782名（31.6%；95%CI，31.1% - 32.0%）在入院前接种了流感疫苗，755名（1.9%；95%CI，1.7% - 2.0%）在住院期间接种，4302名（10.6%；95%CI，10.3% - 10.9%）在出院后接种。在入院前未接种疫苗的患者中，97.3%（95%CI，97.1% - 97.5%）在出院前未接种流感疫苗，99.4%（95%CI，99.3% - 99.4%）未接种肺炎球菌疫苗。
绝大多数符合条件的医疗保险住院患者未遵循国家关于住院患者接种流感和肺炎球菌疾病疫苗的建议。
