Winston Carla A, Lindley Megan C, Wortley Pascale M
Health Services Research and Evaluation Branch, National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-52, Atlanta, GA 30333, USA.
Am J Med Qual. 2006 Mar-Apr;21(2):125-33. doi: 10.1177/1062860605284361.
This study was a retrospective, preintervention and postintervention evaluation of influenza and pneumococcal vaccination among hospitalized patients eligible for vaccination. The authors abstracted 1476 randomly sampled patient charts to compare vaccination before (2002) or after (2003) implementation of vaccination policies in 4 Michigan hospitals. In addition, they assessed completeness of vaccine assessment forms, evaluated reasons for nonvaccination, and conducted interviews with hospital staff. Vaccination increased at 3 of 4 hospitals after implementation of vaccination policies, yet rates remained low (<10% overall; range, 3.4%-12.4%). Vaccine assessment forms were found in most of the charts in 2003, but almost a third were incomplete. Challenges to implementing inpatient vaccination included support and training of hospital staff, interpretation of vaccination recommendations, lack of systematic prompts for vaccinations, and cost reimbursement. These findings underscore the need for continuous quality improvement and process monitoring to determine strategies for overcoming challenges to inpatient vaccination.
本研究是对符合接种条件的住院患者流感和肺炎球菌疫苗接种情况进行的一项回顾性、干预前和干预后评估。作者抽取了1476份随机抽样的患者病历，以比较密歇根州4家医院在实施疫苗接种政策之前（2002年）和之后（2003年）的疫苗接种情况。此外，他们评估了疫苗评估表的完整性，分析了未接种疫苗的原因，并与医院工作人员进行了访谈。在实施疫苗接种政策后，4家医院中有3家的疫苗接种率有所提高，但总体接种率仍然较低（总体<10%；范围为3.4%-12.4%）。2003年，大多数病历中都有疫苗评估表，但几乎三分之一不完整。实施住院患者疫苗接种面临的挑战包括医院工作人员的支持与培训、疫苗接种建议的解读、缺乏系统性的疫苗接种提示以及费用报销。这些发现强调了持续质量改进和流程监测的必要性，以确定克服住院患者疫苗接种挑战的策略。
