Fedson D S, Harward M P, Reid R A, Kaiser D L
Department of Medicine, University of Virginia School of Medicine, Charlottesville.
JAMA. 1990 Sep 5;264(9):1117-22.
To explore the potential usefulness of a strategy of hospital-based pneumococcal immunization, we studied a population-based linked record of hospital discharges for Medicare enrollees living in the Shenandoah region of Virginia. A retrospective study of 1633 persons discharged with pneumonia in 1983 showed that 61% to 62% had been discharged within the previous 4 years. Among these patients, 87% had had one or more high-risk conditions recognized during previous hospital admissions. A cohort study demonstrated that discharged patients had a 6% to 9% probability of readmission with pneumonia within 5 years. Each such readmission could be prevented by immunizing few (approximately 100) discharged patients with pneumococcal vaccine. Furthermore, the costs of vaccination would be approximately one-third the costs of hospital care for unvaccinated discharged patients readmitted with pneumonia. These results provide an epidemiologic rationale for current recommendations that elderly patients discharged from hospitals should be immunized with pneumococcal vaccine.
为了探究基于医院的肺炎球菌免疫策略的潜在效用，我们研究了弗吉尼亚州谢南多厄地区参加医疗保险的居民基于人群的医院出院关联记录。一项对1983年因肺炎出院的1633人的回顾性研究表明，61%至62%的人在之前4年内曾有过出院记录。在这些患者中，87%在之前住院期间被诊断出有一种或多种高危病症。一项队列研究表明，出院患者在5年内因肺炎再次入院的概率为6%至9%。通过为少数（约100名）出院患者接种肺炎球菌疫苗，每次此类再入院都可以避免。此外，接种疫苗的费用约为因肺炎再次入院的未接种疫苗出院患者住院治疗费用的三分之一。这些结果为目前关于医院出院的老年患者应接种肺炎球菌疫苗的建议提供了流行病学依据。
