KEYWORDS:
immunization, pnuemonia, influenza, elderly, hospital, regulation

BACKGROUND:
Influenza and pneumonia are major causes of vaccine-preventable death among the elderly. In an effort to raise immunization rates, New Jersey passed a regulation requiring hospitals to offer pneumonia and influenza vaccinations to all inpatients aged 65 and over.

OBJECTIVE(S):
A CDC-funded evaluation of this regulation has two major compponents; an implementation evaluation and an impact analysis. The overall goal is to see whether the immunization regulation results in a population change in immunization rates, and if "best practices" can be identified from successful hospitals.

METHOD(S):
As part of the implementation evaluation, hospitals were surveyed about their organizational structure, barriers and perceived success in complying with the regulation. This will allow a hospital level analysis of the relationship between patient and hospital characteristics and immunization practices. A chart review, currently underway, will permit an individual-level analysis with controls for patient characteristics.

RESULT(S):
Results from the survey of infection control practitioners suggests that perceived success in compliance with the regulation is low. Multivariate analysis reveals that the major determinant of perceived success is whether or not doctors are believed to agree with the scope and nature of the reglulation.

CONCLUSIONS(S):
While the hospital may seem to present a "missed opportunity" for vaccination of the elderly, initial results from the experience in New Jersey suggest that increasing immunization rates is not simple. It would appear that doctors have major objections to a regulation mandating they offer vaccinations.

LEARNING OBJECTIVES:
Some type of educational outreach to doctors may be beneficial; perhaps the state should explore some other immunization policies.