BACKGROUND:
Standing order programs (SOPs) are effective interventions in which nurses or pharmacists are authorized to vaccinate by institution-approved protocol without a physician order. During 1999-2002, a demonstration project was conducted in long-term care facilities (LTCFs) that involved promotion of SOPs for influenza and pneumococcal vaccination by the CMS Quality Improvement Organizations (QIO).

OBJECTIVE:
To evaluate impact of QIO promotion on adoption of SOPs in LTCFs and to describe characteristics of LTCFs associated with adoption of SOPs.

METHOD:
A controlled before-and-after study was conducted in 13 states (8 intervention and 5 control). Information about Medicare or Medicaid-certified LTCFs’ vaccination programs in each state were collected at baseline (June 1999) and post-intervention (March 2001). Intervention strategies employed by QIOs included state-wide conferences, distribution of educational materials, and on-site visits. Data from the surveys were linked to OSCAR, an administrative database containing information on LTCFs.

RESULT:
Of 3,861 LTCFs at baseline, 2,862 (74%) had complete pre and post survey and OSCAR data (n=1353 intervention; n=1509 control). At baseline, <10% of facilities used SOPs for either vaccine. At post-intervention, 110 (8.1%) additional LTCFs in the intervention states adopted influenza SOPs compared to 102 (6.7%) in the control states (ns); for pneumococcal SOPs, the change was 7.8% in the intervention compared to 5.3% in the control states (p<.05). In a regression model, the characteristics significantly associated with adopting SOPs for influenza were lack of a consistent place in the medical record to document influenza vaccination and having a greater proportion of Medicaid-payer residents; and for adopting pneumococcal SOPs, the only significant factor was being an LTCF located in an intervention state.

CONCLUSION:
Despite few changes overall, state QIOs did appear to positively impact SOP adoption for pneumococcal vaccination. Factors other than the intervention appeared to play a more important role in decisions to adopt SOPs for influenza vaccination in this study. More research is needed to identify other strategies to further promote SOPs for vaccinating resident populations in LTCFs nationally

LEARNING OBJECTIVES:
To understand factors associated with adoption of SOPs in LTCFs in the U.S.