BACKGROUND:
Failure to vaccinate hospitalized patients is a missed opportunity that places them at risk for preventable adverse events associated with influenza and pneumococcal disease. CMS and the JCAHO have adopted influenza and pneumococcal vaccination of inpatients with pneumonia as measures of hospital quality.

OBJECTIVE:
To evaluate trends in vaccination of Medicare inpatients with pneumonia.

METHOD:
Systematic national random samples (baseline and quarterly) of medical records were reviewed by CMS-contracted clinical data abstraction centers using computerized data collection tools with explicit pre-defined criteria. Questions related to influenza vaccination were limited to the charts of patients discharged during the months of October through February. Patients were included in this analysis if they were 65 years or older (50 years or older for influenza vaccine), were discharged alive, were not transferred to another hospital, and did not leave the hospital against medical advice. Patients were included in the numerator of the vaccination measures if there was documentation of previous vaccination, contraindication to vaccination, refusal of vaccine, or if the vaccine was administered during hospitalization.

RESULT:
At baseline (July 1, 2000 through March 31, 2001), 2655/19241 (13.8%) of discharged patients had received or had documentation of influenza vaccination refusal or contraindication, and 4119/24978 (16.5%) had received or had documentation of pneumococcal vaccination refusal or contraindication. On remeasurement (January 1, 2004 through March 31, 2004) there were significant increases in performance on each of these measures [influenza, 1144/2674 (42.8%), P < 0.001; pneumococcal 1538/3772 (40.8%), P < 0.001].

CONCLUSION:
Targeted efforts to measure performance and promote quality improvement on hospital-based vaccination measures have resulted in significant improvements in rates of vaccination in this setting. However, there are still many missed opportunities to vaccinate Medicare inpatients.

LEARNING OBJECTIVES:
To understand current trends in hospital-based adult vaccination.