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QIO HHQI Weekly Update :: February 4, 2008   

TIP OF THE WEEK

Vaccinations

Influenza virus infections cause substantial morbidity in all age groups, but it is at the extremes of the age spectrum that infection becomes the most deadly. Although persons over age 65 years comprise only 10 percent of the population, at least 63 percent of the 300,000 annual influenza-related hospitalizations and 85 percent of the 36,000 yearly deaths in the United States occur in this age group.1 In the elderly, the presence of chronic disease contributes significantly to influenza-associated mortality; a single, underlying chronic medical condition increases risk by 39-fold. Cardiac and pulmonary diseases are considered the most important risk factors, and when both are present, a 100-fold increase in death rate has been observed.2

Pneumococcus is the leading cause of serious community-acquired infections. The frequency of invasive pneumococcal disease is highest among children younger than 2 years and the elderly (= 65 yrs). Together, these two patient groups account for about 53 percent of cases in the United States.3 In addition, the elderly have the highest risk of death due to invasive pneumococcal disease; over half (56 percent) of all deaths occurred in persons 65 years or older.4 The significant burden of pneumococcal disease and the recent emergence and continual rising prevalence of drug-resistant pneumococci5 emphasize the importance of disease prevention.

Below are the most current recommendations for adult influenza and pneumococcal immunization from the Advisory Committee on Immunization Practices (ACIP):6

INFLUENZA -- TRIVALENT INACTIVATED INFLUENZA VACCINE (TIV)

An annual, seasonal vaccine given between October and February to prevent complications of influenza is recommended for:

  • Persons wanting to reduce the likelihood of becoming ill with influenza
  • Persons age 50 years and older
  • Persons with chronic or long-term medical problems, including those which affect the ability of the respiratory system to adequately handle increased secretions
  • Long-term care facility residents
  • Persons working or living with at-risk people
  • Women who will be pregnant during the influenza season (December–March)
  • All healthcare personnel and other persons who provide direct care to at-risk people
  • Household contacts and out-of-home caregivers of children age 0–5 years
  • Travelers who go to areas where influenza activity exists or who may be among people from areas of the world where there is current influenza activity (e.g., on organized tours)
  • Students or other persons in institutional settings (e.g., dormitory residents)

Other considerations:

  • Continue to give vaccine to unvaccinated adults throughout the influenza season (including when influenza activity is present in the community) and at other times when the risk of influenza exists
  • Contraindication: previous anaphylactic reaction to this vaccine, to any of its components, or to eggs
  • Precautions: moderate or severe acute illness, or history of Guillain-Barré syndrome (GBS) within six weeks of previous immunization

PNEUMOCOCCAL POLYSACCHARIDE (PPV)

Routinely given as a one-time dose; given if previous vaccination history is unknown; one-time revaccination is recommended five years later for persons at highest risk of fatal pneumococcal infection or rapid antibody loss (e.g., renal disease) and for persons age 65 years and older if the first dose was given prior to age 65 and five years or more have elapsed since the previous dose. Recommended for:

  • Persons age 65 years and older
  • Persons with chronic illness, those who are immunocompromised, or those with other risk factors

Other considerations:

  • Contraindication: previous anaphylactic reaction to this vaccine
  • Precautions: moderate or severe acute illness

PROVIDER-BASED STRATEGIES7

Practice-based tracking systems assist providers in identifying the total number of their patients who are at risk and maintain rosters showing the proportion of patients who receive vaccination. Physicians using such a tracking system have administered 30 percent more influenza vaccinations than those not using the system.8

Physician reminder systems may consist of charts, computers, or preventive-health checklists that remind practitioners to review the need for pneumococcal vaccine for each patient and to administer the vaccine to those at risk for pneumococcal disease. The use of preventive-health checklists has increased pneumococcal vaccination rates fourfold9 in one study and from 5 percent to 4210 percent in another.11 In one hospital, implementation of a computer reminder system that prompted physicians to review pneumococcal vaccination status before discharge increased pneumococcal vaccination rates from less than 4 percent to 45 percent.12

WHY ARE IMMUNIZATIONS IMPORTANT AND HOW DO THEY RELATE TO REDUCING ACUTE CARE HOSPITALIZATIONS?

Healthy People 2010, a coalition of national organizations, created a statement of national health objectives designed to identify the most significant preventable threats to health and established national goals to reduce these threats, including a 90 percent rate of influenza and pneumococcal immunization for all patients.

Influenza immunization is also a recommendation of the National Strategy for Pandemic Influenza Plan. Please see www.pandemicflu.gov.13

Other immunizations are recommended by the Centers for Disease Control and Prevention (CDC), including a tetanus,diphtheria, pertussis (Td or Tdap) booster every 10 years, a measles,mumps,rubella (MMR) booster depending on each individual’s risk-factors, two doses of varicella (chicken pox) vaccine if the individual has no previous immunization or acquired immunity through previous infection, hepatitis A (HAV), hepatitis B (HBV), and meningococcal (MPSV4) vaccine depending on each individual’s risk-factors, and one dose of herpes zoster vaccine, regardless of risk-factors or previous infection.

Immunizations may be given by the home health agency with a doctor’s order or specific standing order. Patients should also be encouraged to request the vaccines from their primary care or other physicians if it is unavailable to the agency, or they should be referred to community immunization clinics. It is important to keep proof of immunization to be shared with all healthcare providers the patient may come into contact with.

Sources:

1 Centers for Disease Control and Prevention (CDC). Prevention and control of influenza: recommendations of the Advisory Committee of Immunization Practices. MMWR. 2006;55:1-48.
2 Barker WH, Mullooly JP. Impact of epidemic A influenza in a defined adult population. Am J Epidemiol. 1980;112:798-811.
3 Robinson KA, Baughman W, Rothrock G, et al. Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995-1998: opportunities for prevention in the conjugate vaccine era. JAMA 2001;285:1729-35.
4 Ibid.
5 Doern GV, Heilmann KP, Huynh HK, et al. Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in the United States during 1999-2000, including a comparison of resistance rates since 1994-1995. Antimicrob Agents Chemother 2001;45:1721-9.
6 http://www.cdc.gov/mmwr/pdf/wk/mm5641-Immunization.pdf. Accessed January 31, 2008.
7 http://www.cdc.gov/mmwr/preview/mmwrhtml/00047135.htm. Accessed January 31, 2008.
8 Buffington J, Bell KM, LaForce FM, et al. A target-based model for increasing influenza immunizations in private practice. J Gen Intern Med 1991;6:204-9.
9 Cheney C, Ramsdell JW. Effect of medical records' checklists on implementation of periodic health measures. Am J Med 1987;83:129-36.
10 Cohen DI, Littenberg B, Wetzel C, Neuhauser D. Improving physician compliance with preventive medicine guidelines. Med Care 1982;20:1040-5.
11 Clancy CM, Gelfman D, Poses RM. A strategy to improve the utilization of pneumococcal vaccine. J Gen Intern Med 1992;7:14-8.
12 Home Health Quality Improvement National Campaign Immunization Best Practice Intervention Practice, Sept 2007, http://www/homehealthquality.org/shared/content/hhqi_campaign/bpip_immuz/immunization%20BPIP %20bbk%209.10.07.pdf; Accessed January 31, 2008.
13 http://www.cdc.gov/mmwr/pdf/wk/mm5641-Immunization.pdf. Accessed January 31, 2008.

 

RESOURCE SPOTLIGHT

Patient Safety Cards
MedQIC.org -- This set of cards can be used to train staff, caregivers, and patients on the basics of home safety. The cards describe common hazards around the patient's home and ways to make the home safer. The message about safety is specific and clear.

 

IN THE NEWS

MARCH 1, 2008 -- INDUSTRY-WIDE ENFORCEMENT OF THE NPI COMPLIANCE DATE

January 24, 2008 -- CMS -- Medicare claims without an National Provider Identifier (NPI) number in the primary provider field will be rejected beginning March 1, 2008. If you haven’t already, test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI. If the claims reject, call your Medicare carrier or A/B MAC enrollment staff. Read more >>

THE GROWING BURDEN OF DIABETES MELLITUS IN THE US ELDERLY POPULATION

January 28, 2008 -- Frank A. Sloan, M. Angelyn Bethel, David Ruiz, Jr, Alisa H. Shea, and Mark N. Feinglos Arch Intern Med. 2008;168(2):192-199. Read more >>

POSTING OF THE UPDATED/CORRECTED GROUPER LOGIC/PSEUDO CODE FOR THE HH PPS

January 29, 2008 -- CMS -- On December 18, 2007, the Centers for Medicare & Medicaid Services (CMS) alerted the public that revisions to the HH PPS Grouper were pending. As a follow-up to that announcement, CMS is providing revised final documentation (grouper logic/pseudocode, associated tables, readme file, a summary document of pseudocode and software changes, and test cases) to the Home Health Case Mix Grouper Software and Documentation web page for the home health payment regulation effective January 1, 2008. These materials replace those posted on November 16, 2007. The grouper software (.dll) will be forthcoming. View posting/download file >>

 

INDUSTRY EVENTS

Quality Basics for Providers
A national teleconference sponsored by the Process Improvement QIO Support Center.
Tuesday February 12, 2008, 12:00 to 1:30 PM
E-mail piqiosc@waqio.sdps.org for more information.
Space is limited. Register now >>

Upcoming Education from the Ohio Council for Home Care:

 

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