Session number: 1043
Abstract title: Increasing Influenza Vaccinations in the VA SCI&D Population
Author(s):
F Weaver - Midwest Center for Health Services & Policy Research, Hines VA Hospital, Hines, Il
B Goldstein - VA Puget Sound Healthcare System, Seattle, WA
MW Legro - VA Puget Sound Healthcare System, Seattle, WA
CT Evans - Midwest Center for Health Services & Policy Research, Hines VA Hospital, Hines, Il
S LaVela - Midwest Center for Health Services & Policy Research, Hines VA Hospital, Hines, Il
B Smith - Midwest Center for Health Services & Policy Research, Hines VA Hospital, Hines, Il
S Miskevics - Midwest Center for Health Services & Policy Research, Hines VA Hospital, Hines, Il
Objectives: The most frequent causes of mortality in persons with spinal cord injury and disorder (SCI&D) are due to respiratory complications. One report found that persons with SCI&D who contracted influenza or pneumonia were 37 times more likely to die than comparable individuals from the general population. Using EPRP data, rates of vaccination for influenza in the veteran SCI&D population appear to be low averaging 13% to 26% (FY1996-1998). The goal of the current pilot project was to increase vaccination rates for persons with SCI&D. A secondary objective was to assess the effect of increased vaccination rates on respiratory-related illness.
Methods: Eight VA SCI Centers (n=2,425 current patients) served as either intervention sites (n=4) or matched comparison sites (n=4). Comparison sites continued their usual vaccine practices while intervention sites implemented multiple strategies: reminder letters and tailored educational materials for patients and SCI&D providers, and identification of a local vaccine champion. Posters were sent to intervention sites as a further reminder.
Results: Vaccination rates were measured using patient surveys completed by 73% of currently served patients at the 8 sites. A greater proportion of patients from the intervention sites received an influenza vaccine compared with patients from the comparison sites (61.7% vs. 56.2%, n=1740; p=0.0213). Rates were higher for patients 65 and older compared to patients less than 65 (73.7% vs 50.7%; p<0.0001). The number of hospitalizations at the 8 sites for respiratory-related illnesses during the FY2001 influenza season were insufficient to determine the impact of higher vaccination rates on utilization.
Conclusions: Using only these strategies, with known small to moderate effect sizes (i.e., mailed reminders, education), the patients at the sites using these interventions had significantly higher vaccination rates than comparison sites.
Impact statement: In addition to the strategies used in this pilot project, two system-based interventions, standing orders and computerized clinical reminders, are currently under investigation to increase vaccination rates. These interventions have had significant effects in other settings and will be implemented at VA SCI Centers. The VA goal for annual influenza vaccination rates is 72%.