ACHIEVING THE GOAL: PNEUMOCOCCAL VACCINATION
R.Anjum, MD. S.Ali, MD. R.Ciubotaru, MD. J.Hellerman, MD: St Barnabas Hospital
BACKGROUND
Pneumonia caused by Pneumoccoccus is one of the most common cause of Community acquired pneumonia with an estimation of 500,000 cases per year and accounts for approximately 40,000 deaths in the United States. Pneumococcal
vaccination is found to be 75% effective in immunocompetent persons aged greater than or equal to 65 years and even in adults in low risk groups (1). In May 2001, the Joint Commission (JCAHO) announced the four initial core
measurement areas for hospitals, which were acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), and pregnancy and related conditions (PR). Simultaneously the Joint Commission worked with the Centers for Medicare &
Medicaid Services (CMS) on the AMI, HF and PN to align the measure specifications for Joint Commission accredited hospitals that began collecting these measures for patient discharges beginning July 1, 2002.
PNEUMONIA: QUALITY CORE MEASURE
AND DATA COLLECTION:
Pneumonia Core Measures: Pneumococcal vaccination is indicated for
persons 65 years of age and older, because it is up to 75% effective in
preventing pneumococcal bacteremia and meningitis.
St Barnabas Hospital has been strictly following the guidelines set forth
by the JCAHO/CMS and has achieved 100% performance rate.
Method Of Collecting Data Set by the JCAHO/CMS2:
PERFORMANCE OF ST BARNABAS HOSPITAL OVER A PERIOD OF ONE YEAR.
After fulfilling the criteria for inclusion there were 136 patients that were
admitted in the hospital from period January 2005 until now. Eighty Five (85%
116/135) were immunized before discharge.
The percentage of immunization has markedly increased from 32% in 2004
to 100% in 2006. With the help of multiple lecture series on importance of
immunization by the medical chief resident, orientation to the new intern and
by appointing the Floor captain the frequency of immunization has shown
marked improvement.
The recent data published by the Hospital Quality Alliance for period Second
Quarter 2005 through First Quarter 2006 has shown 92% of 83 patients above
age 65 received pneumococcal vaccination before discharge. This is compared
with the 66% state average and 64% national average
Inclusion Criteria/Populations: Discharges who met the following.
• Who were age 65 years and older
• With an ICD-9-CM Principal Diagnosis Code of pneumonia:
Exclusion Criteria/Populations:
• Patients who had no working diagnosis of pneumonia at the
time of admission
• Patients receiving Comfort Measures Only
• Patients who expired in the hospital
• Patients who left against medical advice (AMA)
• Patients who were discharged to hospice care
• Patients who were transferred to another short term general
hospital for inpatient care
• Patients who were discharged to a federal hospital
• Patients less than 65 years of age
• Patients who had no chest x-ray or CT scan that indicated
positive infiltrate within 24 hours prior to hospital arrival or
anytime during this hospitalization
CONCLUSION
% Pneumonia Vaccination: Numerator / Denominator
Numerator: Pneumonia inpatients who were screened for pneumococcal
vaccine status and were administered the vaccine prior to discharge, if
indicated
St Barnabas hospital has excelled in performing and following all the quality core
measures in improving the quality of health. The achievement of goal in
pneumococcal vaccination can be achieved by continuous feedback of the
medical residents.
Denominator: Pneumonia patients age 65 and older
SBH Hospital Performance Pneumococcal Vaccination Reporting period: 4th QTR 2004 through 2nd QTR 2006
REFERENCES
1. Fine MJ, Smith MA, Carson CA, et al. Efficacy of pneumococcal vaccination in adults: a meta-analysis of randomized
controlled trials. Arch Intern Med 1994;154:2666-77.
2. Joint Commission of Accreditation of Health Care Organization (JCAHO)