Characteristics of long-term-care facility residents associated with receipt of influenza and pneumococcal vaccinations.
ABSTRACT Studies have found residency in long-term-care facilities (LTCFs) a risk factor for influenza and pneumonia and have demonstrated that vaccinations against these diseases reduce the risk of disease. However, rates are below Healthy People 2010 goals of 90% for LTCFs. During 1999-2002, a multi-state demonstration project was conducted in LTCFs to implement standing orders programs for immunizations.
Identify nursing home resident-specific characteristics associated with vaccination coverage at baseline.
Facility-level data were collected from self-reported surveys of selected nursing homes in 14 states and from the On-line Survey and Certification Reporting System. Resident-level data, including demographics and physical functioning, were obtained from the Centers for Medicare & Medicaid Services' Minimum Data Set; 2000-2001 vaccination status was obtained by chart review. Influenza vaccination status reflected a single season, whereas pneumococcal vaccination status reflected vaccination in the past. Multilevel analysis was used to control for facility-level variation.
Of 22,188 residents sampled in 249 LTCFs, complete data were obtained for 20,516 (92%). The average coverage for immunizations was 58.5% +/- 0.7% for influenza and 34.6% +/- 0.3% for pneumococcal. On bivariate analyses, residents with cognitive, psychiatric, or neurologic problems were more likely to be vaccinated; those with accidental injuries, unstable conditions, or cancer were less likely to receive either vaccine. On multilevel analysis, the strongest resident characteristics associated with receipt of immunizations, controlling facility variation, were cognitive deficits and psychiatric illness.
The variation in baseline vaccination coverage associated with LTCF resident characteristics supports the need for strategies to increase vaccination coverage in LTCFs.
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ABSTRACT: Nationwide among nursing home residents, receipt of the influenza vaccine is 8 to 9 percentage points lower among blacks than among whites. The objective of this study was to determine if the national inequity in vaccination is because of the characteristics of facilities and/or residents. Cross-sectional study with multilevel modeling. States in which 1% or more of nursing home residents were black and the difference in influenza vaccination coverage between white and black nursing home residents was 1 percentage point or higher (n = 39 states and the District of Columbia). Data on residents (n = 2,359,321) were obtained from the Centers for Medicare & Medicaid Service's Minimum Data Set for October 1, 2008, through March 31, 2009. Residents' influenza vaccination status (vaccinated, refused vaccine, or not offered vaccination). States with higher overall influenza vaccination coverage among nursing home residents had smaller racial inequities. In nursing homes with higher proportions of black residents, vaccination coverage was lower for both blacks and whites. The most dramatic inequities existed between whites in nursing homes with 0% blacks (L1) and blacks in nursing homes with 50% or more blacks (L5) in states with overall racial inequities of 10 percentage points or more. In these states, more black nursing home residents lived in nursing homes with 50% or more blacks (L5); in general, the same homes with low overall coverage. Inequities in influenza vaccination coverage among nursing home residents are largely because of low vaccination coverage in nursing homes with a high proportion of black residents. Findings indicate that implementation of culturally appropriate interventions to increase vaccination in facilities with larger proportions of black residents may reduce the racial gap in influenza vaccination as well as increase overall state-level vaccination.Journal of the American Medical Directors Association 03/2012; 13(5):470-6. · 5.30 Impact Factor
Conference Paper: Multiple self-alignment MOS technology (MUSA/MOST)[Show abstract] [Hide abstract]
ABSTRACT: Multiple self-alignment MOS technology, MUSA/MOST, has been developed to achieve higher packing density and higher performance for Si MOSFETs. The minimum mask feature of 1.5 µm allows fabrication of a 0.5 µm channel length FET in an active device area as narrow as 3.5 µm. This significantly reduces parasitic capacitances and increases device packing density. Metal and metal-silicide can be employed to form the gate and source/drain electrodes, respectively, resulting in reduction of VLSI circuit wiring-delays. The fabricated ring oscillator with enhancement drivers and depletion loads of MUSA/MOSTs exhibited a propagation delay of 540 ps/stage under the 2 µm design rule.Electron Devices Meeting, 1984 International; 02/1984
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ABSTRACT: PURPOSE: To examine accreditation from nursing homes accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and whether this is associated with improved rehabilitation care. DESIGN: Cross-sectional association of CARF accreditation and quality. METHODS: Comparison of the short-stay quality measures (influenza and pneumococcal vaccination; pain; delirium; pressures sores; five-star quality and health inspection scores) between the sample of 246 CARF-accredited homes compared with the 15,393 nursing homes in the 2010 On-Line Survey Certification of Automated Records (OSCAR). FINDINGS: CARF-accredited nursing homes demonstrate better quality with regard to the short-stay quality measures. CONCLUSIONS: Approaches beyond traditional regulation and governmental inspections are necessary to improve the quality of care in nursing homes. CLINICAL RELEVANCE: During a patient's rehabilitation stay, minimizing iatrogenic complications is paramount. Given the findings of this study, it is unfortunate that very few nursing homes are CARF accredited.Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 05/2013; · 0.85 Impact Factor