Influential Authorities for Vaccination Policies and Barriers to Implementing Standing Orders for Influenza Vaccination among Nursing Facilities in 14 States, 2000-2002.
American Journal of Theoretical and Applied Statistics
Volume 1, Issue 1, December 2012, Pages: 1-11
Received: Nov. 18, 2012;
Published: Dec. 30, 2012
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Barbara Bardenheier, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA,USA
Abigail Shefer, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA,USA
Stefan Gravenstein, Quality Partners of Rhode Island and Brown University, Providence, RI, USA
Carolyn Furlow, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA,USA
Carol J. Rowland Hogue, Emory University, Atlanta, GA, USA
To assess barriers to implementing standing order protocols (SOP) for vaccinations and influential authorities in making vaccination decisionswith the proportion of black residents, and vaccination coverage in nursing homes. The Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention in 2000-2002 surveyed approximately 280 nursing homes in14 states. Data from the On-line Survey and Certification Reporting System were included. A demonstration project to adopt SOPs for vaccination and to assess barriers. Factor analysis and structural equation models were used to assess relationships ofbarriers and influential authorities to implementing SOPs. External facility concerns are barriers to implementing SOPs (p=.031), and nursing homes with higher proportions of black residents are more likely to report those concerns. The medical director and the facility administrator are the most influential authorities determining whether SOPs are implemented. The Quality Improvement Organization (QIO) and the state certification sur-veyor also played important roles in influencing staff making vaccination decisions. The state’s QIO and the state certification surveyor may play important roles in addressingconcerns about staff’s authority to vaccinate under SOPs.Barriers external to the nursing home may play a more important role than internal facility barriers.
Carol J. Rowland Hogue,
Influential Authorities for Vaccination Policies and Barriers to Implementing Standing Orders for Influenza Vaccination among Nursing Facilities in 14 States, 2000-2002., American Journal of Theoretical and Applied Statistics.
Vol. 1, No. 1,
2012, pp. 1-11.
Bardenheier B, Wortley PM, Ahmed F, Shefer A, Hales C. Influenza immunization coverage among residents of long-term care facilities certified by CMS, 2005-2006: The newest MDS quality indicator. Journal of the American Medical Directors Association 2010;11:59-69.
Bardenheier B, Wortley PM, Shefer A. Influenza vaccine among African-American and white nursing home residents: Is there a gap? J Am Geriatr Soc 2009;57:2164-5.
Mor V, Zinn J, Angelelli J, Teno JM, Miller SC. Driven to tiers: socioeconomic and racial disparities in the quality of nursing home care. Milbank Q 2004;82:227-56.
Bardenheier B, Wortley PM, Ahmed F, Gravenstein S, Hogue CR. Racial inequities in receipt of influenza vaccination among long-term care residents within and between facilities in Michigan. Med Care 2011;49:371-7.
Use of Standing Orders Programs to Increase Adult Vaccination Rates. MMWR Morb Mortal Wkly Rep 2000 Mar 24;49(RR-1):15-26.
Recommendations regarding interventions to improve vaccination coverage in children, adolescents, and adults. Task Force on Community Preventive Services. Am J Prev Med 2000 Jan;18(1 Suppl):92-6.
The Community Preventative Services Task Force. Universally Recommended Vaccinations: Community-Based Interventions Implemented in Combination. The Community Preventive Services Task Force 2012 April 10.
Bardenheier B, Shefer A, Lu P, Remsburg R, Marsteller J. Are standing order programs associated with influenza vaccination? – NNHS, 2004. J Am Med Dir Assoc 2010;11:654-61.
Shefer A, McKibben L, Bardenheier B, Bratzler D, Roberts H. Characteristics of long-term care facilities associated with standing order programs to deliver influenza and pneumococcal vaccinations to residents in 13 states. J Am Med Dir Assoc 2005;6:97-104.
Bardenheier B, Shefer A, Ahmed A, Remsburg R, Hogue CR, Gravenstein S. Do racial inequities in receipt of influenza vaccination among nursing home residents narrow if facility vaccination policies exist? Results of the National Nursing Home Survey, 2004. J Am Geriatr Soc 2011;59:687-93.
Bardenheier BH, Shefer A, McKibben L, Roberts H, Rhew D, Bratzler D. Factors Predictive of Increased Influenza and Pneumococcal Vaccination Coverage in Long-term Care Facilities: The CMS-CDC Standing Orders Program Project. J Am Med Dir Assoc 2005;6:291-9.
Centers for Medicare & Medicaid Services. State Operations Manual. Baltimore, MD: Appendix Q 42. CFR 483.25 Quality of Care; 1999.
Institute of Medicine. Improving the quality of long-term care. Washington D.C.: National Academy Press; 2001.
Principles and practice of structural equation modeling. 3rd ed. New York, NY: The Guilford Press; 2010.
Huba GJ, Harlow LL. Robust Structural Equation Models: Implications for developmental psychology. Child Development 1987;58:147-66.
Muthén BO, du Toit S, Spisic D. Robust inference using weighted least squares and quadratic estimating equations in latent variable modeling with categorical and continuous outcomes. University of California LA, editor. 1997.
Yu C, Muthén BO. Evaluation of model fit indices for latent variable models with categorical and continuous outcomes. New Orleans, LA: American Educational Research Association; 2002.
U.S.Department of Health and Human Services. National Vaccine Injury Compensation Program (VICP). Health Resources and Services Administration 2011 [cited 2011 Feb. 4] ; Available from: URL: http://www.hrsa.gov/vaccinecompensation/index.html.
Devore E NSDL. State Policies, Laws and Regulations Governing Immunizations in Long-Term Care Facilities. National Conference of State Legislatures; 2001.
Centers for Medicare & Medicaid Services. Medicare and Medicaid Programs; Conditions of Participation:Immunization Standards for Hospitals,Long-Term Care Facilities, and Home Health Agencies. Federal Register 2002;67:61808-14.
Loehlin JC. Latent Variable Models: An introduction to factor, path, and structural equation analysis. 4th ed. Mahwah, NJ: Lawrence Erlbaum Associates; 2004.