Outcome measures

® Vaccines are a cost-effective means for disease prevention. For every dollar spent on routine childhood vaccines there will be a savings of $0.90 to $24.00 in direct medical expense. The rates of vaccination for children are well over 90%. This has been attributed to the requirements for proof of vaccination by states for enrollment into day care centers and school. Additionally, children (18 years of age or younger) may receive routine vaccinations free of charge through state health departments or other assistance programs, such as the national Vaccines for Children program. Many states have developed universal immunization databases to document pediatric and adult vaccination status. This eliminates the problems of lost immunization records if a child changes health care providers.

The vaccination rate in adults is much lower than that in children. Only 50% to 60% of adults who meet criteria have received pneumococcal or influenza vaccination. Comprehensive initiatives need to be implemented to increase the adult vaccination rate. Some proven concepts are providing reminders to patients that vaccines are due and implementation of standing orders for vaccines. This latter concept allows nurses and pharmacists to screen patients to see if pneumococcal, influenza, or other vaccines are needed and to vaccinate without a physician's order.

The Centers for Medicare and Medicaid Services has incorporated pneumococcal and influenza immunization rates into some of their quality standards. Patients admitted to a hospital for community-acquired pneumonia should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines prior to discharge if not previously administered. In physicians' office practice, all persons over 65 years of age who have been hospitalized in the past year should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines if not previously administered. Both of these standards will affect payment if the standard is not met. The Joint Commission has also incorporated these standards into their accreditation reviews of health care facilities.

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