A Statewide System for Improving Influenza Vaccination Rates in Hospital Employees

Abstract

OBJECTIVE To describe and report the progress of a provider-initiated approach to increase influenza immunization rates for healthcare workers. DESIGN Observational study. SETTING The State of Iowa. SUBJECTS Acute care hospitals in Iowa. METHODS Hospitals reported rates of employee influenza vaccination to a provider-based collaborative during 2 influenza seasons (2006–2007 and 2007–2008). Hospital characteristics related to higher vaccination rates were examined. RESULTS One hundred (87.0%) of 115 Iowa hospitals and/or health systems participated in season 1; individual hospital vaccination rates ranged from 43.5% to 99.2% (mean, 72.4%; median, 73.1%). In season 2, 115 (100%) of 115 Iowa hospitals and/or health systems participated. Individual hospital vaccination rates ranged from 53.6% to 100% (mean, 79.5%; median, 82.0%). In both seasons, urban and large hospitals had vaccination rates that were 6.3% to 7.6% lower than those of hospitals in other locations. Hospitals that used declination statements had influenza vaccination rates 12.6% higher than hospitals that did not use declination statements in season 2. CONCLUSION The initial vaccination rates were high for healthcare workers in Iowa, especially in smaller rural hospitals, and rates increased during season 2. The successful voluntary approach for reporting influenza vaccination rates that we describe provides an efficient platform for collecting and disseminating other statewide measures of healthcare quality.

Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel

“…43,44 A strategy involving shared disclosure of vaccination rates has been successful in Iowa, in which a voluntary collaborative involving all 115 acute care hospitals in the state reported institution-specific vaccination rates and strategies used to improve those rates to all member facilities. 45 Although these data were not reported to the general public, this program led to median vaccination rates of 82% in the second year of the program. Coupling such reporting with vaccination mandates would serve to drive these rates even higher.…”

Web-Based Electronic Health Records Improve Data Completeness and Reduce Medical Discrepancies in Employee Vaccination Programs

“…Despite initial concerns that the convenience of an EHR would lead to a high rate of declinations, we observed a voluntary vaccination rate of 77%, which far exceeded national and state averages for healthcare worker vaccination during the 2009 H1N1 influenza pandemic. 6,7 Although causality cannot be proven, the high voluntary vaccination rate may be related to the design and order of the electronic declination form, which prompted users through a series of questions regarding their reasons for declination, educated them on the importance of healthcare worker vaccination, and allowed them to change their minds before submitting the declination form.…”

“…The H1N1 pandemic of 2009 highlighted the need for improved efficiency in immunizing large numbers of healthcare workers and providing documentation that each employee had received or declined vaccination. 5,6 Although research suggests that the use of declination forms improves vaccination rates among healthcare workers, the usefulness of declination forms in an electronic format has been little explored. 7,8 Additionally, little is known about the impact of EHRs on vaccination errors or data quality.…”

Mandate to Protect Patients from Health Care–Associated Influenza

“…In a survey of 22 hospitals, Polgreen [19] found that implementation of declination policies increased coverage by a mean of 11.6%. Other studies have shown an association between a hospital's use of declination forms and higher influenza vaccine coverage, but a causal relationship could not be demonstrated with the cross-sectional design [20].…”