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Evaluation of the First Year of National Reporting on a New Healthcare Personnel Influenza Vaccination Performance Measure by US Hospitals

Published online by Cambridge University Press:  17 December 2015

Samantha B. Dolan,
Elizabeth J. Kalayil,
Megan C. Lindley and
Faruque Ahmed
Samantha B. Dolan*
Affiliation:
Centers for Disease Control and Prevention (CDC), Center for Global Health, Global Immunization Division, Atlanta, Georgia
Elizabeth J. Kalayil
Affiliation:
CDC, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GeorgiaCarter Consulting, Atlanta, Georgia
Megan C. Lindley
Affiliation:
CDC, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, Georgia
Faruque Ahmed
Affiliation:
CDC, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Sexually Transmitted Disease Prevention, Atlanta, Georgia.
*
Address correspondence to Samantha B. Dolan, MPH, Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A 04, Atlanta, GA 30333 (uzn7@cdc.gov).
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Abstract

One thousand hospitals were surveyed on a new measure of healthcare personnel influenza vaccination for the 2012–2013 influenza season. Facilities found it easier to collect data on employees than nonemployees; larger facilities reported more challenges than smaller facilities. Barriers may decrease over time as facilities become accustomed to the measure.

Infect. Control Hosp. Epidemiol. 2016;37(2):222–225

Information

Type
Concise Communications
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 2 , February 2016, pp. 222 - 225
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

In 2007, the Joint Commission began requiring hospitals and long-term care facilities to provide annual influenza vaccinations to healthcare personnel (HCP) and to evaluate vaccination coverage as a condition of accreditation. 1 US hospitals have historically lacked uniformity with how HCP influenza vaccination coverage is measured.Reference Lindley, Yonek, Ahmed, Perz and Williams Torres 2 In May 2012, the National Quality Forum endorsed the Centers for Disease Control and Prevention’s (CDC) HCP Influenza Vaccination Measure (NQF 0431), hereafter referred to as “HCP measure.” More than 4,000 acute care hospitals were required to report on the HCP measure starting January 1, 2013, as a part of the Centers for Medicare & Medicaid Services’ Hospital Inpatient Quality Reporting Program.

The HCP measure requires facilities to collect influenza vaccination data for 3 HCP categories: employees, licensed independent practitioners (LIPs), and adult students/trainees and volunteers. For the 2012–2013 influenza season, facilities were required to collect data on the number of vaccinations received inside or outside the facility, medical contraindications, vaccination declinations, and unknown vaccination status, along with the total number of HCP in each category for those working in the facility for 30 days or more from October 1 through March 31. The data were reported through the CDC’s National Healthcare Safety Network (NHSN), a national Internet-based surveillance system for healthcare-associated infections. 3

METHODS

In August 2013, an online questionnaire was used to survey staff collecting data for NHSN at nonfederal acute care hospitals. More than 4,000 facilities were identified through the NHSN enrollment database; 3,315 facilities were included in the final sampling frame stratified by the 4 US Census Bureau Regions and 3 bed-size groups (≤100 beds, 101–300 beds, >300 beds).Reference Kalayil, Dolan, Lindley and Ahmed 4 A simple random sample of 1,000 facilities was selected using the probability-proportional-to-size method without replacement for each stratum. Data collectors at sampled facilities were invited by email to participate in the survey and nonresponders were reminded to complete this via email and telephone. Data were analyzed in SAS, version 9.3 (SAS Institute) and an electronic spreadsheet (Excel; Microsoft). Statistical significance was set at P=.05.

RESULTS

Of the 1,000 facilities surveyed, 68% (n=680) responded; 277 facilities (41%) had 100 or fewer beds, 248 (37%) had 101–300 beds, and 150 (22%) had more than 300 beds. There were 427 facilities (63%) with policies recommending, but not requiring HCP to receive vaccination; 205 facilities (30%) reported mandatory influenza vaccination policies for all HCP. Of responding facilities, most had at least 2 years of experience collecting HCP influenza vaccination data; 508 facilities (75%) made changes to their data collection procedures to facilitate NHSN reporting. Most facilities used paper records to collect HCP vaccination status.

Most facilities had a mechanism for counting HCP; however, of the major data collection barriers, HCP not routinely present in the facility was most commonly reported (Table 1). Facilities with more than 300 beds were more likely to report major barriers to counting HCP not routinely in or rotating through the facility than smaller facilities, along with having no way to count LIPs or adult students/trainees.

TABLE 1

Barriers Counting the Number of HCP: Overall and By Facility Bed Size

NOTE. HCP, healthcare personnel; LIP, licensed independent practitioner; RR, rate ratio—percent of hospitals with 101-300 or >300 beds reporting the major barrier divided by the percent of hospitals with ≤100 beds reporting major barrier.

a Reference group is ≤100 beds.Using the Marascuilo test, significant differences were found in the proportion of responding facilities for all pair-wise comparisons between:

b All HCP categories except LIPs compared with adult students.

c Employees to LIPs or adult students or adult volunteers.

d All HCP categories except LIPs compared with adult students and employees compared with volunteers.

e All HCP categories except employees compared with adult students.

f All HCP categories except employees compared with LIPs or students and LIPs compared with adult students.

g All HCP categories except employees compared with adult students and LIPs compared with adult students.

Collecting vaccination status data for employees was not a barrier for 396 facilities (68%), but 106 (18%) reported it as a major barrier for LIPs and 83 (15%) for adult students/trainees (Table 2). Facilities reported having barriers to reporting vaccination status due to other entities not providing data on HCP; in particular, 156 facilities (26%) reported this as major barrier for LIPs. Facilities with more than 300 beds were more likely to report major barriers to collecting vaccination status for LIPs and volunteers than smaller facilities.

TABLE 2

Barriers Collecting HCP Vaccination Status: Overall and By Facility Bed Size, for 680 Respondents

NOTE. HCP, healthcare personnel; LIP, licensed independent practitioner; RR, rate ratio— percent of hospitals with 101–300 or >300 beds reporting the major barrier divided by the percent of hospitals with ≤100 beds reporting major barrier.

a Reference group is ≤100 beds.Using the Marascuilo test, significant differences were found in the proportion of responding facilities for all pair-wise comparisons between:

b All HCP categories except LIPs compared with adult students.

c Employees compared with LIPs or students.

d All HCP categories except employees compared with adult volunteers and LIPs compared with adult students.

e All HCP categories except employees compared with adult students.

f All HCP categories except employees compared with LIPs or students and LIPs compared with adult students.

g All HCP categories except employees compared with adult students or volunteers.

h Employees compared with adult volunteers.

i All HCP categories except employees compared with adult volunteers.

Respondents perceived the accuracy of vaccination status data to be very or somewhat accurate for employees (n=639; 99%), LIPs (n=569; 89%), adult students/trainees (n=526; 83%), and adult volunteers (n=577; 90%). Facilities reporting major barriers to collecting data for LIPs, adult students/trainees, or adult volunteers were significantly more likely to have perceived their data to be inaccurate for these HCP categories compared with facilities reporting no major barriers.

Almost half of respondents reported that a benefit of collecting data for NHSN was that it helped communicate vaccination coverage to HCP (n=333; 49%); more than 50% of facilities (n=401) responded that NHSN provides data for other reporting requirements, 44% (n=299) reported that it helped increase vaccination promotion efforts, 42% (n=286) reported that it helped improve the HCP tracking system, and 13% (n=88) reported no perceived benefit.

DISCUSSION

Although facilities reported data collection challenges for the HCP measure, in general, facilities found it easier to collect data on employees and adult volunteers, and smaller facilities reported fewer challenges. Factors such as size of facility, data collection methods, and facilities’ previous experience collecting data may all contribute to the ease of reporting vaccination coverage to NHSN and perceived accuracy of collected data.

Many facilities reported not having mechanisms for counting specific HCP groups; in particular, facilities had difficulty collecting data on HCP who do not routinely work in the facility. It may be difficult for data collectors to report on nonemployees because they do not have access to information owned by other entities, and the reporting facility may have no contractual obligation to report the data, which is consistent with our qualitative evaluation findings.Reference Kalayil, Dolan, Lindley and Ahmed 4 Our findings complement other studies reporting that most organizations can collect data for only a subset of HCP, have difficulty gathering the HCP vaccination status for vaccinations received outside a facility, and have trouble assessing the number of nonemployees.Reference Quach, Pereira and Hamid 5 , Reference Maccannell, Shugart and Schneider 6

Most facilities in our evaluation used paper-based data collection mechanisms rather than electronic systems. Electronic data collection systems can increase the ease of collecting vaccination data and can provide additional benefits beyond collecting influenza vaccination coverage data: reports have found that these systems offer the flexibility of data use for other activities,Reference Melia, O’Neill and Calderon 7 , Reference Palmore, Vandersluis and Morris 8 such as providing the ability to monitor vaccination coverage in real-time by location or occupation.Reference Bertin, Scarpelli and Proctor 9

Although most facilities in our evaluation had previous experience collecting data, they still faced a number of barriers. NHSN reporting requirements may be different than the information facilities have historically collected and more extensive than what facilities’ current data collection systems allow. A study from 2006 found that most hospitals measured influenza vaccination coverage for employees, but fewer hospitals measured coverage for nonemployee HCP or included coverage of vaccine refusal or contraindication.Reference Lindley, Yonek, Ahmed, Perz and Williams Torres 2

Limitations of this evaluation include not being able to determine how respondents defined data accuracy. In addition, the survey was designed to assess the experiences of data collectors in acute care hospitals; therefore, the results may not reflect the experience of reporting data to NHSN for other types of facilities.

The National Quality Forum endorsed the HCP measure with the expectation that it would drive improvement in data collection. A universal standard for HCP influenza vaccination coverage could help ease data collection and reporting for facilities; barriers to NHSN reporting may decrease as facilities develop processes and systems for collecting the necessary data. The measure has been adjusted since the first season of data collection to require facilities to submit data for any HCP working in the facility for at least 1 day; this change may result in a decrease in reported barriers to data collection because most facilities felt such a change would maintain or improve the accuracy of collected data. It is important to continue monitoring implementation of the HCP measure to ensure it is producing high-quality data that can be used to improve influenza vaccination coverage among HCP in the United States.

ACKNOWLEDGMENTS

We gratefully acknowledge assistance of the US Department of Energy’s Oak Ridge Institute for Science and Education in collecting the data.

Financial support. CDC (cooperative agreement U36/CCU300430) and the Association of Schools and Programs of Public Health (salary support to S.B.D.).

Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.

Disclaimer. The findings and conclusions of this publication do not necessarily represent the official views of CDC or the Association of Schools and Programs in Public Health.

References

REFERENCES

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Figure 0

TABLE 1Barriers Counting the Number of HCP: Overall and By Facility Bed Size

Figure 1

TABLE 2Barriers Collecting HCP Vaccination Status: Overall and By Facility Bed Size, for 680 Respondents