Pneumococcal vaccination: analysis of opportunities in an inner-city hospital. Export

@article{citeulike:349479, abstract = {BACKGROUND: Adult pneumococcal vaccination rates for persons at risk of developing pneumococcal disease remain below desired levels. Various sites within the hospital (inpatient medicine wards [IMWs], general medicine clinics [GMCs], and emergency departments [EDs]) have been suggested as venues for administering vaccination. The cost-effectiveness of such sites for delivery of pneumococcal vaccination is not known. OBJECTIVE: To compare the potential coverage of at-risk patients and cost of pneumococcal vaccination delivered in an ED, GMC, and IMWs. METHODS: We studied a retrospective cohort of 300 patients with pneumococcal bacteremia who had been hospitalized at Cook County Hospital, an inner-city Chicago public teaching hospital, from January 1994 through December 1998. We measured the presence of risk factors, as defined by the Centers for Disease Control and Prevention, for developing pneumococcal disease prior to index admission for bacteremia; patient use of ED, GMC, and IMWs from 4 weeks to 5 years before index admission; size of target population for vaccination in each site; and cost benefit of a pneumococcal vaccination strategy at each site. RESULTS: In the 4 weeks to 5 years before index admission, risk factors were present in 209 patients; 182 (87.1\%) of the 209 had been in the ED, 104 (49.7\%) in an IMW, and 64 (30.6\%) in a GMC. The ED showed the greatest potential vaccine coverage, at a cost savings in a best-case scenario; the IMWs showed the best cost-benefit ratio but would provide access to fewer at-risk patients; and a program in the GMC would reach the fewest at-risk patients, with a cost-benefit ratio similar to that of the ED. CONCLUSIONS: The ED in an inner-city hospital has the potential to vaccinate more patients at risk of pneumococcal bacteremia than a GMC or IMWs, and may do so at a cost savings. A prospective evaluation of such a strategy is warranted.}, address = {University of Pittsburgh Medical Center, PA, USA.}, author = {Husain, S. and Slobodkin, D. and Weinstein, R. A.}, citeulike-article-id = {349479}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/12230418}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=12230418}, day = {23}, issn = {0003-9926}, journal = {Arch Intern Med}, keywords = {inner-city, pneumovax, retrospective, vaccine}, month = {September}, number = {17}, pages = {1961--1965}, posted-at = {2005-10-12 21:31:24}, priority = {3}, title = {Pneumococcal vaccination: analysis of opportunities in an inner-city hospital.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/12230418}, volume = {162}, year = {2002} }

TY - JOUR ID - citeulike:349479 L3 - citeulike-article-id:349479 N2 - BACKGROUND: Adult pneumococcal vaccination rates for persons at risk of developing pneumococcal disease remain below desired levels. Various sites within the hospital (inpatient medicine wards [IMWs], general medicine clinics [GMCs], and emergency departments [EDs]) have been suggested as venues for administering vaccination. The cost-effectiveness of such sites for delivery of pneumococcal vaccination is not known. OBJECTIVE: To compare the potential coverage of at-risk patients and cost of pneumococcal vaccination delivered in an ED, GMC, and IMWs. METHODS: We studied a retrospective cohort of 300 patients with pneumococcal bacteremia who had been hospitalized at Cook County Hospital, an inner-city Chicago public teaching hospital, from January 1994 through December 1998. We measured the presence of risk factors, as defined by the Centers for Disease Control and Prevention, for developing pneumococcal disease prior to index admission for bacteremia; patient use of ED, GMC, and IMWs from 4 weeks to 5 years before index admission; size of target population for vaccination in each site; and cost benefit of a pneumococcal vaccination strategy at each site. RESULTS: In the 4 weeks to 5 years before index admission, risk factors were present in 209 patients; 182 (87.1%) of the 209 had been in the ED, 104 (49.7%) in an IMW, and 64 (30.6%) in a GMC. The ED showed the greatest potential vaccine coverage, at a cost savings in a best-case scenario; the IMWs showed the best cost-benefit ratio but would provide access to fewer at-risk patients; and a program in the GMC would reach the fewest at-risk patients, with a cost-benefit ratio similar to that of the ED. CONCLUSIONS: The ED in an inner-city hospital has the potential to vaccinate more patients at risk of pneumococcal bacteremia than a GMC or IMWs, and may do so at a cost savings. A prospective evaluation of such a strategy is warranted. IS - 17 JF - Arch Intern Med SN - 0003-9926 AD - University of Pittsburgh Medical Center, PA, USA. EP - 1965 TI - Pneumococcal vaccination: analysis of opportunities in an inner-city hospital. VL - 162 SP - 1961 KW - inner-city KW - pneumovax KW - retrospective KW - vaccine AU - Husain, S AU - Slobodkin, D AU - Weinstein, RA PY - 2002/09/23/ UR - http://view.ncbi.nlm.nih.gov/pubmed/12230418 ER -