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J Am Med Dir Assoc. 2010 Jan;11(1):59-69. doi: 10.1016/j.jamda.2009.09.011. Epub 2009 Dec 10.

Influenza immunization coverage among residents of long-term care facilities certified by CMS, 2005-2006: the newest MDs quality indicator.

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  • 1Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.



In October 2005, the Centers for Medicare and Medicaid Services (CMS) required that long-term care (LTC) facilities certified by CMS offer each resident annual influenza vaccination. Subsequently, vaccination status was added to resident assessments collected beginning in the influenza season, 2005-2006. This is the first year immunization coverage can be reported based on a census of LTC residents.


Report influenza immunization coverage for LTC residents by state, resident, and facility characteristics. Identify uses of the data and areas in need of improvement.


Analysis of CMS' Minimum Data Set of 1,851,676 residents in nursing homes from October 1 through December 31 but who could have been discharged between January 1 and March 31 merged with data for 14,493 non-hospital-based facilities from the Online Survey and Certification Assessment Reporting System.


Overall, 83% of residents were offered the vaccine and 72% had received the vaccine. Almost 10% refused to receive the vaccine, 14% were not offered the vaccine, 1% were ineligible, and 3% were missing vaccination status. Vaccination coverage varied significantly among states (range: 49% to 87%). Fewer African Americans and Hispanics than whites were offered the vaccine (79% and 79% versus 84%, respectively) and received it (65% and 66% versus 73%, respectively); more African Americans refused the vaccine (12%) than residents of other races and/or ethnicities. Residents of Medicaid-certified-only facilities had higher levels of vaccination than residents of other facilities (82% versus < or =73%).


MDS immunization data can be used as surveillance to work with states to improve coverage. Further research to examine racial disparities in vaccination among LTC residents is needed.

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