Variation in influenza vaccine assessment, receipt, and refusal by the concentration of Medicare Advantage enrollees in U.S. nursing homes

Patience Moyo; Elliott Bosco; Barbara H Bardenheier; Maricruz Rivera-Hernandez; Robertus van Aalst; Ayman Chit; Stefan Gravenstein; Andrew R Zullo

doi:10.1016/j.vaccine.2021.12.069

Variation in influenza vaccine assessment, receipt, and refusal by the concentration of Medicare Advantage enrollees in U.S. nursing homes

Vaccine. 2022 Feb 11;40(7):1031-1037. doi: 10.1016/j.vaccine.2021.12.069. Epub 2022 Jan 13.

Authors

Patience Moyo¹, Elliott Bosco², Barbara H Bardenheier³, Maricruz Rivera-Hernandez², Robertus van Aalst⁴, Ayman Chit⁵, Stefan Gravenstein⁶, Andrew R Zullo⁷

Affiliations

¹ Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA. Electronic address: patience_moyo@brown.edu.
² Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA.
³ Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA; Leslie Dan School of Pharmacy, University of Toronto, Ontario, Canada.
⁴ Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Modelling, Epidemiology, and Data Science, Sanofi Pasteur, Lyon, France; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁵ Sanofi Pasteur, Swiftwater, PA, USA; Leslie Dan School of Pharmacy, University of Toronto, Ontario, Canada.
⁶ Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
⁷ Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.

Abstract

Background: More older adults enrolled in Medicare Advantage (MA) are entering nursing homes (NHs), and MA concentration could affect vaccination rates through shifts in resident characteristics and/or payer-related influences on preventive services use. We investigated whether rates of influenza vaccination and refusal differ across NHs with varying concentrations of MA-enrolled residents.

Methods: We analyzed 2014-2015 Medicare enrollment data and Minimum Data Set clinical assessments linked to NH-level characteristics, star ratings, and county-level MA penetration rates. The independent variable was the percentage of residents enrolled in MA at admission and categorized into three equally-sized groups. We examined three NH-level outcomes including the percentages of residents assessed and appropriately considered for influenza vaccination, received influenza vaccination, and refused influenza vaccination.

Results: There were 936,513 long-stay residents in 12,384 NHs. Categories for the prevalence of MA enrollment in NHs were low (0% to 3.3%; n = 4131 NHs), moderate (3.4% to 18.6%; n = 4127 NHs) and high (>18.6%; n = 4126 NHs). Overall, 81.3% of long-stay residents received influenza vaccination and 14.3% refused the vaccine when offered. Adjusting for covariates, influenza vaccination rates among long-stay residents were higher in NHs with moderate (1.70 percentage points [pp], 95% confidence limits [CL]: 1.15 pp, 2.24 pp), or high (3.05 pp, 95% CL: 2.45 pp, 3.66 pp) MA versus the lowest prevalence of MA. Influenza vaccine refusal was lower in NHs with moderate (-3.10 pp, 95% CL: -3.53 pp, -2.68 pp), or high (-4.63 pp, 95% CL: -5.11 pp, -4.15 pp) MA compared with NHs with the lowest prevalence of MA.

Conclusion: A higher concentration of long-stay NH residents enrolled in MA was associated with greater influenza vaccine receipt and lower vaccine refusal. As MA becomes a larger share of the Medicare program, and more MA beneficiaries enter NHs, decisionmakers need to consider how managed care can be leveraged to improve the delivery of preventive services like influenza vaccinations in NH settings.

Keywords: Influenza; Long-term care; Medicare; Medicare Advantage; Nursing homes; Vaccination.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Humans
Influenza Vaccines*
Influenza, Human* / prevention & control
Medicare Part C*
Nursing Homes
United States
Vaccination

Substances

Influenza Vaccines

Abstract

Publication types

MeSH terms

Substances

Grants and funding