Immunization and health outcomes among nursing homes in New York State: The effect of public reporting

We describe nursing home (NH) influenza immunization trends before and after CMS public-reporting, and examine the association between influenza immunizations and health-related outcomes.

Nursing Home Compare and Minimum Data Set files were linked, focusing on flu seasons before and after public-reporting (10/2005~03/2006; 10/2006~03/2007). NH was the unit of analysis (N=648).

Immunization rates before and after public-reporting were compared. A first-difference model was fit. Outcome variables were hospitalizations & influenza-related infections. Main variables of interest were NH influenza immunization rates for long (LT) and short-term (ST) residents. Facility-level case-mix was controlled.

Flu immunization rates in NY were higher than national average: 79.96%(SD=15.16) for ST and 91.20%(SD=7.66) for LT residents during 2005~2006 season; and 81.57%(SD =14.44) for ST and 90.77%(SD=9.15) for LT residents during 2006~2007.

For facilities with high baseline immunization rates, a 10% increase in immunizations, for LT residents, was associated with 3.4% decrease in baseline infection rates. A 10% increase for ST residents was associated with a 3% decrease in baseline hospitalizations. For facilities with relatively low baseline immunization rates, a 10% increase for LT care residents was correlated with a 7% decline in baseline hospitalization rates.

State average influenza rates for ST residents improved slightly over the two seasons, but could not be attributed to the effect of public-reporting alone. Improvements in immunization rates were associated with improvements in some health-related outcomes. Even at relatively high rates of immunizations, improvements in flu vaccination rates and their associated outcomes can be realized, suggesting potential benefits to public-reporting of this measure.