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  • Measure Summary
  • NQMC:011293
  • Jan 2018
  • NQF-Endorsed Measure

Immunization: percent of acute care hospitalized inpatients age 6 months and older who were screened for seasonal influenza immunization status and were vaccinated prior to discharge if indicated.

Specifications manual for national hospital inpatient quality measures, version 5.3. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2018 Jan 1. various p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percent of acute care hospitalized inpatients age 6 months and older discharged during October, November, December, January, February, or March who were screened for seasonal influenza immunization status and were vaccinated prior to discharge, if indicated.

Rationale

Influenza (flu) is an acute, contagious, viral infection of the nose, throat and lungs (respiratory illness) caused by influenza viruses. Outbreaks of seasonal influenza occur annually during late autumn and winter months although the timing and severity of outbreaks can vary substantially from year to year and community to community. Influenza activity most often peaks in February, but can peak rarely as early as November and as late as April. In order to protect as many people as possible before influenza activity increases, most flu-vaccine is administered in September through November, but vaccine is recommended to be administered throughout the influenza season as well. Because the flu vaccine usually first becomes available in September, health systems can usually meet public and patient needs for vaccination in advance of widespread influenza circulation.

Up to 1 in 5 people in the United States (U.S.) get influenza every season (Centers for Disease Control and Prevention [CDC], 2015). Each year an average of approximately 226,000 people in the U.S. are hospitalized with complications from influenza and between 3,000 and 49,000 die from the disease and its complications (Thompson et al., 2003). Combined with pneumonia, influenza is the nation's 8th leading cause of death (Heron, 2015). Up to two-thirds of all deaths attributable to pneumonia and influenza occur in the population of patients that have been hospitalized during flu season regardless of age (Fedson, Houck, & Bratzler, 2000). The Advisory Committee on Immunization Practices (ACIP) recommends seasonal influenza vaccination for all persons 6 months of age and older to highlight the importance of preventing influenza. Vaccination is associated with reductions in influenza among all age groups (Kostova et al., 2013).

The influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications. Screening and vaccination of inpatients is recommended, but hospitalization is an underutilized opportunity to provide vaccination to persons 6 months of age or older.

Evidence for Rationale

Centers for Disease Control and Prevention. Key facts about influenza and the influenza vaccine. [internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2015 Oct [accessed 2015 Oct 14].

Fedson DS, Houck P, Bratzler D. Hospital-based influenza and pneumococcal vaccination: Sutton's Law applied to prevention. Infect Control Hosp Epidemiol. 2000 Nov;21(11):692-9. [70 references] PubMed External Web Site Policy

Heron M. Deaths: leading causes for 2012. Natl Vital Stat Rep. 2015 Aug 31;64(10):1-93. PubMed External Web Site Policy

Kostova D, Reed C, Finelli L, Cheng PY, Gargiullo PM, Shay DK, Singleton JA, Meltzer MI, Lu PJ, Bresee JS. Influenza illness and hospitalizations averted by influenza vaccination in the United States, 2005-2011. PLoS ONE. 2013 Jun 19;8(6):e66312. PubMed External Web Site Policy

Specifications manual for national hospital inpatient quality measures, version 5.3. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2018 Jan 1. various p.

Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003 Jan 8;289(2):179-86. PubMed External Web Site Policy

Primary Health Components

Influenza vaccination

Denominator Description

Acute care hospitalized inpatients age 6 months and older discharged during October, November, December, January, February, or March (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Inpatient discharges who were screened for influenza vaccine status and were vaccinated prior to discharge, if indicated (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Accreditation

Collaborative inter-organizational quality improvement

External oversight/Medicaid

External oversight/Medicare

Internal quality improvement

Pay-for-performance

Pay-for-reporting

Public reporting

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age greater than or equal to 6 months

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Case Finding Period

Discharges January 1 through June 30

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Institutionalization

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window precedes index event

Denominator Inclusions/Exclusions

Inclusions
Acute care hospitalized inpatients age 6 months and older discharged during October, November, December, January, February, or March

Exclusions

  • Patients less than 6 months of age
  • Patients who expire prior to hospital discharge
  • Patients with an organ transplant during the current hospitalization (as defined in the appendices of the original measure documentation)
  • Patients for whom vaccination was indicated, but supply had not been received by the hospital due to problems with vaccine production or distribution
  • Patients who have a Length of Stay (LOS) greater than 120 days
  • Patients who are transferred or discharged to another acute care hospital
  • Patients who leave Against Medical Advice (AMA)

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

System factors addressed

Numerator Inclusions/Exclusions

Inclusions
Inpatient discharges who were screened for influenza vaccine status and were vaccinated prior to discharge, if indicated

  • Patients who received the influenza vaccine during this inpatient hospitalization
  • Patients who received the influenza vaccine during the current year's flu season but prior to the current hospitalization
  • Patients who were offered and declined the influenza vaccine
  • Patients who have an allergy/sensitivity to the influenza vaccine, anaphylactic latex allergy or anaphylactic allergy to eggs, or for whom the vaccine is not likely to be effective because of bone marrow transplant within the past 6 months, or history of Guillain-Barré syndrome within 6 weeks after a previous influenza vaccination

Exclusions
None

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

  • Global Initial Patient Population Algorithm Flowchart
  • IMM-2: Influenza Immunization Flowchart

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Does not apply to this measure

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

IMM-2: influenza immunization.

Measure Collection Name

National Hospital Inpatient Quality Measures

Measure Set Name

Immunization Measure

Submitter

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Developer

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Funding Source(s)

Centers for Medicare & Medicaid Services (CMS) funding is from the United States Government.

Composition of the Group that Developed the Measure

Technical advisory panel of stakeholders

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Endorser

National Quality Forum

NQF Number

1659

Date of Endorsement

2017 Jan 23

Measure Initiative(s)

Hospital Compare

Hospital Inpatient Quality Reporting Program

Inpatient Psychiatric Facility Quality Reporting Program

Quality Check®

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2018 Jan

Measure Maintenance

This measure is reviewed and updated every 6 months.

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

Source(s)

Specifications manual for national hospital inpatient quality measures, version 5.3. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2018 Jan 1. various p.

Measure Availability

Source available from the QualityNet Web site External Web Site Policy.

Check the QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.

Companion Documents

The following are available:

  • A software application designed for the collection and analysis of quality improvement data, the CMS Abstraction and Reporting Tool (CART), is available from the QualityNet Web site External Web Site Policy.
  • Hospital compare: a quality tool provided by Medicare. [internet]. Washington (DC): U.S. Department of Health and Human Services; [accessed 2017 Oct 10]. Available from the Medicare Web site External Web Site Policy.

NQMC Status

The Joint Commission originally submitted this NQMC measure summary to ECRI Institute on February 15, 2012. This NQMC summary was reviewed accordingly by ECRI Institute on July 5, 2012. The information was verified by the Centers for Medicare & Medicaid Services (CMS) on August 1, 2012.

The Joint Commission and CMS informed NQMC that this measure was updated on July 19, 2013 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on October 11, 2013.

This NQMC summary was updated by ECRI Institute on July 13, 2015. The information was verified by CMS on August 31, 2015.

This NQMC summary was edited by ECRI Institute on November 16, 2015.

This NQMC summary was updated again by ECRI Institute on October 16, 2017. The information was verified by the measure developer on November 8, 2017.

Copyright Statement

No copyright restrictions apply.

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