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Pneumococcal Vaccination
Analysis of Opportunities in an Inner-city Hospital
Shahid Husain, MD;
David Slobodkin, MD, MPH;
Robert A. Weinstein, MD
Arch Intern Med. 2002;162:1961-1965.
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.
From the University of Pittsburgh Medical Center, Pittsburgh, Pa (Dr
Husain); School of Public Health, University of Illinois at Chicago (Dr Slobodkin),
and Cook County Hospital and Rush Medical College (Dr Weinstein), Chicago,
Ill.
RELATED LETTER
Corrections to Table
Shahid Husain, David Slobodkin, and Robert A. Weinstein
Arch Intern Med. 2004;164(5):573.
EXTRACT
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Lessons learned from inpatient vaccination in michigan.
Winston et al.
American Journal of Medical Quality 2006;21:125-133.
ABSTRACT
Corrections to Table
Husain et al.
Arch Intern Med 2004;164:573-573.
FULL TEXT
A Vaccine-Preventable Infection -- So What's the Problem?
JWatch Infect. Diseases 2002;2002:5-5.
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