Abstract
Despite the fact that invasive Streptococcus pneumoniae remains a leading cause of death, current levels of immunization in the at risk population remain low and well below the 90% goal for Healthy People 2010. A number of intervention strategies to increase immunization rates (for influenza and pneumonia) have been demonstrated to be effective in increasing these rates when used alone or in combination. A summary of this literature is presented including recent data on the effectiveness of pay-for-performance approaches for increasing preventive care. Data are also presented on intervention strategies judged to be most effective in a large health care system, the Veterans Health Administration, which has essentially reached the Healthy People 2010 goal for pneumococcal immunization.
Similar content being viewed by others
References and Recommended Reading
Messonnier ML, Corso PS, Teutsch SM, et al.: An ounce of prevention...what are the returns? Second edition 1999. Am J Prev Med 1999, 16:248–263.
Robinson KA, Baughman W, Rothrock G, et al.: Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995–1998: opportunities for prevention in the conjugate vaccine era. JAMA 2001, 285:1729–1735.
Christenson B, Lundbergh P, Hedlund J, Ortqvist A: Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in adults aged 65 years or older: a prospective study. Lancet 2001, 357:1008–1011.
Coffield AB, Maciosek MV, McGinnis JM, et al.: Priorities among recommended clinical preventive services. Am J Prev Med 2001, 21:1–9.
Sisk JE, Moskowitz AJ, Whang W, et al.: Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA 1997, 278:1333–1339.
Neumann PJ, Levine BS: Do HEDIS measures reflect cost-effective practices? Am J Prev Med 2002, 23:276–289.
Centers for Disease Control and Prevention (CDC): Public health and aging: influenza vaccination coverage among adults aged > or =50 years and pneumococcal vaccination coverage among adults aged > or =65 years — United States, 2002. MMWR 2003, 52:987–992.
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2004. [www.cdc.gov/brfss/index.htm]
Pham HH, Schrag D, Hargraves JL, Bach PB: Delivery of preventive services to older adults by primary care physicians. JAMA 2005, 294:473–481.
Zaza S, Briss PA, Harris KW (eds.): The Guide to Community Preventive Services: What Works to Promote Health? Oxford University Press; 2005. A very comprehensive review of studies to improve vaccination coverage based on rigorous study selection and review criteria.
Briss PA, Rodewald LE, Hinman AR, et al.: Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000, 18(Suppl 1):97–140.
Task Force on Community Preventive Services: Recommendations regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000, 18(Suppl 1):92–96.
Ndiaye SM, Hopkins DP, Shefer AM, et al.: Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among highrisk adults: a systematic review. Am J Prev Med 2005, 28(Suppl 5):248–279.
Jacobson Vann JC, Szilagyi P: Patient reminder and recall systems to improve immunization rates. Cochrane Datab Syst Rev 2005, 3:1–50. A very comprehensive review of studies to improve vaccination coverage by means of patient recall and reminder systems based on rigorous study selection and review criteria.
Terrell-Perica SM, Effler PV, Houck PM, et al.: The effect of a combined influenza/pneumococcal immunization reminder letter. Am J Prev Med 2001, 21:256–260.
Smith DM, Zhou XH, Weinberger M, et al.: Mailed reminders for area-wide in.uenza immunization: a randomized controlled trial. J Am Geriatr Soc 1999, 47:1–5.
Stone EG, Morton SC, Hulscher ME, et al.: Interventions that increase use of adult immunization and cancer screening services: a meta-analysis. Ann Int Med 2002, 136:641–651.
Maglione MA, Stone EG, Shekelle PG: Mass mailings have little effect on utilization of in.uenza vaccine among Medicare bene.ciaries. Am J Prev Med 2002, 23:43–46.
Kane RL, Johnson PE, Town RJ, Butler M: A structured review of the effect of economic incentives on consumers’ preventive behavior. Am J Prev Med 2004, 27:327–352.
Nexoe J, Kragstrup J, Ronne T: Impact of postal invitations and user fee on in.uenza vaccination rates among the elderly: a randomized controlled trial in general practice. Scand J Prim Health Care 1997, 15:109–112.
Town R, Kane R, Johnson P, Butler M: Economic incentives and physicians’ delivery of preventive care: a systematic review. Am J Prev Med 2005, 28:234–240.
Fairbrother G, Hanson KL, Friedman S, Butts GC: The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates. Am J Pub Health 1999, 89:171–175.
Fairbrother G, Siegel MJ, Friedman S, et al.: Impact of financial incentives on documented immunization rates in the inner city: results of a randomized controlled trial. Ambul Pediatr 2001, 1:206–212.
Hillman AL, Ripley K, Goldfarb N, et al.: The use of physician financial incentives and feedback to improve pediatric preventive care in Medicaid managed care. Pediatrics 1999, 104:931–935.
Kouides RW, Bennett NM, Lewis B, et al.: Performancebased physician reimbursement and influenza immunization rates in the elderly. Am J Prev Med 1998, 14:89–95.
Hillman AL, Ripley K, Goldfarb N, et al.: Physician financial incentives and feedback: failure to increase cancer screening in Medicaid managed care. Am J Public Health 1998, 88:1699–1701.
Grady KF, Lemkau JP, Lee NR, Caddell C: Enhancing mammography referral in primary care. Prev Med 1997, 26:791–800.
Rosenthal MB, Frank RG, Zhonghe L, Epstein AM: Early experience with pay-for-performance: from concept to practice. JAMA 2005, 294:1788–1793. A good example of how well-designed field research can be conducted in the area of pay-for-performance.
Dudley RA: Pay-for-performance research: how to learn what clinicians and policy makers need to know. JAMA 2005, 294:1821–1823. A succinct summary of the many challenges of pay-for-performance research including study design, selecting theory-driven hypotheses, reporting research findings, and setting research priorities.
Epstein AM, Lee TH, Hamel MB: Paying physicians for high-quality care. N Engl J Med 2004, 350:406–410.
Rashidian A, Black N, Russell I: Financial incentives and quality improvement. Qual Saf Health Care 2005, 14:227.
American College of Physicians: Linking physician payments to quality care. Philadelphia: American College of Physicians, 2005. Position Paper.
Rosenthal MB, Fernandopulle R, Song HR, Landon B: Paying for quality: providers’ incentives for quality improvement. Health Affairs 2004, 23:127–141.
Perlin JB, Kolodner RM, Roswell RH: The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care. Am J Manag Care 2004, 10:828–836.
Jha AK, Perlin JB, Kizer KW, Dudley RA: Effect of the transformation of the Veterans Health Care System on the quality of care. N Engl J Med 2003, 348:2218–2227.
Warner EA, Seleznick MJ: Using medical record reminders to improve pneumococcal vaccination rates. Jt Comm J Qual Saf 2004, 30:331–334.
Steinberg EP: Improving the Quality of Care-can we practice what we preach? N Engl J Med 2003, 348:2681–2683.
Poon EG, Jha AK, Christino M, et al.: Assessing the level of healthcare information technology adoption in the United States: a snapshot. BMC Med Inform Decis Mak 2006, 6:1–26.
Garg AX, Adhikari NKJ, McDonald H: Effects of computerized clinical decision support systems on practitioner performance and patient outcomes. JAMA 2005, 293:1223–1238.
Dexter PR, Perkins SM, Maharry KS, et al.: Inpatient computer-based standing orders vs physician reminders to increase influenza and pneumococcal vaccination rates: a randomized trial. JAMA 2004, 292:2366–2371.
Coyle CM, Currie BP: Improving the rates of inpatient pneumococcal vaccination: impact of standing orders versus computerized reminders to physicians. Infect Control Hosp Epidemiol 2004, 25:904–907.
Fung CH, Woods JN, Asch SM, et al.: Variation in implementation and use of computerized clinical reminders in an integrated healthcare system. Am J Manag Care 2004, 10:878–885.
Schellhase KG, Koepsell TD, Norris TE: Providers’ reactions to an automated health maintenance reminder system incorporated into the patients’ electronic medical record. J Am Board Fam Pract 2003, 16:312–317.
Kawamoto K, Houlihan CA, Balas EA, Lobach DF: Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005, 330:765–772.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Smith, J.M., Craig, T.J. Strategies for improving pneumococcal vaccination in eligible patients. Curr Infect Dis Rep 8, 231–237 (2006). https://doi.org/10.1007/s11908-006-0064-y
Issue Date:
DOI: https://doi.org/10.1007/s11908-006-0064-y