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Hospital-based pneumococcal immunization. Epidemiologic rationale from the Shenandoah study.

D S Fedson¹, M P Harward, R A Reid

¹Department of Medicine, University of Virginia School of Medicine, Charlottesville.

|September 5, 1990

Summary

Hospital-based pneumococcal immunization is useful for preventing pneumonia readmissions in elderly patients. Vaccinating around 100 discharged patients can prevent readmissions and save costs compared to hospital care.

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Area of Science:

Epidemiology
Preventive Medicine
Health Economics

Background:

Pneumonia is a significant cause of hospital readmission, particularly among the elderly.
Identifying high-risk patients after hospital discharge is crucial for preventive strategies.
Previous hospitalizations often indicate underlying high-risk conditions for pneumonia.

Purpose of the Study:

To evaluate the effectiveness of hospital-based pneumococcal immunization.
To assess the potential for preventing pneumonia readmissions through vaccination.
To analyze the cost-effectiveness of pneumococcal vaccination in discharged patients.

Main Methods:

Retrospective analysis of linked hospital discharge records for Medicare enrollees in Virginia.
Cohort study to determine readmission rates for pneumonia within 5 years.

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Calculation of vaccination costs versus hospital care costs for readmissions.

Main Results:

61-62% of pneumonia patients had prior discharges within 4 years.
87% of these had recognized high-risk conditions during previous admissions.
Discharged patients had a 6-9% probability of 5-year pneumonia readmission.
Vaccinating ~100 patients could prevent readmissions.
Vaccination costs are one-third of readmission hospital care costs.

Conclusions:

Hospital-based pneumococcal immunization is an effective preventive strategy.
Vaccination offers a cost-effective approach to reduce pneumonia readmissions.
Supports recommendations for vaccinating elderly hospital discharge patients.