Performance Measures, Vaccinations, and Pneumonia Rates Among High-Risk Patients in Veterans Administration Health Care

Influenza and pneumococcal vaccinations reduce morbidity, mortality and health care costs, but their use lags behind goals set by public health experts. The authors evaluated the effect of a performance measurement program instituted by the Veterans Health Administration in 1995 to improve vaccination rates.

Using cross-sectional chart-abstracted data the authors calculated influenza and pneumococcal vaccination rates among eligible patients, and used administrative data to calculate pneumonia admission rates. The study compared vaccination and hospitalization rates before and after the institution of the performance measurement program with rates outside the Veterans Health Administration.

Influenza and pneumococcal vaccination rates for eligible patients rose from 27 percent and 28 percent during 1994 to 1995 to 70 percent and 85 percent, respectively, by 2003 (P for trend <.001). Geographic and other variations were substantially reduced. During this time, pneumonia hospitalization rates decreased by 50 percent among elderly Veterans Health Administration enrollees but increased among Medicare enrollees by 15 percent (P for differences in trend <.001).

The study concluded that the performance measurement program was associated with increases in vaccination rates, reduced variation and reduced pneumonia admissions. They suggest that health systems instituting similarly effective programs may substantially improve the quality of their clinical health care.