Project protect: pneumococcal vaccination in Washington State nursing homes.

Background: Pneumonia is the third most frequent cause of hospitalization among Medicare beneficiaries in Washington State. While a vaccine against pneumococcal disease has been available since 1977, the 1999 Behavioral Risk Factor Surveillance System estimates that less than 60% of adults aged 65 years and older in Washington State have been vaccinated.

Methods: To assess the prevalence of pneumococcal vaccination policies, we surveyed all Washington nursing homes in 1999 and again in 2001 to assess changes during the intervening period.

Antithrombotic therapy for stroke prevention among Medicare beneficiaries hospitalized in Alaska with atrial fibrillation.

Although warfarin therapy reduces the risk of stroke among patients with atrial fibrillation (AF), the risk of hemorrhagic complications and other concerns may make clinicians reluctant to prescribe this treatment for elderly patients. Aspirin is a lower-risk alternative to warfarin but is also less effective. This study examines the use of antithrombotic therapy with warfarin or aspirin at hospital discharge among 182 Medicare beneficiaries 65 or older with chronic AF who were admitted to nine Alaska hospitals during 1996.

Assessing influenza immunization rates in Medicare managed care plans: a comparison of three methods.

Background: In an effort to improve care delivered to Medicare beneficiaries, the Health Care Financing Administration (HCFA) has encouraged competitive Medicare risk plans to collaborate on quality improvement projects. PRO-West, a private, nonprofit quality improvement organization, fostered a collaboration of all Medicare risk plans in Washington State in order to assess and improve influenza immunization rates among seniors enrolled in managed care.

Methodology: After the 1994-1995 influenza immunization season, immunization rates were determined for each participating plan from administrative data and medical record review.

Adequacy of well-child care and immunizations in US infants born in 1988.

Objective: To determine adequacy of preventive care for US infants, including both well-child care visits and immunizations, and to identify risk factors for inadequate receipt of care.

Design: Analysis of the 1988 National Maternal and Infant Health Survey of the National Center for Health Statistics.

Sample: Nationally representative sample of all US children born in 1988.