Vaccination Uptake Among Health Care Workers and Institutional Policies to Promote Vaccination in Hospice and Home Health Agencies in the U.S.

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Research Objective: Influenza is one of the most prevalent causes of vaccine-preventable morbidity and mortality among the elderly. Health care workers (HCWs) have direct contact with the elderly, and influenza vaccination is recommended for HCWs in long-term care (LTC) facilities. Research on LTC HCWs vaccination beyond nursing homes and LTC hospitals is scant. We sought to describe the state of HCWs vaccination uptake in hospice and home health agencies and to examine the importance of institutional policies in promoting HCWs vaccination uptake within such agencies in the U.S.

Study Design: We conducted a cross-sectional study using the 2007 National Home and Hospice Care Survey (NHHCS) (unweighted n = 1,036). Consistent with the Healthy People 2010 target of 60% vaccination uptake among HCWs, our outcome was having 61-100% of employees who had received a flu shot. The main covariates were agencies’ institutional policies promoting vaccination: offering vaccination on site, for free, or at a reduced cost, providing employee incentives for vaccinations and requiring proof of vaccination for employment. We controlled for agency characteristics including, agency type (home health, hospice, or both), proprietary status, chain affiliation, agency size (quartiles of total full-time equivalents), and location (metropolitan vs. other). Weighted percentages and corresponding 95% confidence intervals (CIs) were calculated to describe the distribution of variables. Univariate and multivariable logistic regressions were used to test the relationships between the agencies’ policies and vaccination uptake and to estimate marginal effects. All analyses accounted for the two-stage probability sampling design of NHHCS and nonresponse.

Population Studied: Hospice and Home Health Agencies in the U.S.

Principal Findings: Only a third of agencies (33%; 95% CI: 27 – 39) reported having more than 60% of vaccinated employees, although approximately 73% (95% CI: 65 – 79) of agencies reported having at least one institutional policy encouraging employee influenza vaccinations. The two most frequently reported policies were offering vaccinations on site (55%; 95% CI: 48 – 62) and for free (55%; 95% CI: 48 – 62). Policies endorsed by a minority of agencies included offering vaccinations at a reduced cost (7%, 95% CI: 4 – 12), providing employee incentives for vaccination (14%, 95% CI: 9 – 20), and requiring proof of vaccination for employment (20%, 95% CI: 15 – 27). Controlling for agency characteristics and all the institutional policies, agencies offering vaccinations for free were 44% (95% CI: 35 – 53) more likely to have 61%- 100% vaccinated employees (p <0.001). Other policies were not statistically associated with vaccination uptake in multivariable analyses. Significantly fewer for-profit (vs. private not-forprofit and government) agencies and those located in metropolitan (vs. other) areas reported having 61%-100% vaccinated employees in adjusted analyses (p-values < 0.01).

Conclusions: Based on the latest available data, the uptake of vaccination among HCWs in U.S hospice and home health agencies was below the Healthy People 2010 target of 60%. Implications for Policy, Delivery, or Practice: Providing vaccination for free may be the most effective institutional policy to boost HCWs influenza vaccination uptake in these LTC facilities. An examination of financial and organizational facilitators and barriers to free vaccine provision is necessary to boost HCWs vaccination coverage in U.S. hospice and home health agencies.


Academy Health Annual Research Meeting (ARM)


San Diego, CA

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