Percent of Residents or Patients Assessed and Appropriately Given the Pneumococcal Vaccine (Short-Stay)

The measure reports the percentage of short stay nursing home residents or IRF or LTCH patients who were assessed and appropriately given the pneumococcal vaccine during the 12-month reporting period. This measure is based on data from Minimum Data Set (MDS) 3.0 assessments of nursing home residents, the Inpatient Rehabilitation Facilities Patient Assessment Instrument (IRF-PAI) for IRF patients, and the Long Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set for long-term care hospital patients, using items that have been harmonized across the three assessment instruments. Short-stay nursing home residents are those residents who are discharged within the first 100 days of their nursing home stay.


The NQF standard specifications were harmonized to achieve a uniform approach to measurement across settings and populations, addressing who is included in or excluded from the target denominator population, who is included in the numerator population, and the time windows. In 2008, the NQF steering committee met to identify voluntary consensus measures for influenza and pneumococcal vaccination that were harmonized across healthcare settings. The steering committee recognized that “in the interest of standardization and minimizing burden for those implementing and using measures, measure harmonization is an important consideration in evaluating and recommending measures for endorsement.” The committee supported the use of measure IM-017-which reports the percent of nursing home/Skilled Nursing Facility residents whose pneumococcal polysaccharide vaccine (PPV) status is up to date during the 12-month reporting period - as the basis for a harmonized measure across settings (National Quality Forum, 2008b). The NQF standardized specifications differ from the currently reported measure in several ways. Note that for some residents or patients, a single vaccination during their lifetime is sufficient and the vaccination would be considered up to date; for others (those who are immunocompromised or older than age 65, but the first vaccine was administered more than 5 years before when the resident was younger than 65), a second dose would be needed to qualify as vaccination up to date. Although the guidelines recommend a second dose in these circumstances, the NQF Committee believed that adding that requirement would make measurement too complex for the amount of benefit gained. Also, given the importance of revaccination among older adults, focusing on up-to-date status, rather than on ever having received the vaccine, is critically important. This focus on up-to-date rather than ever having received a vaccination is supported by the NQF steering committee in their discussion of the national voluntary consensus standards for this measure (National Quality Forum, 2008a).

This measure will include only residents or patients aged 5 years and older in the denominator. In their 2008 review of voluntary consensus standards for influenza and pneumococcal vaccination the NQF steering committee recommended limiting the use of measure IM -017 which reports the percent of nursing home/Skilled Nursing Facility residents whose PPV status is up to date, to residents age 5 and older. They state in their recommendation, “the specifications for high-risk groups begin at age 5, because the schedule for children ages 2-5 is different and complicated.” (National Quality Forum. 2008b) The Advisory Committee on Immunization Practices (ACIP) provides age specific guidelines for pneumococcal immunization for both children and adults. These guidelines vary based on age and risk level and should be followed accordingly. Up–to-date vaccination status is defined as a resident or patient who has been vaccinated in accordance with the current CDC vaccination guidelines for pneumococcal disease for his/her age and health status. The current CDC vaccination guidelines for adults and children are available at http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/pneumo.html.

National Quality Forum (2008a, June). Revised voting draft for national voluntary consensus standards for influenza and pneumococcal immunizations. Received from the Health Services Advisory Group on August 19, 2011.

National Quality Forum. (2008b, December). National voluntary consensus standards for influenza and pneumococcal immunizations. Available from http://www.qualityforum.org/Publications/2008/12/National_Voluntary_Consensus_Standards_for_Influenza_and_Pneumococcal_Immunizations.aspx.