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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2006.099440v1 97/12/2167    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jha, A. K. Articles by Perlin, J. B. Search for Related Content PubMed PubMed Citation Articles by Jha, A. K. Articles by Perlin, J. B. Related Collections Quality of Care Other Health Service Delivery Immunization/Vaccines

Ashish K. Jha, MD, MPH, Steven M. Wright, PhD and Jonathan B. Perlin, MD, PhD

At the time of the study, Ashish K. Jha was with the Harvard School of Public Health, Boston, Mass, and the Veterans Administration Boston Healthcare System, Boston. Steven M. Wright was with the Office of Quality and Performance, Veterans Health Administration, Washington, DC. Jonathan B. Perlin was with the Office of the Under Secretary of Health, Veterans Health Administration, Washington, DC.

Correspondence: Requests for reprints should be sent to Ashish K. Jha, Department of Health Policy & Management, 677 Huntington Ave, Boston, MA 02115 (e-mail: ajha{at}hsph.harvard.edu).

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

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

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

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