Journal Article

Estimating Influenza Vaccination Status Among Medicare Beneficiaries: Comparison of Billing Claims and Vaccination Data Obtained from Medical Records and Self-report

Elif Alyanak, Alicia M Fry, Courtney Strickland, Jeffrey Kelman, Yoganand Chillarige, Xiyuan Wu, Michael Wernecke, David Shay and Jill M Ferdinands

in Open Forum Infectious Diseases

Volume 4, issue suppl_1, pages S575-S575
ISSN: n/a
Published online October 2017 | e-ISSN: 2328-8957 | DOI: https://dx.doi.org/10.1093/ofid/ofx163.1503
Estimating Influenza Vaccination Status Among Medicare Beneficiaries: Comparison of Billing Claims and Vaccination Data Obtained from Medical Records and Self-report

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Abstract

Background

Accurate ascertainment of vaccination status is needed to evaluate influenza vaccine effectiveness (VE). Few studies have compared methods of identifying vaccination among hospitalized adults. We assessed accuracy of self-reported influenza vaccination status among adults hospitalized with acute respiratory illness with influenza vaccination billing claims submitted to the Centers for Medicare and Medicaid Services (CMS) and other vaccination records.

Methods

For Medicare enrollees ≥65 years old recruited for the 2015–16 US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) study, we compared self-reported influenza vaccination status with CMS claims and vaccination data collected from inpatient and outpatient medical records, pharmacies, and immunization registries (“HAIVEN vaccination records”). Measures were compared by kappa, sensitivity (Sn.) and specificity (Sp.).

Results

Among 391 HAIVEN enrollees with continuous Medicare enrollment, influenza vaccine coverage was 75% by self-report, 66% by HAIVEN vaccination records and 51% by CMS claims [Tbl 1]. Of 293 patients self-reporting vaccination, 107 (37%) lacked CMS claims (Sn. = 63%) and 49 (17%) lacked HAIVEN records (Sn. = 83%). Of 259 patients with HAIVEN vaccination records, 87 (34%) lacked CMS claims (Sn. = 63%) [Fig 1]. Agreement between measures was moderate, with kappas of 0.38–0.61.

Conclusion

In this sample of hospitalized older adults, influenza vaccination coverage estimates from CMS claims and other documented sources underestimated coverage compared with patient self-report. Reliance on billing claims could lead to substantial misclassification of vaccination status, suggesting that a lack of vaccination claims data should not be taken as evidence of lack of vaccination. Further improvement in understanding the accuracy of vaccination status data is needed for VE studies.

Table 1.

CMS and HAIVEN influenza vaccination status

Tbl. 1A HAIVEN Vacc. Records No. Subjects (%) Yes No Total CMS Yes 172 (66) 27 (20) 199 (51) No 87 (34) 105 (80) 192 (49) Total 259 (66) 132 (34) 391 Tbl. 1B Self-Report Y N Total CMS Y 186 (63) 13 (13) 199 (51) N 107 (37) 85 (87) 192 (49) Total 293 (75) 98 (25) 391 Tbl. 1C Self-Report Y N Total HAIVEN Y 244 (83) 15 (15) 259 (66) Vacc. N 49 (17) 83 (85) 132 (34) Records Total 293 (75) 98 (25) 391

Disclosures

All authors: No reported disclosures.

Journal Article.  0 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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