Variations in Influenza and Pneumonia Immunizations For Medicare Beneficiaries Served by Rural Health Clinics

摘要

The availability of rural health clinic (RHC) database over the period of six years (2008 through 2013) offers a unique opportunity to examine the trends and patterns of disparities in immunization for influenza and pneumonia among rural Medicare beneficiaries in the southeastern states. The purpose of this exploratory study was twofold. First, it examined the rural trends and patterns of immunization rates before (2008 through 2009) and after (2010 through 2013) the ACA enactment by state and year. Second, it investigated how contextual, organizational, and aggregate patient characteristics may influence the variations in immunization for influenza and pneumonia of Medicare beneficiaries served by RHCs. Four data sources from federal agencies were merged to perform a longitudinal analysis of the influences of contextual, organizational, and aggregate patient characteristics on the disparities in immunization rates of rural Medicare beneficiaries for influenza and pneumonia. We included both time-varying and time-constant predictors in a multivariate analysis using Generalized Estimating Equation. This study reveals the increased immunization rates for both influenza and pneumonia over a period of six years. The ACA had a positive effect on increased immunization rates for pneumonia, but not for influenza, of rural Medicare beneficiaries in the eight states. The RHCs that served more dually-eligible patients had higher immunization rates. For influenza immunization, provider-based RHCs had a higher rate than the independent RHCs. For pneumonia immunization, no organizational variables were relevant in the explanation of the variability. The results also show that no single dominant factor influences health care disparities. This investigation suggested further improvement of preventive care needed to target the poor and isolated rural beneficiaries. Furthermore, the integration of immunization data from multiple sources is critically needed for understanding health disparities.