Measure Information Form

Measure Set: Immunization (IMM)

Set Measure ID: IMM-2

Performance Measure Name: Influenza Immunization

Description: This prevention measure addresses acute care hospitalized inpatients age 6 months and older who were screened for seasonal influenza immunization status and were vaccinated prior to discharge if indicated. The numerator captures two activities: screening and the intervention of vaccine administration when indicated. As a result, patients who had documented contraindications to the vaccine, patients who were offered and declined the vaccine and patients who received the vaccine during the current year’s influenza season but prior to the current hospitalization are captured as numerator events.

Influenza (flu) is an acute, contagious, viral infection of the nose, throat and lungs (respiratory illness) caused by influenza viruses. Outbreaks of seasonal influenza occur annually during late autumn and winter months although the timing and severity of outbreaks can vary substantially from year to year and community to community. Influenza activity most often peaks in February, but can peak rarely as early as November and as late as April. In order to protect as many people as possible before influenza activity increases, most flu vaccine is administered in September through November, but vaccine is recommended to be administered throughout the influenza season as well. Because the flu vaccine usually first becomes available in September, health systems can usually meet public and patient needs for vaccination in advance of widespread influenza circulation.

Rationale: Up to 1 in 5 people in the United States get influenza every season (CDC, Key Facts 2015). Each year an average of approximately 226,000 people in the US are hospitalized with complications from influenza and between 3,000 and 49,000 die from the disease and its complications (Thompson 2003). Combined with pneumonia, influenza is the nation’s 8th leading cause of death (Heron 2012). Up to two-thirds of all deaths attributable to pneumonia and influenza occur in the population of patients that have been hospitalized during flu season regardless of age (Fedson 2000). The Advisory Committee on Immunization Practices (ACIP) recommends seasonal influenza vaccination for all persons 6 months of age and older to highlight the importance of preventing influenza. Vaccination is associated with reductions in influenza among all age groups (Kostova 2013).

The influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications. Screening and vaccination of inpatients is recommended, but hospitalization is an underutilized opportunity to provide vaccination to persons 6 months of age or older.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Inpatient discharges who were screened for influenza vaccine status and were vaccinated prior to discharge if indicated.

Included Populations:

Patients who received the influenza vaccine during this inpatient hospitalization

Patients who received the influenza vaccine during the current year’s flu season but prior to the current hospitalization

Patients who were offered and declined the influenza vaccine

Patients who have an allergy/sensitivity to the influenza vaccine, anaphylactic latex allergy or anaphylactic allergy to eggs, or for whom the vaccine is not likely to be effective because of bone marrow transplant within the past 6 months, or history of Guillian-Barre syndrome within 6 weeks after a previous influenza vaccination, or symptomatic suspected or confirmed COVID-19

Excluded Populations: None
Data Elements:

ICD-10-CM Other Diagnosis Codes

ICD-10-CM Principal Diagnosis Code

ICD-10-PCS Other Procedure Codes

ICD-10-PCS Principal Procedure Code

Influenza Vaccination Status

Denominator Statement: Acute care hospitalized inpatients age 6 months and older discharged during October, November, December, January, February or March.

Included Populations: Inpatient discharges 6 months of age and older
Excluded Populations:

Patients less than 6 months of age

Patients who expire prior to hospital discharge

Patients with an organ transplant during the current hospitalization(Appendix A, Table 12.10)

Patients for whom vaccination was indicated, but supply had not been received by the hospital due to problems with vaccine production or distribution

Patients who have a Length of Stay greater than 120 days

Patients who are transferred or discharged to another acute care hospital

Patients who leave Against Medical Advice (AMA)

Data Elements:

Admission Date

Birthdate

Discharge Date

Discharge Disposition

ICD-10-PCS Other Procedure Codes

ICD-10-PCS Principal Procedure Code

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-10 diagnosis and procedure codes, which require retrospective data entry.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: Hospitals may wish to analyze the measure data by individual high risk populations, for example, diabetes, COPD, etc., in order to determine if all defined high risk populations are equally vaccinated or if there are opportunities to improve care to a specific population of patients.

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

Benowitz I, Esposito DB, Gracey KD, Shapiro ED, Vazquez M. Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants.CID. December 2010; 51 (12): 1355-1361.
Carr S, Allison Kim J, et al. Safety and immunogenicity of live attenuated and inactivated influenza vaccines in children with cancer. J Infect Dis.2011:204:1475-1482.
Centers for Disease Control and Prevention. (2013). Estimated Applications/LocalApps.Influenza Illnesses and Hospitalizations Averted by Influenza Vaccination — United States,2012–13 Influenza Season. MMWR. 2013;62(49):997-1000.
Centers for Disease Control and Prevention. (2015). Key facts about influenza and the influenza vaccine, October 2015. Available at:http://www.cdc.gov/flu/keyfacts.htm. Accessed October 14, 2015
Centers for Disease Control and Prevention. (2013). Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2013-2014. MMWR, September 20,2013; 62(RR07); 1-43. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6207a1.htm
Centers for Disease Control and Prevention. (2015). Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2015–16 Influenza Season. MMWR,August 7, 2015; 64(30);818-825. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm
Centers for Disease Control and Prevention. (2017). Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2017-2018. MMWR, August 17, 2017;62(RR07); 1-20. https://www.cdc.gov/mmwr/volumes/66/rr/rr6602a1.htm
Chung EY, Huang L, and Schneider L. Safety of influenza vaccine administration in egg-allergic patients. Pediatrics. 2010 May;125(5):e1024-30. Epub 2010 Apr 5.
Darvishiana M, Gefenaitea G, Turnerc RM, Pechlivanogloua P, Van der HoekeW, Van den Heuvelb ER, Haka E (2014). After adjusting for bias in meta-analysis seasonal influenza vaccine remains effective in community-dwelling elderly. JClin Epidemiol 2014;67:734-744.
Fedson DS, Houck PM, Bratzler DW. Hospital-based influenza and pneumococcal vaccination: Sutton’s Law applied to prevention. Infect ControlHosp Epi. 2000;21:692-699.
Grohskopf LA, Alyanak E, Ferdinands JM, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021–22 Influenza Season. MMWR Recomm Rep 2021;70(No. RR-5):1–28. DOI: http://dx.doi.org/10.15585/mmwr.rr7005a1
Heron M (2015). Deaths: Leading Causes for 2012. National Vital StatisticsReports; vol 64 no 10. Hyattsville, MD: National Center for Health Statistics.2015.
Kostova D, Reed C, Finelli L, Cheng P, Gargiullo PM, Shay DK, Singleton JA,Meltzer MI, Lu P, Joseph S. (2013). Influenza Illness and HospitalizationsAverted by Influenza Vaccination in the United States, 2005–2011. PLoS One.2013; 8(6): e66312.
Mandell LA, Wunderink RG, Anzueta A, Bartlett JG, Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 March 1;44 Suppl2:S27-72.
Nichol KL, Nordin J, Mullooly J, et al. Influenza Vaccination and Reduction in Hospitalizations for Cardiac Disease and Stroke among the Elderly. N Engl JMed. 2003;348:1322-1332.
Reed C, Chaves SS, Daily Kirley P, Emerson R, Aragon D, Hancock EB, et al.(2015). Estimating Influenza Disease Burden from Population-Based Surveillance Data in the United States. PLoS ONE 10(3): e0118369
Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ,Fukuda. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003 January 8; 289 (2): 179-186.

Measure Algorithm:
IMM-2_pg1

Algorithm Narrative

IMM-2: Influenza Immunization
Numerator: Inpatient discharges who were screened for Influenza vaccine status and were vaccinated prior to discharge if indicated.
Denominator: Acute care hospitalized inpatients age 6 months and older discharged during October, November, December, January, February or March.

Variable Key: Patient Age

1. Start processing. Run cases, which are included in the Global Initial Patient Population and pass the edits defined in the Clinical Data Processing Flow, through this measure.

2. Calculate Patient Age. Patient Age, in years, is equal to the Admission Date minus the Birthdate. Use the month and day portion of admission date and birthdate to yield the most accurate age. Only cases with valid Admission Date and Birthdate will pass the critical feedback messages into the measure specific algorithms.

3. Check Patient Age
a. If the Patient Age is less than 6 months old, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
b. If the Patient Age is greater than or equal to 6 months, continue processing and proceed to ICD-10-PCS Principal or Other Procedure Codes.

4. Check ICD-10-PCS Principal or Other Procedure Codes
a. If at least one of ICD-10-PCS Principal or Other Procedure Codes is on Table 12.10 the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
b. If all of ICD-10-PCS Principal or Other Procedure Codes are missing or none of ICD-10-PCS Principal or Other Procedure Codes is on Table 12.10, continue processing and check Discharge Disposition.

5. Check Discharge Disposition
a. If Discharge Disposition is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
b. If Discharge Disposition equals 4, 6, or 7 the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
c. If Discharge Disposition equals 1, 2, 3, 5, or 8 continue processing and proceed to Discharge Date.

6. Check Discharge Date. Note: ‘yyyy’ refers to the specific year of discharge.
a. If the Discharge Date is 04-01-yyyy through 09-30-yyyy, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
b. If the Discharge Date is 10-01-yyyy through 03-31-yyyy, continue processing and proceed to Influenza Vaccination Status.

7. Check Influenza Vaccination Status
a. If Influenza Vaccination Status is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
b. If Influenza Vaccination Status equals 6, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
c. If Influenza Vaccination Status equals 1, 2, 3, 4, or 5, continue processing and recheck Influenza Vaccination Status.

8. Recheck Influenza Vaccination Status
a. If Influenza Vaccination Status equals 5, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
b. If Influenza Vaccination Status equals 1, 2, 3, or 4 the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population. Stop processing.

Specifications Manual for Joint Commission National Quality Measures (v2024A1)
Applicable 01-01-24 (1Q24) through 06-30-24 (2Q24)

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