Measure Information Form

***Removed from ORYX. Measure will be maintained until further notice.*** 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 (Grohskopf et al., 2021). 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 (Grohskopf et al., 2025). 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: An estimated 9.3 to 51 million people in the United States get influenza every season (Centers for Disease Control and Prevention [CDC], 2024a). Each year approximately 120,000 to 710,000 people in the US are hospitalized with complications from influenza and between 6,300 and 52,000 die from the disease and its complications (CDC, 2024a). In 2024, influenza, combined with pneumonia, is in the nation’s top 10 leading causes of death for ages 1 through 44 and those 65 and older (CDC, n.d.). About 14.1% of people of all ages hospitalized with influenza were admitted to the intensive care unit during the 2021-22 flu season, down from 22.3% during the 2013-14 flu season (Naquin et al., 2024). 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 (Grohskopf et al., 2025). Flu vaccines substantially reduced the risk of flu related medical visits and hospitalizations for all age groups during the 2023-24 flu season (CDC, 2024b).

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 (CDC, 2024c).

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 documentation of a severe allergic reaction (e.g. anaphylaxis) after previous dose of influenza vaccine or to vaccine component, OR history of Guillian-Barré syndrome within 6 weeks after a previous influenza vaccination OR moderate or severe acute illness with or without fever.

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:

Centers for Disease Control and Prevention. (n.d.). Leading causes of death, United States [WISQARS database]. U.S. Department of Health and Human Services. Retrieved April 28, 2026, from https://wisqars.cdc.gov/lcd/
Centers for Disease Control and Prevention. (2024a, February 25). Frequently asked questions about estimating influenza burden. U.S. Department of Health and Human Services. https://www.cdc.gov/flu-burden/php/about/faq.html
Centers for Disease Control and Prevention. (2024b, February 29). 2023-2024 flu vaccines reduce medical visits. U.S. Department of Health and Human Services. https://www.cdc.gov/flu/whats-new/2023-2024-vaccines-reduce-medical-visits.html
Centers for Disease Control and Prevention. (2024c, July 25). General best practices for immunization. U.S. Department of Health and Human Services. https://www.cdc.gov/vaccines/hcp/imz-best-practices/
Grohskopf, L. A., Alyanak, E., Ferdinands, J. M., Chung, J. R., Broder, K. R., Talbot, H. K., & Fry, A. M. (2021). Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021–22 influenza season. MMWR Recommendations and Reports, 70(RR 5), 1–28. https://doi.org/10.15585/mmwr.rr7005a1
Grohskopf, L. A., Blanton, L. H., Ferdinands, J. M., Reed, C., Dugan, V. G., & Daskalakis, D. C. (2025). Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2025–26 influenza season. MMWR Morbidity and Mortality Weekly Report, 74, 500–507. https://doi.org/10.15585/mmwr.mm7432a2
Naquin, A., O’Halloran, A., Ujamaa, D., Sundaresan, D., Masalovich, S., Cummings, C. N., Noah, K., Jain, S., Kirley, P. D., Alden, N. B., Austin, E., Meek, J., Yousey Hindes, K., Openo, K., Witt, L., Monroe, M. L., Henderson, J., Tellez Nunez, V., Lynfield, R., … Bozio, C. H. (2024). Laboratory confirmed influenza associated hospitalizations among children and adults — Influenza Hospitalization Surveillance Network, United States, 2010–2023. MMWR Surveillance Summaries, 73(SS 6), 1–18. https://doi.org/10.15585/mmwr.ss7706a1

Measure Algorithm:
Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step.

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 (v2027A)
Discharges 01-01-2027 (1Q27) through 06-30-2027 (2Q27)

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