***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Known disparities in pneumococcal vaccination in the community raise the question of whether disparities also exist in the nursing home setting , which is better controlled . This study used nationally representative nursing home data to compare black and white nursing home residents with respect to receiving , not receiving , or having an unknown PPV vaccination status , and to examine the interaction of race with various facility characteristics . DESIGN Multinomial logistic regression was used to analyze a 2-year merged file ( 1997 and 1999 ) of the National Nursing Home Survey , a cross-sectional national probability sample of nursing homes and residents . SETTING AND PARTICIPANTS Residents 65 years or older ( n = 14,782 ) residing in nursing homes between July and December of 1997 or 1999 . MEASUREMENTS Record-based staff report of whether residents ever had a pneumococcal immunization  ( yes/no/unknown ) ; race measured as black or white . RESULTS Pneumococcal vaccination rates are lower for black nursing home residents than for white residents , as shown using a merged file of the 1997 and 1999 National Nursing Home Surveys . Participants include 14,303 r and omly sample d residents 65 years or older . In this sample , 31 % of black residents compared with 24 % of white residents 65 years or older had never received pneumococcal vaccination ( P < .01 ) . Multivariate logistic regression confirmed that blacks were more likely to be unimmunized than whites ( 95 % CIs ) , specifically in Medicaid-only facilities and dually certified Medicare and Medicaid facilities . Blacks also had higher odds of unknown vaccination status than whites in Medicaid-only facilities and lower odds of unknown status in government-owned facilities . CONCLUSIONS Results suggest that the racial difference in pneumococcal vaccination exists predominantly in certain facility types . In addition , facility-based interventions such as having an organized PPV immunization program or improving documentation of vaccination status can be effective in increasing vaccination rates for all races OBJECTIVE To examine the effects of the racial composition of residents on nursing homes ' financial and quality performance . The study examined Medicare and Medicaid-certified nursing homes across the United States that su bmi tted Medicare cost reports between the years 1999 and 2004 ( 11,472 average per year ) . DATA SOURCE Data were obtained from the Minimum Data Set , the On-Line Survey Certification and Reporting , Medicare Cost Reports , and the Area Re source File . STUDY DESIGN Panel data regression with r and om intercepts and negative binomial regression were conducted with state and year fixed effects . PRINCIPAL FINDINGS Financial and quality performance differed between nursing homes with high proportions of black residents and nursing homes with no or medium proportions of black residents . Nursing homes with no black residents had higher revenues and higher operating margins and total profit margins and they exhibited better processes and outcomes than nursing homes with high proportions of black residents . CONCLUSION Nursing homes ' financial viability and quality of care are influenced by the racial composition of residents . Policy makers should consider initiatives to improve both the financial and quality performance of nursing homes serving predominantly black residents OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND  Influenza vaccination coverage  among nursing home residents has consistently been reported well below the Healthy People goals . We sought to determine if st and ing order programs ( SOPs ) in long-term care facilities are associated with greater  influenza vaccination coverage among residents . METHODS The National Nursing Home Survey ( 2004 ) is cross-sectional . A total of 1152 US long-term care facilities were systematic ally sample d with probability proportional to number of beds . A total of 11,939 people aged 65 years or older residing in sample d long-term care facilities between August and December 2004 were r and omly sample d.  Influenza vaccination  coverage of residents was obtained from facility records . Facility 's immunization program included st and ing orders versus other ( preprinted admission order , advance physician order , personal physician order , and no program ) . Multinomial logistic regression was used to examine the relationship between type of influenza immunization program  and receipt of vaccination , adjusted for resident and facility confounders . RESULTS The proportion of residents aged 65 years or older who received influenza vaccination  was 64 % ; 41 % of residents lived in a facility with an SOP . Influenza vaccination coverage among residents residing in facilities with st and ing orders was 68 % compared with 59 % to 63 % of residents in facilities with other program types . Logistic regression showed that st and ing order programs were independently associated with greater influenza vaccination coverage ( 66.7 % versus 62.0 % , P < .01 ) . CONCLUSION This study indicates that residents in long-term care facilities having st and ing order programs for influenza were more likely to be immunized . More research needs to be done to underst and how to facilitate adoption of these programs OBJECTIVE To evaluate collaborative efforts and intervention strategies by peer- review organizations ( PROs ) and long-term-care facilities ( LTCFs ) for improving pneumococcal vaccination rates among residents of LTCFs . DESIGN Prospect i ve , before-after quality improvement project . SETTING 133 LTCFs in Alaska , Idaho , Montana , and Wyoming . PATIENTS All residents of participating LTCFs . METHODS Baseline pneumococcal  vaccination rates were determined by medical-record review , self-reporting by patient or family members , and review of Medicare cl aims information . Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF . RESULTS 133 LTCFs with 7,623 residents from Alaska , Idaho , Montana , and Wyoming participated in this quality -improvement project . This accounted for 41 % ( 133/321 ) of the potential nursing homes and resident population in the participating states . Baseline overall vaccination rates were 40 % ( 3,050/7,589 ) . The overall vaccination rate improved to 75 % ( 5,720/7,623 , P<.001 ) . The number of facilities meeting the Healthy People 2000 vaccination goal of 80 % improved from 18 % ( 24/133 ) to 62 % ( 83/133 , P<.001 ) . Initial use of chart stickers and implementation of st and ing orders led to similar increases in vaccination rates , but the st and ing-order strategy required commitment of fewer PRO re sources at a statewide level . Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70 % in facilities enforcing a st and ing-order policy . CONCLUSIONS Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates . Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives . St and ing orders appear to be one intervention effective in sustaining successful vaccination efforts . Regardless of the specific interventions employed , PROs played a significant role in facilitating vaccination program development and intervention implementation OBJECTIVES To assess Advisory Committee for Immunization Practice s recommendations for the pneumococcal vaccine in nursing home residents using national surveys to examine factors associated with vaccination . DESIGN Cross-sectional national sample surveys of nursing homes and nursing home residents with a two-stage probability design , stratified on size and Medicare and Medicaid certification status . SETTING U.S. nursing homes during 1995 , 1997 , and 1999 . PARTICIPANTS Six current residents were r and omly selected from each facility ( n = approximately 8,000 each year ) . MEASUREMENTS Residents '  pneumococcal vaccination status was obtained by asking the facility respondent for each resident : " Has [ the resident ] EVER had a pneumococcal vaccine , that is a pneumonia vaccination ? " Vaccination status was coded as yes , no , and unknown . RESULTS The proportion of residents aged 65 and older that received pneumococcal vaccination increased significantly , from 23.6 % in 1995 to 28.2 % in 1997 to 37.4 % in 1999 ( P<.001 ) . The proportion of residents in homes with pneumococcal immunization programs increased significantly , from 65.2 % in 1995 to 88.9 % in 1999 . CONCLUSION The proportion of  nursing home residents aged 65 and older  receiving the pneumococcal vaccine increased significantly from 1995 to 1999 . Residents living in nursing homes with programs for pneumococcal immunizations were significantly more likely to be vaccinated OBJECTIVE To identify nursing home resident and facility characteristics associated with patients not receiving influenza immunization and having unknown immunization status . DESIGN Secondary data analysis using multinomial logistic regression of data from the National Nursing Home Survey , a nationally representative establishment-based survey . SETTING A total of 1,423 nursing facilities of all ownerships and certifications systematic ally sample d with probability proportional to number of beds . PATIENTS A total of 7,350 r and omly sample d people aged 65 years or older residing in nursing homes between July and December 1999 ( approximately 6 per facility ) . MAIN OUTCOME MEASURE Immunization status of residents . RESULTS Fifteen percent of residents were not immunized and 19 % had unknown immunization status . In multivariate analysis , lack of immunization and unknown immunization status were each separately associated with being newly admitted , with no or unknown pneumococcal immunization , and with facility failures to screen for immunization and to record inoculation in the medical record . High-risk status and staff immunization requirements had no effect . Separate analyses showed that residents with unknown immunization status are statistically significantly different from both those vaccinated and those not vaccinated . CONCLUSION This study indicates that both resident and facility characteristics are associated with failure to be immunized for influenza . Facilities should consider targeting younger , newly admitted , and residential care residents for influenza immunization , since they are more likely to be missed . Further research into the barriers to immunization specific to nursing home resident choice or opportunity may be warranted OBJECTIVES To determine whether the racial inequity between African Americans and Caucasians in receipt of influenza vaccine  is narrower in residents of nursing homes with facility-wide vaccination strategies than in residents of facilities without vaccination strategies . DESIGN Secondary data analysis using the National Nursing Home Survey 2004 , a nationally representative survey . SETTING One thous and one hundred seventy-four participating nursing homes sample d systematic ally with probability proportional to bed size . PARTICIPANTS Thirteen thous and five hundred seven r and omly sample d residents of nursing homes between August and December 2004 . MEASUREMENTS Receipt of influenza vaccine within the last year .  Logistic regression was used to examine the relationship between facility-level  influenza immunization strategy  and racial inequity in receipt of vaccination , adjusted for characteristics at the resident , facility , state , and regional levels . RESULTS Overall in the United States , vaccination coverage was higher for Caucasian and African-American residents ; the racial vaccination gaps were smaller ( < 6 percentage points ) and nons 
    Output:
    
Research ers reported racial/ethnic minorities were more likely to refuse vaccinations and less likely to have vaccinations offered and their vaccination status tracked compared to Whites .