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AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Topic Suggestion Description

View Topic Suggestion Disposition (PDF) 1.2 MB

Date submitted: December 07, 2012

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
Does a mandate that health care workers and volunteers be vaccinated annually against influenza have any effect on the rate of laboratory-confirmed influenza in nursing home patients?
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
Flu vaccine mandate, as in Arkansas and Rhode Island, versus voluntary vaccination, everywhere else.
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
Nursing home residents.
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
Decrease in incidence of laboratory-confirmed influezna
Describe any health-related risks, side effects, or harms that you are concerned about.
Impairment of the health care workers' right of informed consent to medical treatment (the coercion).

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Dementia, including Alzheimer's disease
  • Functional limitations and disability
AHRQ Priority Populations
  • Elderly
Federal Health Care Program
  • Medicaid
  • Medicare


Describe why this topic is important.
Health Care workers willingly accept vaccination requirements in cases (e.g. measles) where research establishes the benefit to their patients. If this could be accomplished for flu vaccination, it would greatly assist in assuring compliance. Also, the ethics of a flu vaccination mandate are questionable in the absence of solid evidence of effectiveness.
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
The new law in Rhode Island. I run the state's association of nursing homes, and we are experiencing serious resistance to a new regulatory requirement that all health care workers be vaccinated. The ethical problem is serious, since workers are threatened with losing their jobs if they don't comply. Careful review of relevant research reveals no solid evidence of effectiveness/efficacy. Although effectiveness/efficacy is strongly suggested, it has not been established because so few studies use laboratory confirmation of influenza.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
If yes, please explain:
See above. At the hearings concerning this proposed regulation, advocates on both sides of the question presented peer reviewed studies in support of their positions. Those studies don't definitively answer the question.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?
If annual flu vaccination provides sufficient protection to patients to justify the mandate, then all states should have the mandate. And if not, then flu vaccination should be optional.
Describe the timeframe in which an answer to your question is needed.
As soon as feasible, due to the public health implications
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
It applies to two groups: the 1.3 million or so nursing home residents in the United States, and the 2.5 million or so certified nursing assistants who provide their personal care. I focus on nursing assistants, because these are the individuals who get the least "benefit" (on a cost benefit basis), from being subjected to mandatory vaccination. They perform demanding work for low pay. But the question technically applies to all those who are employed in nursing homes.

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
  • Professional Society
Are you making a suggestion as an individual or on behalf of an organization?
Please tell us how you heard about the Effective Health Care Program
Came to the website to do research, and found it here.