In the last post, I explained that CDC was the source of the plan to investigate rates of healthcare worker flu vaccinations. CDC collaborates with the Centers for Medicare and Medicaid Services to use staff (and patient) flu vaccination rates to calculate hospital “quality” — and the “quality” number determines up to 4% of acute care hospitals’ total Medicare reimbursements.
It turns out that the same person, Faruque Ahmed, PhD of CDC’s Immunization Services Division is both the responsible person for getting NQF #0431 (healthcare worker [HCW] yearly flu shots) accepted as a quality measure, and is first author of CDC’s meta-analysis of healthcare worker/ healthcare personnel flu shots and whether they benefited patients. Studies over 64 years fail to show that staff vaccinations reduce flu infections and deaths in patients–but good luck figuring that out from the gobbledygook they published.
I wondered how Dr. Ahmed squared forcing a million American healthcare workers to get yearly flu shots with his evaluation of the lack of evidence to support them.
While I can’t tell you what he thought, I can tell you what he and his coauthors did. They created a smokescreen.
First, they wrote long, confusing sentences so it was very difficult to extract their meaning. For example:
“… It would have been preferable to have data on influenza‐specific mortality and hospitalization, but direct ascertainment of these specific outcomes is problematic because of the difficulty of distinguishing whether hospitalizations and deaths due to exacerbation of chronic illnesses and other conditions are attributable to the complications of influenza or to other reasons; estimates of influenza‐associated mortality and hospitalization are usually computed at the population level using statistical modeling techniques…”
Second, they said that although they had evaluated the world literature on this subject from 1948 to mid 2012 (over 6,000 articles had been considered and eventually whittled down to 8), the quality of the evidence of the 8 papers that made the cut was only moderate or low.
Third, the authors did some handwaving about the importance of evidence quality and transparency when making recommendations. Yet they admit that the quality of evidence they used was poor, and their recommendation is characterized by utter lack of transparency.
Fourth, the paper concludes in surprising fashion. Despite lack of discussion of safety, the authors assert that the benefits of staff vaccinations outweigh the harms (which they never weighed) and that they “can” enhance patient safety. Note that they didn’t say vaccinations do enhance patient safety, only that they can. Presumably they refer to an alternate universe in which there is an alternate body of medical literature:
“For any clinical question, the quality of evidence will vary based on the question and the context, and the best available evidence should be used for developing recommendations. An evidence‐based approach for developing recommendations requires transparency concerning the evidence and transparency in how judgments regarding the quality of evidence were made. Key factors for developing recommendations include the quality of evidence, balance of benefits and harms, values and preferences, and health economic analyses.[7, 39] The benefits of HCP influenza vaccination, which include likely reduction in morbidity and mortality among patients and reduction in illness among HCP themselves, outweigh possible harms. HCP influenza vaccination can enhance patient safety.”
To coin a phrase, “You’re doing a heck of a job, Faruque.” And CDC thinks so, too:
“Dr. Ahmed’s responsibilities at CDC include developing and directing an innovative, cutting edge, and methodologically sound research program on adult immunization to move health services interventions and evaluations into national, state and local vaccine-preventable diseases prevention strategies, programs and policies. The research includes evaluation of immunization services activities in both the public and private sectors, and translation of science into practice. Dr. Ahmed is a recipient of the Partners in Public Health CDC Civil Service Honor Award.”