{"id":"https://openalex.org/W7225612836","doi":"https://doi.org/10.1016/j.jamda.2026.106541","title":"Challenges and Improvement Strategies to Increase Staff Vaccination Coverage in Long-Term Care","display_name":"Challenges and Improvement Strategies to Increase Staff Vaccination Coverage in Long-Term Care","publication_year":2026,"publication_date":"2026-11-09","ids":{"openalex":"https://openalex.org/W7225612836","doi":"https://doi.org/10.1016/j.jamda.2026.106541","pmid":"https://pubmed.ncbi.nlm.nih.gov/43002984"},"language":"en","primary_location":{"id":"doi:10.1016/j.jamda.2026.106541","doi":"https://doi.org/10.1016/j.jamda.2026.106541","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jamda.2026.106541","pdf_url":"https://www.jamda.com/article/S1525-8610(26)00431-7/pdf","source":{"id":"https://openalex.org/S132839637","display_name":"Journal of the American Medical Directors Association","issn_l":"1525-8610","issn":["1525-8610","1538-9375"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-c","doyens","jufo-2","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the American Medical Directors Association","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://www.jamda.com/article/S1525-8610(26)00431-7/pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5028878439","display_name":"Elizabeth A. Sobczyk","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Elizabeth A. Sobczyk","raw_affiliation_strings":["The Post-Acute and Long-Term Care Medical Association, Columbia, MD, USA. Electronic address: esobczyk@paltmed.org"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"The Post-Acute and Long-Term Care Medical Association, Columbia, MD, USA. Electronic address: esobczyk@paltmed.org","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5111969194","display_name":"Ellen M. Schultz","orcid":"https://orcid.org/0009-0001-3728-0566","observed_orcids":["https://orcid.org/0009-0001-3728-0566"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Ellen M. Schultz","raw_affiliation_strings":["Ellen Schultz Consulting, Deerfield, IL, USA"],"raw_orcid":"https://orcid.org/0009-0001-3728-0566","affiliations":[{"raw_affiliation_string":"Ellen Schultz Consulting, Deerfield, IL, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5113532901","display_name":"David M. Casey","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"David M. Casey","raw_affiliation_strings":["The Post-Acute and Long-Term Care Medical Association, Columbia, MD, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"The Post-Acute and Long-Term Care Medical Association, Columbia, MD, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5093748829","display_name":"Heather L Roney","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Heather L. Roney","raw_affiliation_strings":["The Post-Acute and Long-Term Care Medical Association, Columbia, MD, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"The Post-Acute and Long-Term Care Medical Association, Columbia, MD, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161351649","display_name":"Rachel C. Davis","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Rachel C. Davis","raw_affiliation_strings":["Rachel Davis Consulting, Denver, CO, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Rachel Davis Consulting, Denver, CO, USA","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5001649882","display_name":"Amy Parker Fiebelkorn","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1289490764","display_name":"Centers for Disease Control and Prevention","ror":"https://ror.org/042twtr12","country_code":"US","type":"government","lineage":["https://openalex.org/I1289490764","https://openalex.org/I1299022934"]},{"id":"https://openalex.org/I150468666","display_name":"Emory University","ror":"https://ror.org/03czfpz43","country_code":"US","type":"education","lineage":["https://openalex.org/I150468666"]},{"id":"https://openalex.org/I19085752","display_name":"National Center for Immunization and Respiratory Diseases","ror":"https://ror.org/05je2tx78","country_code":"US","type":"facility","lineage":["https://openalex.org/I1289490764","https://openalex.org/I1299022934","https://openalex.org/I19085752","https://openalex.org/I4210109567"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Amy Parker Fiebelkorn","raw_affiliation_strings":["Rollins School of Public Health, Emory University, Atlanta, GA, USA; Formerly Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Rollins School of Public Health, Emory University, Atlanta, GA, USA; Formerly Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA","institution_ids":["https://openalex.org/I1289490764","https://openalex.org/I150468666","https://openalex.org/I19085752"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5028878439"],"corresponding_institution_ids":[],"apc_list":{"value":4370,"currency":"USD","value_usd":4370},"apc_paid":{"value":4370,"currency":"USD","value_usd":4370},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"28","issue":"1","first_page":"106541","last_page":"106541"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10833","display_name":"Vaccine Coverage and Hesitancy","score":0.9940999746322632,"subfield":{"id":"https://openalex.org/subfields/3306","display_name":"Health"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10833","display_name":"Vaccine Coverage and Hesitancy","score":0.9940999746322632,"subfield":{"id":"https://openalex.org/subfields/3306","display_name":"Health"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11376","display_name":"Geriatric Care and Nursing Homes","score":0.0027000000700354576,"subfield":{"id":"https://openalex.org/subfields/2717","display_name":"Geriatrics and Gerontology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11000","display_name":"Infection Control in Healthcare","score":0.0007999999797903001,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/long-term-care","display_name":"long-term care","score":0.8859999775886536},{"id":"https://openalex.org/keywords/post-acute-care","display_name":"post-acute care","score":0.8949999809265137},{"id":"https://openalex.org/keywords/skilled-nursing-facilities","display_name":"skilled nursing facilities","score":0.9570000171661377},{"id":"https://openalex.org/keywords/assisted-living","display_name":"assisted living","score":0.9649999737739563},{"id":"https://openalex.org/keywords/covid-19-vaccines","display_name":"COVID-19 vaccines","score":0.859000027179718},{"id":"https://openalex.org/keywords/influenza-vaccination","display_name":"influenza vaccination","score":0.9980000257492065},{"id":"https://openalex.org/keywords/hepatitis-b-vaccine","display_name":"hepatitis B vaccine","score":1.0},{"id":"https://openalex.org/keywords/vaccine-hesitancy","display_name":"vaccine hesitancy","score":0.9670000076293945},{"id":"https://openalex.org/keywords/labor-shortage","display_name":"labor shortage","score":0.7770000100135803},{"id":"https://openalex.org/keywords/job-autonomy","display_name":"employee autonomy","score":0.6200000047683716},{"id":"https://openalex.org/keywords/quality-improvement-strategies","display_name":"quality improvement strategies","score":0.671999990940094}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.896399974822998},{"id":"https://openalex.org/C2777512617","wikidata":"https://www.wikidata.org/wiki/Q1783605","display_name":"Staffing","level":2,"score":0.7709000110626221},{"id":"https://openalex.org/C22070199","wikidata":"https://www.wikidata.org/wiki/Q192995","display_name":"Vaccination","level":2,"score":0.7544000148773193},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.483599990606308},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.42910000681877136},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.4162999987602234},{"id":"https://openalex.org/C71405471","wikidata":"https://www.wikidata.org/wiki/Q757012","display_name":"Quality management","level":3,"score":0.4025000035762787},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.4016000032424927},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.38100001215934753},{"id":"https://openalex.org/C166888038","wikidata":"https://www.wikidata.org/wiki/Q4118322","display_name":"Infection control","level":2,"score":0.35339999198913574},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.3458999991416931},{"id":"https://openalex.org/C2780668467","wikidata":"https://www.wikidata.org/wiki/Q1333024","display_name":"Personal protective equipment","level":5,"score":0.3271999955177307},{"id":"https://openalex.org/C3008058167","wikidata":"https://www.wikidata.org/wiki/Q84263196","display_name":"Coronavirus disease 2019 (COVID-19)","level":4,"score":0.3237999975681305},{"id":"https://openalex.org/C2779530757","wikidata":"https://www.wikidata.org/wiki/Q1207505","display_name":"Quality (philosophy)","level":2,"score":0.30730000138282776},{"id":"https://openalex.org/C2780233487","wikidata":"https://www.wikidata.org/wiki/Q6672123","display_name":"Long-term care","level":2,"score":0.2833999991416931},{"id":"https://openalex.org/C2989236134","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Patient care","level":2,"score":0.27880001068115234},{"id":"https://openalex.org/C2775876817","wikidata":"https://www.wikidata.org/wiki/Q157661","display_name":"Hepatitis A","level":3,"score":0.2718000113964081},{"id":"https://openalex.org/C2778139618","wikidata":"https://www.wikidata.org/wiki/Q13440398","display_name":"Workforce","level":2,"score":0.2712000012397766},{"id":"https://openalex.org/C12725497","wikidata":"https://www.wikidata.org/wiki/Q810247","display_name":"Baseline (sea)","level":2,"score":0.2696000039577484},{"id":"https://openalex.org/C89623803","wikidata":"https://www.wikidata.org/wiki/Q12184","display_name":"Pandemic","level":5,"score":0.26570001244544983},{"id":"https://openalex.org/C5395021","wikidata":"https://www.wikidata.org/wiki/Q1061410","display_name":"Program evaluation","level":2,"score":0.2578999996185303},{"id":"https://openalex.org/C3019644165","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing staff","level":2,"score":0.2578999996185303},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.2540000081062317}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1016/j.jamda.2026.106541","doi":"https://doi.org/10.1016/j.jamda.2026.106541","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jamda.2026.106541","pdf_url":"https://www.jamda.com/article/S1525-8610(26)00431-7/pdf","source":{"id":"https://openalex.org/S132839637","display_name":"Journal of the American Medical Directors Association","issn_l":"1525-8610","issn":["1525-8610","1538-9375"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-c","doyens","jufo-2","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the American Medical Directors Association","raw_type":"journal-article"},{"id":"pmid:43002984","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/43002984","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the American Medical Directors Association","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.1016/j.jamda.2026.106541","doi":"https://doi.org/10.1016/j.jamda.2026.106541","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jamda.2026.106541","pdf_url":"https://www.jamda.com/article/S1525-8610(26)00431-7/pdf","source":{"id":"https://openalex.org/S132839637","display_name":"Journal of the American Medical Directors Association","issn_l":"1525-8610","issn":["1525-8610","1538-9375"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-c","doyens","jufo-2","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the American Medical Directors Association","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":1.0,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[{"id":"https://openalex.org/F4320332162","display_name":"Centers for Disease Control and Prevention","ror":"https://ror.org/042twtr12"}],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225612836.pdf","grobid_xml":"https://content.openalex.org/works/W7225612836.grobid-xml"},"referenced_works_count":14,"referenced_works":["https://openalex.org/W2734790791","https://openalex.org/W3014825142","https://openalex.org/W3211141169","https://openalex.org/W4200248378","https://openalex.org/W4282959103","https://openalex.org/W4376223641","https://openalex.org/W4388414076","https://openalex.org/W4389660761","https://openalex.org/W4402572806","https://openalex.org/W4403941152","https://openalex.org/W4409154615","https://openalex.org/W4412391995","https://openalex.org/W4415103961","https://openalex.org/W7167513379"],"related_works":["https://openalex.org/W7167513379","https://openalex.org/W2077881318","https://openalex.org/W7128707510","https://openalex.org/W2163794537","https://openalex.org/W1579774505","https://openalex.org/W1971510406","https://openalex.org/W4379538389","https://openalex.org/W4412391995","https://openalex.org/W2047037040","https://openalex.org/W3211141169"],"abstract_inverted_index":{"OBJECTIVES:":[0],"Keeping":[1],"staff":[2,42,89,120,147,176,234,238,279],"in":[3,55,82,99,239,266],"post-acute":[4],"and":[5,21,61,73,90,96,109,128,135,152,163,210,236,250,260,291,295],"long-term":[6],"care":[7],"(PALTC)":[8],"settings":[9],"up":[10],"to":[11,18,28,36,48,141,258],"date":[12],"on":[13,229],"adult":[14],"vaccinations":[15],"is":[16],"important":[17],"protect":[19],"them":[20],"reduce":[22],"the":[23,83,94],"spread":[24],"of":[25,107,166,181,197,212],"vaccine-preventable":[26],"illness":[27],"residents.":[29],"This":[30],"quality":[31],"improvement":[32,45,193],"(QI)":[33],"project":[34,53],"aimed":[35],"increase":[37],"vaccination":[38,116,121,148,177,231,280,289],"coverage":[39,122,149,187,203,219,270,281],"among":[40],"PALTC":[41,278],"while":[43],"exploring":[44],"strategies":[46],"tailored":[47],"this":[49],"setting.":[50],"DESIGN:":[51],"QI":[52,66,84,86,113,168,227],"conducted":[54],"2,":[56],"12-month":[57],"cohorts":[58],"between":[59],"2022":[60],"2024.":[62],"SETTING":[63],"AND":[64,275],"PARTICIPANTS:":[65],"teams":[67,87,114],"from":[68],"15":[69,198],"skilled":[70],"nursing":[71],"facilities":[72,77,140,172,183,199,214],"6":[74,213],"assisted":[75],"living":[76],"across":[78,160],"9":[79],"states":[80],"participated":[81],"project.":[85],"included":[88],"administrators":[91],"working":[92],"at":[93,150],"facility":[95],"corporate":[97],"level":[98],"roles":[100],"such":[101],"as":[102],"medical":[103],"directors,":[104],"directors/assistant":[105],"directors":[106],"nursing,":[108],"infection":[110],"preventionists.":[111],"METHODS:":[112],"implemented":[115],"strategies,":[117],"reported":[118],"monthly":[119,132],"for":[123,264,293],"3":[124],"vaccines":[125],"(COVID-19,":[126],"influenza,":[127],"hepatitis":[129,217],"B),":[130],"received":[131],"technical":[133],"assistance,":[134],"met":[136],"quarterly":[137],"with":[138,184,200,215],"other":[139],"share":[142],"lessons":[143],"learned.":[144],"We":[145],"report":[146,261],"baseline":[151],"end":[153],"point":[154],"by":[155,244],"vaccine,":[156],"highlight":[157],"common":[158],"challenges":[159],"participating":[161],"facilities,":[162],"provide":[164],"examples":[165],"facilities'":[167],"strategies.":[169],"RESULTS:":[170],"Most":[171],"did":[173],"not":[174],"improve":[175],"coverage.":[178],"Only":[179],"1":[180],"16":[182],"complete":[185,201,216],"COVID-19":[186],"data":[188,204,220,248,263,286],"(6%)":[189],"showed":[190,222],"a":[191],"modest":[192],"over":[194],"time,":[195],"7":[196],"influenza":[202],"(47%)":[205],"maintained":[206],"or":[207],"improved":[208],"coverage,":[209],"4":[211],"B":[218],"(67%)":[221],"improvement.":[223],"Facilities":[224,253],"focused":[225],"their":[226],"efforts":[228],"making":[230,288],"convenient,":[232],"respecting":[233],"autonomy,":[235],"engaging":[237],"dialog":[240],"but":[241],"were":[242],"challenged":[243],"staffing":[245],"shortages,":[246],"limited":[247],"infrastructure,":[249],"vaccine":[251,297],"hesitancy.":[252],"found":[254],"it":[255],"especially":[256],"difficult":[257],"gather":[259],"immunization":[262],"staff;":[265],"some":[267],"cases,":[268],"low":[269],"reflected":[271],"missing":[272],"data.":[273],"CONCLUSIONS":[274],"IMPLICATIONS:":[276],"Improving":[277],"nationally":[282],"will":[283],"require":[284],"addressing":[285,296],"gaps,":[287],"convenient":[290],"affordable":[292],"staff,":[294],"hesitancy":[298],"through":[299],"respectful":[300],"dialog.":[301]},"counts_by_year":[],"updated_date":"2026-11-11T12:16:26.678958","created_date":"2026-11-10T00:00:00"}