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2.
Med Care ; 59(12): 1099-1106, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1447673

ABSTRACT

BACKGROUND: The Skilled Nursing Facility Value-based Purchasing Program (SNF-VBP) incentivizes facilities to coordinate care, improve quality, and lower hospital readmissions. However, SNF-VBP may unintentionally punish facilities with lower profit margins struggling to invest resources to lower readmissions. OBJECTIVE: The objective of this study was to estimate the SNF-VBP penalty amounts by skilled nursing facility (SNF) profit margin quintiles and examine whether facilities with lower profit margins are more likely to be penalized by SNF-VBP. RESEARCH DESIGN: We combined the first round of SNF-VBP performance data with SNF profit margins and characteristics data. Our outcome variables included estimated penalty amount and a binary measure for whether facilities were penalized by the SNF-VBP. We categorized SNFs into 5 profit margin quintiles and examined the relationship between profit margins and SNF-VBP performance using descriptive and regression analysis. RESULTS: The average profit margins for SNFs in the lowest profit margin quintile was -14.4% compared with the average profit margin of 11.1% for SNFs in the highest profit margin quintile. In adjusted regressions, SNFs in the lowest profit margin quintile had 17% higher odds of being penalized under SNF-VBP compared with facilities in the highest profit margin quintile. The average penalty for SNFs in the lowest profit margin quintile was $22,312. CONCLUSIONS: SNFs in the lowest profit margins are more likely to be penalized by the SNF-VBP, and these losses can exacerbate quality problems in SNFs with lower quality. Alternative approaches to measuring and rewarding SNFs under SNF-VBP or programs to assist struggling SNFs is warranted, particularly considering the coronavirus disease 2019 pandemic, which requires resources for prevention and management.


Subject(s)
Skilled Nursing Facilities/economics , Skilled Nursing Facilities/statistics & numerical data , Value-Based Purchasing/economics , Value-Based Purchasing/statistics & numerical data , Medicare/organization & administration , Reimbursement, Incentive/organization & administration , United States
5.
Stroke ; 52(3): 905-912, 2021 03.
Article in English | MEDLINE | ID: covidwho-1066984

ABSTRACT

BACKGROUND AND PURPOSE: Acute ischemic stroke may occur in patients with coronavirus disease 2019 (COVID-19), but risk factors, in-hospital events, and outcomes are not well studied in large cohorts. We identified risk factors, comorbidities, and outcomes in patients with COVID-19 with or without acute ischemic stroke and compared with patients without COVID-19 and acute ischemic stroke. METHODS: We analyzed the data from 54 health care facilities using the Cerner deidentified COVID-19 dataset. The dataset included patients with an emergency department or inpatient encounter with discharge diagnoses codes that could be associated to suspicion of or exposure to COVID-19 or confirmed COVID-19. RESULTS: A total of 103 (1.3%) patients developed acute ischemic stroke among 8163 patients with COVID-19. Among all patients with COVID-19, the proportion of patients with hypertension, diabetes, hyperlipidemia, atrial fibrillation, and congestive heart failure was significantly higher among those with acute ischemic stroke. Acute ischemic stroke was associated with discharge to destination other than home or death (relative risk, 2.1 [95% CI, 1.6-2.4]; P<0.0001) after adjusting for potential confounders. A total of 199 (1.0%) patients developed acute ischemic stroke among 19 513 patients without COVID-19. Among all ischemic stroke patients, COVID-19 was associated with discharge to destination other than home or death (relative risk, 1.2 [95% CI, 1.0-1.3]; P=0.03) after adjusting for potential confounders. CONCLUSIONS: Acute ischemic stroke was infrequent in patients with COVID-19 and usually occurs in the presence of other cardiovascular risk factors. The risk of discharge to destination other than home or death increased 2-fold with occurrence of acute ischemic stroke in patients with COVID-19.


Subject(s)
Atrial Fibrillation/epidemiology , COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Heart Failure/epidemiology , Hospital Mortality , Hyperlipidemias/epidemiology , Hypertension/epidemiology , Ischemic Stroke/epidemiology , Acute Kidney Injury/epidemiology , Adult , African Americans , Aged , Aged, 80 and over , Brain Edema/epidemiology , COVID-19/ethnology , Cerebral Hemorrhage/epidemiology , Cohort Studies , Comorbidity , Female , Hospitals, Rehabilitation/statistics & numerical data , Humans , Ischemic Stroke/ethnology , Liver Failure/epidemiology , Male , Middle Aged , Myocardial Infarction/epidemiology , Nursing Homes/statistics & numerical data , Patient Discharge , Respiratory Insufficiency/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Skilled Nursing Facilities/statistics & numerical data , United States/epidemiology
6.
J Am Geriatr Soc ; 69(7): 1722-1728, 2021 07.
Article in English | MEDLINE | ID: covidwho-1066719

ABSTRACT

OBJECTIVE: To describe the frequency and timing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody detection in a convenience sample of skilled nursing facility (SNF) residents with and without confirmed SARS-CoV-2 infection. DESIGN: Retrospective analysis of SNF electronic health records. SETTING: Qualitative SARS-CoV-2 antibody test results were available from 81 SNFs in 16 states. PARTICIPANTS: Six hundred and sixty nine SNF residents who underwent both polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2. MEASUREMENTS: Presence of SARS-CoV-2 antibodies following the first positive PCR test for confirmed cases, or first PCR test for non-cases. RESULTS: Among 397 residents with PCR-confirmed infection, antibodies were detected in 4 of 7 (57.1%) tested within 7-14 days of their first positive PCR test; in 44 of 47 (93.6%) tested within 15-30 days; in 182 of 219 (83.1%) tested within 31-60 days; and in 110 of 124 (88.7%) tested after 60 days. Among 272 PCR negative residents, antibodies were detected in 2 of 9 (22.2%) tested within 7-14 days of their first PCR test; in 41 of 81 (50.6%) tested within 15-30 days; in 65 of 148 (43.9%) tested within 31-60 days; and in 9 of 34 (26.5%) tested after 60 days. No significant differences in baseline resident characteristics or symptoms were observed between those with versus without antibodies. CONCLUSIONS: These findings suggest that vulnerable older adults can mount an antibody response to SARS-CoV-2, and that antibodies are most likely to be detected within 15-30 days of diagnosis. That antibodies were detected in a large proportion of residents with no confirmed SARS-CoV-2 infection highlights the complexity of identifying who is infected in real time. Frequent surveillance and diagnostic testing based on low thresholds of clinical suspicion for symptoms and/or exposure will remain critical to inform strategies designed to mitigate outbreaks in SNFs while community SARS-CoV-2 prevalence remains high.


Subject(s)
COVID-19 Serological Testing/methods , COVID-19 , SARS-CoV-2 , Skilled Nursing Facilities , Aged , Aged, 80 and over , Asymptomatic Infections/epidemiology , COVID-19/blood , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Nucleic Acid Testing/statistics & numerical data , Early Diagnosis , Electronic Health Records/statistics & numerical data , Female , Health Services Needs and Demand , Humans , Male , Prevalence , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , Skilled Nursing Facilities/standards , Skilled Nursing Facilities/statistics & numerical data , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data , United States/epidemiology
7.
Health Aff (Millwood) ; 40(1): 146-155, 2021 01.
Article in English | MEDLINE | ID: covidwho-1007110

ABSTRACT

Medicare's Skilled Nursing Facility Value-Based Purchasing Program, which awards value-based incentive payments based on hospital readmissions, distributed its first two rounds of incentives during fiscal years 2019 and 2020. Incentive payments were based on achievement or improvement scores-whichever was better. Incentive payments were as low as -2.0 percent in both program years and as high as +1.6 percent in FY 2019 and +3.1 percent in FY 2020. In FY 2019, 26 percent of facilities earned positive incentives and 72 percent earned negative incentives, compared with 19 percent positive and 65 percent negative incentives in FY 2020. Larger, rural, and not-for-profit facilities were more likely to earn positive incentives, as were those with the highest registered nurse staffing levels. Although these findings indicate the potential to reward high-quality care at skilled nursing facilities, intended and unintended outcomes of this new value-based purchasing program should be monitored closely for possible program refinements, particularly in light of the disproportionate impacts of coronavirus disease 2019 (COVID-19) on nursing facilities.


Subject(s)
Medicare , Motivation , Patient Readmission/statistics & numerical data , Skilled Nursing Facilities/statistics & numerical data , Value-Based Purchasing/statistics & numerical data , COVID-19 , Humans , Medicare/economics , Medicare/statistics & numerical data , Quality of Health Care/standards , Skilled Nursing Facilities/economics , United States
8.
Disabil Health J ; 14(2): 101051, 2021 04.
Article in English | MEDLINE | ID: covidwho-957008

ABSTRACT

BACKGROUND: People with intellectual and developmental disabilities (IDD) appear to be at greater risk for severe outcomes from COVID-19. The roles of congregate living and skilled nursing care needs in this disparity are unclear. OBJECTIVE: To determine the impact of residential setting and level of skilled nursing care on COVID-19 outcomes for people receiving IDD services, compared to those not receiving IDD services. METHODS: Utilizing publicly available California data on COVID-19 outcomes for people receiving IDD services (early May through October 2, 2020), we report outcomes based on seven types of residence, differentiated by number of residents and level of skilled nursing care provided. We compared these results to the larger California published outcomes. RESULTS: Compared to Californians not receiving IDD services, in general, those receiving IDD services had a 60% lower case rate, but 2.8 times higher case-fatality rate. COVID-19 outcomes varied significantly among Californians receiving IDD services by type of residence and skilled nursing care needs: higher rates of diagnosis in settings with larger number of residents, higher case-fatality and mortality rates in settings that provided 24-h skilled nursing care. CONCLUSIONS: Diagnosis with COVID-19 among Californians receiving IDD services appears to be related to the number of individuals within the residence, while adverse COVID-19 outcomes were associated with level of skilled nursing care. When data is available, future research should examine whether these relationships persist even when controlling for age and pre-existing conditions.


Subject(s)
COVID-19/complications , Developmental Disabilities/complications , Disabled Persons/statistics & numerical data , Health Status Disparities , Intellectual Disability/complications , Residential Facilities/statistics & numerical data , Adult , California , Child , Female , Humans , SARS-CoV-2 , Skilled Nursing Facilities/statistics & numerical data
9.
BMJ Open ; 10(10): e038390, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-810653

ABSTRACT

INTRODUCTION: In order to avoid unnecessary hospital admission and associated complications, there is an urgent need to improve the early detection of infection in nursing home residents. Monitoring signs and symptoms with checklists or aids called decision support tools may help nursing home staff to detect infection in residents, particularly during the current COVID-19 pandemic.We plan to conduct a survey exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden. METHODS AND ANALYSIS: An international cross-sectional descriptive survey, using a pretested questionnaire, will be used to explore nurses, care workers and managers views and experiences of how infections are detected and managed in practice in nursing homes. Data will be analysed descriptively and univariate associations between personal and organisational factors explored. This will help identify important factors related to awareness, knowledge, attitudes, belief and skills likely to affect future implementation of a decision support tool for the early detection of infection in nursing home residents. ETHICS AND DISSEMINATION: This study was approved using the self-certification process at the University of Surrey and Linköping University ethics committee (Approval 2018/514-32) in 2018. Study findings will be disseminated through community/stakeholder/service user engagement events in each country, publication in academic peer-reviewed journals and conference presentations. A LAY summary will be provided to participants who indicate they would like to receive this information.This is the first stage of a plan of work to revise and evaluate the Early Detection of Infection Scale (EDIS) tool and its effect on managing infections and reducing unplanned hospital admissions in nursing home residents. Implementation of the EDIS tool may have important implications for the healthcare economy; this will be explored in cost-benefit analyses as the work progresses.


Subject(s)
Communicable Disease Control , Coronavirus Infections , Medical Overuse/prevention & control , Nursing Homes/statistics & numerical data , Pandemics , Patient Care Management , Pneumonia, Viral , Skilled Nursing Facilities/statistics & numerical data , Betacoronavirus/isolation & purification , COVID-19 , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Cost-Benefit Analysis , Cross-Sectional Studies , England/epidemiology , Health Knowledge, Attitudes, Practice , Health Personnel/standards , Hospitalization , Humans , Patient Care Management/economics , Patient Care Management/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Practice Management/economics , Research Design , SARS-CoV-2 , Sweden/epidemiology
10.
Age Ageing ; 50(1): 16-20, 2021 01 08.
Article in English | MEDLINE | ID: covidwho-780321

ABSTRACT

In the COVID-19 pandemic, patients who are older and residents of long-term care facilities (LTCF) are at greatest risk of worse clinical outcomes. We reviewed discharge criteria for hospitalised COVID-19 patients from 10 countries with the highest incidence of COVID-19 cases as of 26 July 2020. Five countries (Brazil, Mexico, Peru, Chile and Iran) had no discharge criteria; the remaining five (USA, India, Russia, South Africa and the UK) had discharge guidelines with large inter-country variability. India and Russia recommend discharge for a clinically recovered patient with two negative reverse transcription polymerase chain reaction (RT-PCR) tests 24 h apart; the USA offers either a symptom based strategy-clinical recovery and 10 days after symptom onset, or the same test-based strategy. The UK suggests that patients can be discharged when patients have clinically recovered; South Africa recommends discharge 14 days after symptom onset if clinically stable. We recommend a unified, simpler discharge criteria, based on current studies which suggest that most SARS-CoV-2 loses its infectivity by 10 days post-symptom onset. In asymptomatic cases, this can be taken as 10 days after the first positive PCR result. Additional days of isolation beyond this should be left to the discretion of individual clinician. This represents a practical compromise between unnecessarily prolonged admissions and returning highly infectious patients back to their care facilities, and is of particular importance in older patients discharged to LTCFs, residents of which may be at greatest risk of transmission and worse clinical outcomes.


Subject(s)
COVID-19 , Disease Transmission, Infectious/prevention & control , Long-Term Care , Patient Discharge , Patient Transfer , Skilled Nursing Facilities/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , Convalescence , Female , Hospitalization/statistics & numerical data , Humans , Internationality , Long-Term Care/methods , Long-Term Care/statistics & numerical data , Male , Needs Assessment , Patient Discharge/standards , Patient Discharge/trends , Patient Transfer/methods , Patient Transfer/standards , Quality Improvement/organization & administration , SARS-CoV-2/isolation & purification
11.
J Gen Intern Med ; 35(11): 3302-3307, 2020 11.
Article in English | MEDLINE | ID: covidwho-739677

ABSTRACT

BACKGROUND: Skilled nursing facilities (SNFs) are high-risk settings for SARS-CoV-2 transmission. Infection rates among employees are infrequently described. OBJECTIVE: To describe SARS-CoV-2 rates among SNF employees and residents during a non-outbreak time period, we measured cross-sectional SARS-CoV-2 prevalence across multiple sites in the Seattle area. DESIGN: SARS-CoV-2 testing was performed for SNF employees and residents using quantitative real-time reverse transcription polymerase chain reaction. A subset of employees completed a sociodemographic and symptom questionnaire. PARTICIPANTS: Between March 29 and May 13, 2020, we tested 1583 employees and 1208 residents at 16 SNFs for SARS-CoV-2. MAIN MEASURE: SARS-CoV-2 testing results and symptom report among employees and residents. KEY RESULTS: Eleven of the 16 SNFs had one or more resident or employee test positive. Overall, 46 (2.9%) employees had positive or inconclusive testing for SARS-CoV-2, and among those who completed surveys, most were asymptomatic and involved in direct patient care. The majority of employees tested were female (934, 73%), and most employees were Asian (392, 30%), Black (360, 28%), or white (360, 28%). Among the 1208 residents tested, 110 (9.1%) had positive or inconclusive results. There was no association between the presence of positive residents and positive employees within a SNF (p = 0.62, McNemar's test). CONCLUSIONS: In the largest study of SNFs to date, SARS-CoV-2 infections were detected among both employees and residents. Employees testing positive were often asymptomatic and involved in direct patient care. Surveillance testing is needed for SNF employees and residents during the pandemic response.


Subject(s)
COVID-19 Testing/methods , COVID-19/epidemiology , Health Personnel/statistics & numerical data , Skilled Nursing Facilities/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19 Testing/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Occupational Diseases/epidemiology , Prevalence , SARS-CoV-2 , Skilled Nursing Facilities/organization & administration , Surveys and Questionnaires , Washington/epidemiology , Young Adult
12.
CMAJ Open ; 8(3): E514-E521, 2020.
Article in English | MEDLINE | ID: covidwho-725389

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak increases the importance of strategies to enhance urgent medical care delivery in long-term care (LTC) facilities that could potentially reduce transfers to emergency departments. The study objective was to model resource requirements to deliver virtual urgent medical care in LTC facilities. METHODS: We used data from all general medicine inpatient admissions at 7 hospitals in the Greater Toronto Area, Ontario, Canada, over a 7.5-year period (Apr. 1, 2010, to Oct. 31, 2017) to estimate historical patterns of hospital resource use by LTC residents. We estimated an upper bound of potentially avoidable transfers by combining data on short admissions (≤ 72 h) with historical data on the proportion of transfers from LTC facilities for which patients were discharged from the emergency department without admission. Regression models were used to extrapolate future resource requirements, and queuing models were used to estimate physician staffing requirements to perform virtual assessments. RESULTS: There were 235 375 admissions to general medicine wards, and residents of LTC facilities (age 16 yr or older) accounted for 9.3% (n = 21 948) of these admissions. Among the admissions of residents of LTC facilities, short admissions constituted 24.1% (n = 5297), and for 99.8% (n = 5284) of these admissions, the patient received laboratory testing, for 86.9% (n = 4604) the patient received plain radiography, for 41.5% (n = 2197) the patient received computed tomography and for 81.2% (n = 4300) the patient received intravenous medications. If all patients who have short admissions and are transferred from the emergency department were diverted to outpatient care, the average weekly demand for outpatient imaging per hospital would be 2.6 ultrasounds, 11.9 computed tomographic scans and 23.9 radiographs per week. The average daily volume of urgent medical virtual assessments would range from 2.0 to 5.8 per hospital. A single centralized virtual assessment centre staffed by 2 or 3 physicians would provide services similar in efficiency (measured by waiting time for physician assessment) to 7 separate centres staffed by 1 physician each. INTERPRETATION: The provision of acute medical care to LTC residents at their facility would probably require rapid access to outpatient diagnostic imaging, within-facility access to laboratory services and intravenous medication and virtual consultations with physicians. The results of this study can inform efforts to deliver urgent medical care in LTC facilities in light of a potential surge in COVID-19 cases.


Subject(s)
COVID-19/diagnosis , Health Resources/supply & distribution , Physicians/supply & distribution , SARS-CoV-2/genetics , Skilled Nursing Facilities/statistics & numerical data , Telemedicine/statistics & numerical data , Aged , Aged, 80 and over , Ambulatory Care , COVID-19/epidemiology , COVID-19/virology , Cross-Sectional Studies , Diagnostic Imaging/statistics & numerical data , Disease Outbreaks/prevention & control , Disease Outbreaks/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Hospitalization/trends , Humans , Long-Term Care/statistics & numerical data , Male , Middle Aged , Ontario/epidemiology , Patient Transfer/statistics & numerical data , Retrospective Studies , Skilled Nursing Facilities/organization & administration , Workforce/statistics & numerical data
13.
Geriatr Gerontol Int ; 20(7): 715-719, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-682347

ABSTRACT

AIM: To clarify the association of cluster number and size of coronavirus disease 2019 (COVID-19) in long-term care (LTC) hospitals/facilities, general medical/welfare facilities and non-medical/welfare facilities with morbidity and mortality in 47 prefectures during 16 January to 9 May 2020 in Japan. METHODS: Information on COVID-19 clusters (n ≥2), and morbidity and mortality of COVID-19 was collected. RESULTS: A total of 381 clusters with 3786 infected cases were collected, accounting for 23.9% of 15 852 cumulated cases on 9 May 2020. Although the cluster number (/107 subjects) in LTC hospitals/facilities was significantly smaller compared with those in the other two groups, the cluster size in LTC hospitals/facilities was significantly larger than that in non-medical/welfare facilities. Cluster numbers in general medical/welfare facilities and in non-medical/welfare facilities were significantly positively correlated with morbidity (/105 ), indicating relatively early identification of clusters in these facilities. Unlike in these facilities, cluster size in LTC hospitals/facilities was significantly positively correlated with morbidity, indicating that clusters in LTC hospitals/facilities were finally identified after already having grown to a large size in areas where infection was prevalent. Multivariate logistic regression analysis showed that both cluster number and cluster size only in LTC hospitals/facilities were independently associated with higher mortality (≥median 0.64/105 subjects) after adjustment. CONCLUSIONS: Preventive efforts against COVID-19 outbreaks even at the early phase of the epidemic are critically important in LTC hospitals/facilities, as both the larger number and size of clusters only in LTC hospitals/facilities were independently linked to higher mortality in prefectures in Japan. Geriatr Gerontol Int 2020; 20: 715-719.


Subject(s)
Coronavirus Infections , Hospitals, Chronic Disease/statistics & numerical data , Long-Term Care , Pandemics , Pneumonia, Viral , Skilled Nursing Facilities/statistics & numerical data , Aged , Betacoronavirus/isolation & purification , COVID-19 , Cluster Analysis , Coronavirus Infections/mortality , Coronavirus Infections/prevention & control , Female , Humans , Infection Control/organization & administration , Japan/epidemiology , Long-Term Care/methods , Long-Term Care/organization & administration , Long-Term Care/trends , Male , Mortality , Pandemics/prevention & control , Pneumonia, Viral/mortality , Pneumonia, Viral/prevention & control , SARS-CoV-2
15.
J Am Geriatr Soc ; 68(10): 2167-2173, 2020 10.
Article in English | MEDLINE | ID: covidwho-648533

ABSTRACT

OBJECTIVE: To identify county and facility factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks in skilled nursing facilities (SNFs). DESIGN: Cross-sectional study linking county SARS-CoV-2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post-acute and long-term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020. SETTING AND PARTICIPANTS: The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non-Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks. MEASUREMENTS: For Genesis and non-Genesis SNFs: any outbreak (one or more residents testing positive for SARS-CoV-2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, and prevalence after universal testing. RESULTS: One hundred eighteen (34.6%) Genesis SNFs and 640 (21.2%) non-Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% confidence interval (CI) = 9.6-57.7 percentage point; P = .008) difference in the probability of an outbreak for Genesis and non-Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI = 4.4-20.8 cases; P = .003) for Genesis SNFs. A 10-bed difference in facility size was associated with a 0.9 percentage point (95% CI = 0.6-1.2 percentage point; P < .001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five-Star ratings or past infection control deficiency citations and probability or severity of outbreak. CONCLUSIONS: Larger SNFs and SNFs in areas of high SARS-CoV-2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications. J Am Geriatr Soc 68:2167-2173, 2020.


Subject(s)
COVID-19/epidemiology , Skilled Nursing Facilities/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/transmission , Case-Control Studies , Cross-Sectional Studies , Humans , Infection Control/standards , Nursing Staff/statistics & numerical data , Pandemics , Prevalence , Risk Assessment , SARS-CoV-2 , Skilled Nursing Facilities/organization & administration , United States/epidemiology
16.
Emerg Infect Dis ; 26(10): 2416-2419, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-624970

ABSTRACT

Our analysis of coronavirus disease prevalence in 9 long-term care facilities demonstrated a high proportion (40.7%) of asymptomatic infections among residents and staff members. Infection control measures in congregate settings should include mass testing-based strategies in concert with symptom screening for greater effectiveness in preventing the spread of severe acute respiratory syndrome coronavirus 2.


Subject(s)
Assisted Living Facilities/statistics & numerical data , Asymptomatic Infections/epidemiology , Coronavirus Infections/epidemiology , Health Personnel/statistics & numerical data , Pneumonia, Viral/epidemiology , Skilled Nursing Facilities/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19 , California/epidemiology , Cities/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Female , Humans , Maintenance/statistics & numerical data , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Prevalence
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