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Impact of a Public Policy Restricting Staff Mobility Between Nursing Homes in Ontario, Canada During the COVID-19 Pandemic.
Jones, Aaron; Watts, Alexander G; Khan, Salah Uddin; Forsyth, Jack; Brown, Kevin A; Costa, Andrew P; Bogoch, Isaac I; Stall, Nathan M.
  • Jones A; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada. Electronic address: jonesa13@mcmaster.ca.
  • Watts AG; BlueDot, Toronto, Ontario, Canada.
  • Khan SU; BlueDot, Toronto, Ontario, Canada.
  • Forsyth J; BlueDot, Toronto, Ontario, Canada.
  • Brown KA; Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
  • Costa AP; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, Canada.
  • Bogoch II; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Divisions of General Internal Medicine and Infectious Diseases, University Health Network, Toronto, Canada.
  • Stall NM; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Divisions of General Internal Medicine and Geriatrics, Sinai Health System and the University Health Network, Toronto, On
J Am Med Dir Assoc ; 22(3): 494-497, 2021 03.
Article in English | MEDLINE | ID: covidwho-1065277
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ABSTRACT

OBJECTIVES:

To assess changes in the mobility of staff between nursing homes in Ontario, Canada, before and after enactment of public policy restricting staff from working at multiple homes.

DESIGN:

Pre-post observational study. SETTING AND

PARTICIPANTS:

623 nursing homes in Ontario, Canada, between March 2020 and June 2020.

METHODS:

We used GPS location data from mobile devices to approximate connectivity between all 623 nursing homes in Ontario during the 7 weeks before (March 1-April 21) and after (April 22-June 13) the policy restricting staff movement was implemented. We constructed a network diagram visualizing connectivity between nursing homes in Ontario and calculated the number of homes that had a connection with another nursing home and the average number of connections per home in each period. We calculated the relative difference in these mobility metrics between the 2 time periods and compared within-home changes using McNemar test and the Wilcoxon rank-sum test.

RESULTS:

In the period preceding restrictions, 266 (42.7%) nursing homes had a connection with at least 1 other home, compared with 79 (12.7%) homes during the period after restrictions, a drop of 70.3% (P < .001). Including all homes, the average number of connections in the before period was 3.90 compared to 0.77 in the after period, a drop of 80.3% (P < .001). In both periods, mobility between nursing homes was higher in homes located in larger communities, those with higher bed counts, and those part of a large chain. CONCLUSIONS AND IMPLICATIONS Mobility between nursing homes in Ontario fell sharply after an emergency order by the Ontario government limiting long-term care staff to a single home, though some mobility persisted. Reducing this residual mobility should be a focus of efforts to reduce risk within the long-term care sector during the COVID-19 pandemic.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Public Policy / COVID-19 / Nursing Homes / Nursing Staff Type of study: Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Male Country/Region as subject: North America Language: English Journal: J Am Med Dir Assoc Journal subject: History of Medicine / Medicine Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Public Policy / COVID-19 / Nursing Homes / Nursing Staff Type of study: Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Male Country/Region as subject: North America Language: English Journal: J Am Med Dir Assoc Journal subject: History of Medicine / Medicine Year: 2021 Document Type: Article