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SARS-CoV-2 and Wisconsin Nursing Homes: Temporal Dynamics During the COVID-19 Pandemic.
Gmehlin, Cameron G; Rivera, Frida; Ramos-Castaneda, Jorge A; Pezzin, Liliana E; Ehn, Diane; Duthie, Edmund H; Muñoz-Price, L Silvia.
  • Gmehlin CG; Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
  • Rivera F; Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
  • Ramos-Castaneda JA; Research Group Innovación y Cuidado, Faculty of Nursing, Universidad Antonio Nariño, Neiva, Colombia.
  • Pezzin LE; Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, WI, USA; Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
  • Ehn D; Froedtert Health, Milwaukee, WI, USA.
  • Duthie EH; Division of Geriatrics and Palliative Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
  • Muñoz-Price LS; Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: smunozprice@mcw.edu.
J Am Med Dir Assoc ; 22(11): 2233-2239, 2021 11.
Article in English | MEDLINE | ID: covidwho-1373102
ABSTRACT

OBJECTIVES:

Evidence suggests that quality, location, and staffing levels may be associated with COVID-19 incidence in nursing homes. However, it is unknown if these relationships remain constant over time. We describe incidence rates of COVID-19 across Wisconsin nursing homes while examining factors associated with their trajectory during 5 months of the pandemic.

DESIGN:

Retrospective cohort study. SETTING/

PARTICIPANTS:

Wisconsin nursing homes.

METHODS:

Publicly available data from June 1, 2020, to October 31, 2020, were obtained. These included facility size, staffing, 5-star Medicare rating score, and components. Nursing home characteristics were compared using Pearson chi-square and Kruskal-Wallis tests. Multiple linear regressions were used to evaluate the effect of rurality on COVID-19.

RESULTS:

There were a total of 2459 COVID-19 cases across 246 Wisconsin nursing homes. Number of beds (P < .001), average count of residents per day (P < .001), and governmental ownership (P = .014) were associated with a higher number of COVID-19 cases. Temporal analysis showed that the highest incidence rates of COVID-19 were observed in October 2020 (30.33 cases per 10,000 nursing home occupied-bed days, respectively). Urban nursing homes experienced higher incidence rates until September 2020; then incidence rates among rural nursing homes surged. In the first half of the study period, nursing homes with lower-quality scores (1-3 stars) had higher COVID-19 incidence rates. However, since August 2020, incidence was highest among nursing homes with higher-quality scores (4 or 5 stars). Multivariate analysis indicated that over time rural location was associated with increased incidence of COVID-19 (ß = 0.05, P = .03). CONCLUSIONS AND IMPLICATIONS Higher COVID-19 incidence rates were first observed in large, urban nursing homes with low-quality rating. By October 2020, the disease had spread to rural and smaller nursing homes and those with higher-quality ratings, suggesting that community transmission of SARS-CoV-2 may have propelled its spread.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pandemics / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Humans 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 Affiliation country: J.jamda.2021.08.021

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pandemics / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Humans 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 Affiliation country: J.jamda.2021.08.021