Qualitative review of promising practices for testing vulnerable populations at off-site COVID-19 testing centers.

BACKGROUND: Many off-site COVID-19 testing centers (OSCTCs) are struggling with strategies to serve vulnerable populations who have some of the highest rates of COVID-19 cases, hospitalizations, and deaths. Inter-OSCTC sharing of successful protocols and systems has been hampered by evolving resource constraints, the changing science of testing, and ever increasing COVID-19 case counts. OBJECTIVE: The aim of the present study was to identify promising approaches to testing vulnerable populations. METHODS: We conducted a qualitative study using semi-structured interviews with 26 leaders of OSCTCs and public health departments across the United States between June 8th and August 10th, 2020. All interviews were coded utilizing oral coding via rapid identification of themes from audio recordings, and analysis occurred concurrently with data collection to assess when saturation was achieved. RESULTS: Six main themes emerged highlighting approaches to testing within vulnerable populations including: 1. Expanding services to support health and health-related needs beyond COVID-19; 2. Gaining community trust; 3. Developing and leveraging community partnerships; 4. Promoting clear and creative messaging; 5. Prioritizing patient experience; and 6. Managing patient results. CONCLUSIONS: Testing among the vulnerable not only helps those at highest risk of severe disease or death from COVID-19, but also presents a critical opportunity to control viral spread within and from these communities. Reaching vulnerable populations is challenging and requires multi-sector collaboration, additional funding, and high levels of creativity and flexibility.

Qualitative review of early experiences of off-site COVID-19 testing centers and associated considerations.

Given the predicted need for continued SARS-CoV-2 diagnostic testing, as well as the evolving availability and types of diagnostic tests, off-site COVID-19 testing centers (OSCTC) leaders need timely guidance to ensure they are meeting the needs of their unique populations. This research discusses the challenges and offers considerations for healthcare organizations and others when setting up and running OSCTCs. It also provides a springboard to engage policy makers and leaders in the healthcare community in a discussion about emergency preparedness, and how to better respond to testing needs going forward.

Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States.

OBJECTIVES: To evaluate community-specific nursing home performance with community-specific hospital 30-day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia. DESIGN: Cross-sectional study using 2009-2012 hospital risk-standardised 30-day readmission data for Medicare fee-for-service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System. SETTING: Medicare-certified nursing homes and acute care hospitals. PARTICIPANTS: 12,542 nursing homes and 3,039 hospitals treating 30 or more Medicare fee-for-service patients for all three conditions across 2,032 hospital service areas in the United States. MEASUREMENTS: Community-specific hospital 30-day risk-standardised readmission rates. Community-specific nursing home performance measures: health inspection, staffing, Registered Nurses and quality performance; and an aggregated performance score. Mixed-effects models evaluated associations between nursing home performance and hospital 30-day risk-standardised readmission rates for all three conditions. RESULTS: The relationship between community-specific hospital risk-standardised readmission rates and community-specific overall nursing home performance was statistically significant for all three conditions. Increasing nursing home performance by one star resulted in decreases of 0.29% point (95% CI: 0.12-0.47), 0.78% point (95% CI: 0.60-0.95) and 0.46% point (95% CI: 0.33-0.59) of risk-standardised readmission rates for AMI, HF and pneumonia, respectively. Among the specific measures, higher performance in nursing home overall staffing and Registered Nurse staffing measures was statistically significantly associated with lower hospital readmission rates for all three conditions. Notable geographic variation in the community-specific nursing home performance was observed. CONCLUSION: Community-specific nursing home performance is associated with community-specific hospital 30-day readmission rates for Medicare fee-for-service patients for acute myocardial infarction, heart failure or pneumonia. IMPLICATIONS FOR PRACTICE: Coordinated care between hospitals and nursing homes is essential to reduce readmissions. Nursing homes can improve performance and reduce readmissions by increasing registered nursing homes. Further, communities can work together to create cross-continuum care teams comprised of hospitals, nursing homes, patients and their families, and other community-based service providers to reduce unplanned readmissions.

Community Level Association between Home Health and Nursing Home Performance on Quality and Hospital 30-day Readmissions for Medicare Patients.

We evaluated whether community-level home health agencies and nursing home performance is associated with community-level hospital 30-day all-cause risk-standardized readmission rates for Medicare patients used data from the Centers for Medicare & Medicaid Service from 2010 to 2012. Our final sample included 2,855 communities that covered 4,140 hospitals with 6,751,713 patients, 13,060 nursing homes with 1,250,648 residents, and 7,613 home health agencies providing services to 35,660 zipcodes. Based on a mixed effect model, we found that increasing nursing home performance by one star for all of its 4 measures and home health performance by 10 points for all of its 6 measures is associated with decreases of 0.25% (95% CI 0.17-0.34) and 0.60% (95% CI 0.33-0.83), respectively, in community-level risk-standardized readmission rates.