U.S. Nursing Home Quality Ratings Associated with COVID-19 Cases and Deaths.
U.S. Nursing Home Quality Ratings Associated with COVID-19 Cases and Deaths.
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DOI：
10.1016/j.jamda.2021.07.034
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发表时间：
2021-10
影响因子：
7.6
通讯作者：
Kistler CE
中科院分区：
文献类型：
--
作者：
Khairat S;Zalla LC;Adler-Milstein J;Kistler CE
为了为脆弱的养老院环境中的未来政策和备灾计划提供信息，我们需要更深入地了解养老院（NH）质量与NH设施中COVID-19的传播和严重程度之间的关系。因此，我们扩展了目前关于卫生保健质量与居民COVID-19感染率和死亡率之间关系的证据，并考虑了卫生保健的结构特征和社区特征。横断面研究。15，390名医疗补助和医疗保险认证的NHS。我们获得并合并了以下数据集：（1）每家养老院向疾病控制和预防中心的国家医疗安全网络报告的COVID-19每周数据，（2）医疗保险和医疗补助服务中心五颗星星质量评级系统，（3）县级COVID-19病例计数，（4）县级人口数据，以及（5）县级社会人口数据。在1-星星卫生院中，2020年5月25日至12月20日期间，平均每周每千名居民有13.19例病例和2.42例死亡。在5-星星卫生保健机构中，每1000名居民每周平均有9.99例病例和1.83例死亡。1-星星卫生院的COVID-19确诊病例率比5-星星卫生院高31%[模型1：发病率比（IRR）1.31，95%置信区间（CI）1.23-1.39]，COVID-19死亡率高30%（IRR 1.30，95% CI 1.20，1.41）。COVID-19的社区传播、病例组合以及NH的营利性地位和规模的差异只能部分解释这些关联。我们发现，在星星评级较低的NHS中，COVID-19病例和死亡率显著较高，这表明质量远低于平均水平的NHS更容易受到COVID-19的传播。这种关系，特别是在病例率方面，可以部分归因于外部因素：评级较低的卫生院通常位于COVID-19社区传播更大的地区，并且比评级较高的卫生院为更多社会经济弱势居民提供服务。
To inform future policies and disaster preparedness plans in the vulnerable nursing home setting, we need greater insight into the relationship between nursing homes’ (NHs’) quality and the spread and severity of COVID-19 in NH facilities. We therefore extend current evidence on the relationships between NH quality and resident COVID-19 infection rates and deaths, taking into account NH structural characteristics and community characteristics. Cross-sectional study. 15,390 Medicaid- and Medicare-certified NHs. We obtained and merged the following data sets: (1) COVID-19 weekly data reported by each nursing home to the Centers for Disease Control and Prevention’s National Healthcare Safety Network, (2) Centers for Medicare & Medicaid Services Five Star Quality Rating System, (3) county-level COVID-19 case counts, (4) county-level population data, and (5) county-level sociodemographic data. Among 1-star NHs, there were an average of 13.19 cases and 2.42 deaths per 1000 residents per week between May 25 and December 20, 2020. Among 5-star NHs, there were an average of 9.99 cases and 1.83 deaths per 1000 residents per week. The rate of confirmed cases of COVID-19 was 31% higher among 1-star NHs compared with 5-star NHs [model 1: incidence rate ratio (IRR) 1.31, 95% confidence interval (CI) 1.23-1.39], and the rate of COVID-19 deaths was 30% higher (IRR 1.30, 95% CI 1.20, 1.41). These associations were only partially explained by differences in community spread of COVID-19, case mix, and the for-profit status and size of NHs. We found that COVID-19 case and death rates were substantially higher among NHs with lower star ratings, suggesting that NHs with quality much below average are more susceptible to the spread of COVID-19. This relationship, particularly with regard to case rates, can be partially attributed to external factors: lower-rated NHs are often located in areas with greater COVID-19 community spread and serve more socioeconomically vulnerable residents than higher-rated NHs.
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影响因子：
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DOI：
10.1016/j.jamda.2021.02.023
发表时间：
2021-04-05
影响因子：
7.6
作者：
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通讯作者：
Zimmerman, Sheryl