COVID-19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates
COVID-19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates
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DOI：
10.1111/jgs.16689
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发表时间：
2020-07-21
影响因子：
6.3
通讯作者：
Cai, Xueya
中科院分区：
文献类型：
--
作者：
Li, Yue;Temkin-Greener, Helena;Cai, Xueya
背景/目的确定疗养院注册护士（RN）人员配备、整体护理质量以及医疗补助或少数族裔居民与2019年冠状病毒病（COVID-19）确诊病例和死亡人数的集中度之间的关联，截至2020年4月16日，康涅狄格州疗养院居民。设计对康涅狄格州护理之家（n = 215）COVID-19报告进行横断面分析，并与其他护理之家档案和县确诊病例和死亡人数相关联。多变量两部分模型确定了关键养老院特征与该设施中至少一例确诊病例（或死亡）的可能性之间的关联，以及与至少一例确诊病例（死亡）的设施中的病例（死亡）计数之间的关联。研究对象：康涅狄格州所有疗养院（n = 215）。参加者干预计量COVID-19确诊病例及居民死亡人数。平均每家疗养院确诊病例数为8例（107家疗养院为0例），平均每家疗养院确诊死亡人数为1.7例（131家疗养院为0例）。在至少有一例确诊病例的设施中，RN人员每增加20分钟（每住院日）与确诊病例减少22%有关（发病率比[IRR] = 0.78; 95%可信区间[CI] = 0.68 - 0.89;P <0.001）;与一至三星级医疗机构相比，四星级或五星级医疗机构的确诊病例减少了13（IRR = 0.87; 95% CI = 0.78 - 0.97;P <0.015），以及医疗补助居民高度集中的设施（IRR = 1.16; 95% CI = 1.02-1.32;P= 0.025）或种族/少数民族居民（IRR = 1.15; 95% CI = 1.03-1.29;P= 0.026）的确诊病例分别比他们的同行多16%和15%。在至少有一人死亡的设施中，RN人员每增加20分钟，COVID-19死亡人数就显著减少26%（IRR = 0.74; 95%CI = 1.55 -1.00;P= 0.047）。其他关注的特征未显示与死亡的统计学显著相关性。结论拥有较高RN人员和质量评级的养老院有可能更好地控制新型冠状病毒的传播并减少死亡。主要照顾医疗补助或种族和少数民族居民的养老院往往有更多的确诊病例。
BACKGROUND/OBJECTIVES To determine the associations of nursing home registered nurse (RN) staffing, overall quality of care, and concentration of Medicaid or racial and ethnic minority residents with 2019 coronavirus disease (COVID-19) confirmed cases and deaths by April 16, 2020, among Connecticut nursing home residents. DESIGN Cross-sectional analysis on Connecticut nursing home (n = 215) COVID-19 report, linked to other nursing home files and county counts of confirmed cases and deaths. Multivariable two-part models determined the associations of key nursing home characteristics with the likelihood of at least one confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least one confirmed case (death). SETTING All Connecticut nursing homes (n = 215). PARTICIPANTS None. INTERVENTION None. MEASUREMENTS Numbers of COVID-19 confirmed cases and deaths among residents. RESULTS The average number of confirmed cases was eight per nursing home (zero in 107 facilities), and the average number of confirmed deaths was 1.7 per nursing home (zero in 131 facilities). Among facilities with at least one confirmed case, every 20-minute increase in RN staffing (per resident day) was associated with 22% fewer confirmed cases (incidence rate ratio [IRR] = .78; 95% confidence interval [CI] = .68-.89;P < .001); compared with one- to three-star facilities, four- or five-star facilities had 13% fewer confirmed cases (IRR = .87; 95% CI = .78-.97;P < .015), and facilities with high concentration of Medicaid residents (IRR = 1.16; 95% CI = 1.02-1.32;P= .025) or racial/ethnic minority residents (IRR = 1.15; 95% CI = 1.03-1.29;P= .026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least one death, every 20-minute increase in RN staffing significantly predicted 26% fewer COVID-19 deaths (IRR = .74; 95% CI = I .55-1.00;P= .047). Other focused characteristics did not show statistically significant associations with deaths. CONCLUSION Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths. Nursing homes caring predominantly for Medicaid or racial and ethnic minority residents tend to have more confirmed cases.