Effectiveness of a On-site Medicalization Program for Nursing Homes With COVID-19 Outbreaks
Effectiveness of a On-site Medicalization Program for Nursing Homes With COVID-19 Outbreaks
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DOI：
10.1093/gerona/glaa192
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发表时间：
2021-03-01
影响因子：
5.1
通讯作者：
Ollero-Baturone, M.
中科院分区：
文献类型：
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作者：
Bernabeu-Wittel, M.;Ternero-Vega, J. E.;Ollero-Baturone, M.
背景：疗养院非常容易发生COVID-19疫情，导致死亡率很高。方法：针对4家养老院的COVID-19大规模爆发，组织了一个协调的现场医疗化计划（MP），旨在提高生存率，为自然环境中的居民提供人性化的姑息治疗，减少医院转诊。确定了10项关键进程和干预措施（提供信息学基础设施、医疗设备和人力资源、普遍检测、区分“清洁”和“污染”地区、流行病学调查以及区分积极或姑息治疗方法的统一协议等）。主要结果是一个复合终点的生存或最佳姑息治疗（SOPC），生存，转诊hospital.Results：二百七十二457（59.5%）居民和85 320（26.5%）的工作人员受到影响。在MP开始前诊断的患者中，SOPC、生存率和转诊率分别为77%、72.5%和29%，而在项目期间诊断的患者中，SOPC、生存率和转诊率分别为97%、83.7%和17%。SOPC与MP独立相关（OR = 15 [3-81]）;分层为活性方法的患者的生存率与使用任何抗病毒治疗独立相关（OR = 28 [5-160]）。所有疫情均在39 [37-42]天内得到控制。结论：对发生COVID-19疫情的养老院进行协调的现场MP，实现了更高的SOPC率，并减少了转诊到医院，从而确保了对居民的严格但人性化和温和的护理。
Background: Nursing homes are highly vulnerable to the occurrence of COVID-19 outbreaks, which result in high lethality rates. Most of them are not prepared to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.Method: A coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in 4 nursing homes was organized, with the objectives of improving survival, offering humanistic palliative care to residents in their natural environment, and reducing hospital referrals. Ten key processes and interventions were established (provision of informatics infrastructure, medical equipment, and human resources, universal testing, separation of "clean" and "contaminated" areas, epidemiological surveys, and unified protocols stratifying for active or palliative care approach, among others). Main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to hospital.Results: Two hundred and seventy-two of 457 (59.5%) residents and 85 of 320 (26.5%) staff members were affected. The SOPC, survival, and referrals to hospital occurred in 77%, 72.5%, and 29% of patients diagnosed before the start of MP, with respect to 97%, 83.7%, and 17% of those diagnosed during the program, respectively. The SOPC was independently associated to MP (OR = 15 [3-81]); and survival in patients stratified to active approach, to the use of any antiviral treatment (OR = 28 [5-160]). All outbreaks were controlled in 39 [37-42] days.Conclusions: A coordinated on-site MP of nursing homes with COVID-19 outbreaks achieved a higher SOPC rate, and a reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care to residents.