Nursing homes' visitation bans during the COVID-19 pandemic: Effectiveness and consequences.

项目总结/摘要 截至2022年5月，全球已有超过100万例COVID-19病例和超过15万例COVID-19死亡病例， 美国养老院的居民养老院实施的最广泛的缓解措施之一 禁止探视2020年3月和4月，31个州发布了全州范围的探视禁令，影响了至少66%的人 的设施和70%的居民在美国的访问禁令可能会阻止设施之间的传播和 社区然而，任何禁令都是不完整的，因为工作人员往返于设施和社区之间。到 据我们所知，目前还没有实证研究来检验探视禁令对预防新冠肺炎的有效性- 19感染率、住院和死亡。同样重要的是禁止探视对儿童的不利影响。 居民探视禁令可以大大减少非正式护理，增加社会孤立，扰乱日常生活， 护理，导致不良事件，如功能下降和抑郁增加，福尔斯，和 住院患有阿尔茨海默病和相关痴呆症（ADRD）的居民更依赖于护理人员， 可能比没有ADRD的患者发生不良事件的风险更大。我们的团队收集了 国家和设施级别，记录了国家启动和解除禁令的日期，以及 每周禁止俄亥俄州设施级别的数据。我们还收集了来自家庭成员的开放式评论， 在俄亥俄州进行的全州范围的家庭满意度调查。通过将禁止探视的数据与国家医疗保险索赔联系起来， 和评估数据，我们提出了一个收敛的并行混合方法研究， 禁止探访疗养院的有效性和不良后果。我们将研究9876个 2020年3月，31个州的养老院禁止室内探视， 和2020年11月。我们还将研究俄亥俄州的701家养老院，在那里我们每周都有关于 每个设施都有禁令。既往感染率匹配病例对照设计和分层 广义线性混合模型将研究取消探视禁令与COVID-19和健康的关联 结果。将与直接护理人员进行焦点小组访谈，并分析家庭意见， 检查探视禁令对日常护理做法和居民健康结果的影响。理解两者 探视禁令的好处和危害可以为养老院未来的流行病应对提供信息。 该项目的具体目标是：1）评估禁止探视对预防COVID-19的有效性 护理之家居民的感染（原发），住院和死亡; 2）评估 长期住院患者中功能（主要）、情绪/行为和不良事件变化的探视禁令 有或没有ADRD的居民;和3）了解探视禁令如何影响日常护理实践， 养老院和居民健康结果。

PROJECT SUMMARY/ABSTRACT As of May 2022, there have been over 1 million COVID-19 cases and over 150,000 COVID-19 deaths among U.S. nursing home residents. One of the most widespread mitigation measures implemented by nursing homes was a visitation ban. In March and April 2020, 31 states issued state-wide visitation bans, affecting at least 66% of facilities and 70% of residents in the U.S. Visitation bans may prevent transmission between facilities and the community. Yet, any ban is incomplete because of staff who travel between the facility and the community. To our knowledge, there is no empirical study examining the effectiveness of visitation bans on preventing COVID- 19 infection rates, hospitalizations, and deaths. What also matters are the adverse effects of visitation bans on residents. Visitation bans can substantially reduce informal care, increase social isolation, and disrupt routine care, resulting in adverse events such as decreased function and increases in depression, falls, and hospitalization. Residents with Alzheimer's Disease & Related Dementias (ADRD), who rely more on caregivers, may have a greater risk of adverse events than those without ADRD. Our team has collected visitation data at both the state and facility levels, which document the dates when states initiated and lifted bans, as well as weekly bans data at the facility level in Ohio. We also collect open-ended comments from family members from a state-wide family satisfaction survey in Ohio. By linking data on visitation bans with national Medicare claims and assessment data, we propose a convergent parallel mixed methods study to examine the effectiveness and adverse consequences of visitation bans in nursing homes. We will study the 9,876 nursing homes in the 31 states that banned indoor visitation in March 2020, then lifted those bans between June and November 2020. We will also study the 701 nursing homes in Ohio, where we have weekly data on the presence of bans for each facility. Matched case-control design on prior infection rates and Hierarchical Generalized Linear Mixed Models will examine the association of lifting visitation bans with COVID-19 and health outcomes. Focus group interviews with direct care staff and analyses of family comments will be conducted to examine the effects of visitation bans on daily care practices and resident health outcomes. Understanding both the benefits and harms of visitation bans can inform future pandemic responses in nursing homes. The specific aims of this project are: 1) To assess the effectiveness of visitation bans on preventing COVID-19 infection (primary), hospitalization, and deaths among nursing home residents; 2) To evaluate the association of visitation bans with changes in function (primary), mood/behaviors, and adverse events among long-stay residents with or without ADRD; and 3) To understand how visitation bans affected daily care practices within nursing homes and resident health outcomes.