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

COVID-19 大流行期间疗养院的探视禁令：有效性和后果。

• 批准号: 10635829
• 负责人: Huiwen Xu
• 金额: $ 35.65万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10635829
• 关键词: Address; Adverse effects; Adverse event; Affect; Alzheimer' s disease related dementia; Behavior; COVID-19; COVID-19 mortality; COVID-19 pandemic; COVID-19 prevention; Caregivers; Caring; Cessation of life; Characteristics; Communities; Commuting; County; Data; Data Set; Effectiveness; Ensure; Family; Family member; Focus Groups; Friends; General Population; Group Interviews; Health; Health Personnel; Home visitation; Hospitalization; Hour; Individual; Infection; Infection Control; Intervention; Knowledge; Laws; Lifting; Link; Masks; Measures; Medicare claim; Mental Depression; Methods; Modeling; Moods; Nurses' Aides; Nursing Homes; Ohio; Outcome; Pathway interactions; Physical Function; Physicians; Policies; Policy Maker; Published Comment; Recommendation; Rights; SARS-CoV-2 infection; SARS-CoV-2 transmission; Social isolation; Surveys; Time; Travel; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Variant; Visit; Work; adverse event risk; adverse outcome; case control; design; effectiveness evaluation; falls; functional decline; future pandemic; hospice environment; infection rate; informal care; informal caregiver; pandemic disease; pandemic response; prevent; response; routine care; satisfaction; transmission process; viral transmission

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.

项目摘要/摘要 截至2022年5月，中国已有100多万人感染新冠肺炎，150,000多人死亡。 美国养老院居民。疗养院实施的最广泛的缓解措施之一 是一项探视禁令。2020年3月和4月，31个州发布了全州范围的探视禁令，影响到至少66%的人 设施和美国70%的居民的探视禁令可能会阻止设施和 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。至 据我们所知，目前还没有实证研究来检验探视禁令对预防COVID的有效性- 19感染率、住院率和死亡率。同样重要的是探视禁令对 居民。探视禁令可以大大减少非正式护理，增加社会孤立，并扰乱日常生活 护理，导致不良事件，如功能下降和抑郁增加，摔倒，和 住院治疗。患有阿尔茨海默病和相关痴呆症(ADRD)的居民更依赖于照顾者， 可能比那些没有ADRD的人有更大的不良事件风险。我们的团队收集了访问数据， 州和设施两级，记录各州启动和解除禁令的日期，以及 每周禁止俄亥俄州设施层面的数据。我们还收集来自以下家庭成员的开放式评论 俄亥俄州的一项全州家庭满意度调查。通过将探视禁令的数据与国家医疗保险索赔联系起来 和评估数据，我们提出了一种收敛的并行混合方法研究 养老院禁止探视的有效性和不良后果。我们将研究9876个 在2020年3月禁止室内探视的31个州的养老院，然后在6月之间解除了这些禁令 和2020年11月。我们还将研究俄亥俄州的701家养老院，在那里我们有关于 每个设施都有禁令。既往感染率和分层的配对病例对照设计 广义线性混合模型将检验解除探视禁令与新冠肺炎和健康的关联 结果。将进行与直接护理人员的焦点小组访谈和分析家庭意见，以 检查探视禁令对日常护理做法和居民健康结果的影响。了解两者 探视禁令的好处和坏处可以为养老院未来的大流行应对提供信息。 该项目的具体目标是：1)评估禁止探视对预防新冠肺炎的有效性 疗养院居民的感染(原发)、住院和死亡；2)评估 在长期逗留期间禁止探视，包括功能(主要)、情绪/行为和不良事件 患有或不患有ADRD的居民；以及3)了解探视禁令如何影响 疗养院和居民健康结果。