Developing improved guidelines for nursing home-associated viral respiratory infections: Learning from the COVID-19 experience

项目总结/摘要 COVID-19大流行凸显了近140万养老院（NH）居民的脆弱性 呼吸道卫生保健相关感染（HAI），如COVID-19。到2020年8月， 200，000例COVID-19确诊病例，超过50，000例居民死亡报告。居民是 由于多种合并症以及身体和认知虚弱，易患呼吸道HAI。这些 脆弱性因共同照顾者、共同生活空间 以及一个有着资源不足和准备不足的历史的环境来管理感染爆发。而 COVID-19相关的NH感染和死亡率在全国范围内继续增加，没有人报告 COVID-19对NH应对大流行的能力的影响，以及了解其 对临床、功能和心理社会住院医师结果的反应。 我们提出了一个纵向的混合方法研究，目标是发展知识， 建议提高美国卫生保健机构应对呼吸道HAI疫情的能力。我们有唯一的权限 密苏里州质量改进计划（QIPMO）记录的数据， 程序. 2020年3月，QIPMO开始记录NH COVID-19感染，并为 密苏里州的健康中心。到6月，有超过2,400个记录在案的QIPMO遭遇，为我们提供了前所未有的 有机会研究NHS如何应对COVID-19。在目标1中，我们将使用QIPMO数据， 访谈，并与来自24个有目的抽样的NHS的300多名领导和工作人员进行访谈，以评估不同的 NH大流行应对措施，包括制定联邦指南。在aim 2中，使用中断的时间序列 分析，我们将利用最小数据集（MDS）的统计数据来确定 新冠肺炎对NH住院医师临床、功能和心理社会结果的反应。在目标3中，我们将 目标1和目标2的结果，以确定NH反应中的背景差异之间的关系， 居民健康结果，以描述减轻或促进不利影响的做法和战略， 结果。最后，在目标4中，我们将召集一个专家小组，审查并建议更新现有的NH HAI指导方针，并确定新的做法和战略，以提高NHS应对传染病的能力。 疾病暴发，包括确定实施障碍、最终传播计划和未来 干预发展。 COVID-19成为地方性流行病并产生持续管理需求的可能性正在增加。 了解NHS的反应如何影响结果，包括长期居民效应， 美国国家卫生保健机构系统地预防和管理传染病的未来干预发展 爆发。这项研究讨论了AHRQ的优先事项，以更好地为预防和管理做好准备， 特别是高风险的呼吸道HAI疾病，如COVID-19。

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic highlighted the vulnerability of the nearly 1.4 million nursing home (NH) residents to respiratory healthcare associated infections (HAI) such as COVID-19. By August 2020, there were nearly 200,000 confirmed cases of COVID-19 with more than 50,000 reported resident deaths. NH residents are vulnerable to respiratory HAI because of multiple comorbidities and physical and cognitive frailty. These vulnerabilities are compounded by an institutional environment of common caregivers, shared living spaces, and a setting with a history of being under-resourced and ill-prepared to manage infection outbreaks. While COVID-19 related NH infections and mortality continue to increase nationwide, no one has reported on the impact of COVID-19 on NHs’ capacity to respond to the pandemic and to understand the impact of their response on clinical, functional, and psychosocial resident outcomes jointly. We are proposing a longitudinal mixed-methods study with the goal to develop knowledge and recommendations to improve US NHs’ ability to respond to respiratory HAI outbreaks. We have unique access to data recorded by the Quality Improvement Program for Missouri (QIPMO), a state-sponsored cooperative program. In March 2020, QIPMO began documenting NH COVID-19 infections and support provided to Missouri NHs. By June, there were over 2,400 documented QIPMO encounters providing us an unprecedented opportunity to study how NHs responded to COVID-19. In aim 1, we will use QIPMO data, state key informant interviews, and interviews with over 300 leaders and staff from 24 purposively sampled NHs to assess diverse NH pandemic responses, including enactment of federal guidance. In aim 2, using an interrupted time-series analysis, we will leverage statistical data from the Minimum Data Set (MDS) to determine the effects of the COVID-19 response on NH resident clinical, functional, and psychosocial outcomes. In aim 3, we will converge findings from aims 1 and 2 to identify relationships between contextual differences in NH responses and resident health outcomes to describe practices and strategies that either mitigated or contributed to adverse outcomes. Finally, in aim 4 we will convene an expert panel to review and recommend updates to current NH HAI guidelines and identify new practices and strategies to enhance NHs’ capacity to respond to infectious disease outbreaks including identifying implementation barriers, final dissemination plans and future intervention development. The likelihood that COVID-19 will become endemic and create needs for ongoing management is growing. Understanding how NHs’ responses influenced outcomes, including long-term resident effects, will inform future intervention development for US NHs to systematically prepare and manage infectious disease outbreaks. This study addresses the AHRQ priority to better prepare NHs for prevention and management, specifically high-risk respiratory HAI illnesses like COVID-19.