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

项目摘要/摘要 新冠肺炎疫情突显了近140万养老院居民的脆弱性 对呼吸道保健相关感染(HAI)，如新冠肺炎。到2020年8月，几乎有 20万例新冠肺炎确诊病例，50,000多名居民报告死亡。NH居民是 由于多种合并症以及身体和认知的脆弱，容易受到呼吸道HAI的影响。这些 脆弱性因共同照顾者、共享生活空间、 以及历史上资源不足和准备不足的环境，以管理感染爆发。而当 新冠肺炎相关的NH感染和死亡率在全国范围内继续上升，没有人报告 新冠肺炎对国民保健系统应对大流行能力的影响以及了解他们的影响 对临床、功能和心理社会居民结果的联合反应。 我们提出了一项纵向混合方法研究，目标是发展知识和 建议提高美国NHS应对呼吸道HAI疫情的能力。我们拥有独特的访问权限 到密苏里州质量改进计划(QIPMO)记录的数据，QIPMO是一个州赞助的合作社 程序。2020年3月，青岛市计生办开始记录NH新冠肺炎感染情况和为 密苏里州国民健康保险制度。截至6月，记录在案的QIPMO遭遇超过2400次，为我们提供了前所未有的 有机会研究国民健康保险制度如何回应新冠肺炎。在目标1中，我们将使用QIPMO数据，国家关键线人 采访和采访了来自24个有目的抽样的NHS的300多名领导人和工作人员，以评估不同的 NH大流行应对措施，包括颁布联邦指导方针。在目标2中，使用中断的时间序列 分析时，我们将利用最小数据集(MDS)中的统计数据来确定 新冠肺炎对NH住院患者的临床、功能和心理社会结果的反应。在目标3中，我们将汇聚 来自目标1和目标2的发现，以确定NH反应中的上下文差异和 居民健康结果描述减轻或促成不良后果的做法和战略 结果。最后，在目标4中，我们将召集一个专家小组来审查和建议对当前NH的更新 HAI指导方针，并确定新的做法和战略，以增强NHS应对传染病的能力 疾病暴发，包括确定执行障碍、最终传播计划和未来 干预性发展。 新冠肺炎成为地方病并创造对持续管理的需求的可能性正在增加。 了解国民健康保险制度的反应如何影响结果，包括长期的居民效应，将有助于 美国NHS系统准备和管理传染病的未来干预发展 疫情爆发。这项研究涉及AHRQ的优先事项，以更好地为NHS的预防和管理做好准备， 特别是像新冠肺炎这样的高危呼吸道HAI疾病。

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.