康涅狄格州养老院居民中的 COVID-19 感染和死亡：设施相关性。
COVID-19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates.
机构信息
Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA.
Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA.
出版信息
J Am Geriatr Soc. 2020 Sep;68(9):1899-1906. doi: 10.1111/jgs.16689. Epub 2020 Jul 21.
BACKGROUND/OBJECTIVES: To determine the associations of nursing home registered nurse (RN) staffing, overall quality of care, and concentration of Medicaid or racial and ethnic minority residents with 2019 coronavirus disease (COVID-19) confirmed cases and deaths by April 16, 2020, among Connecticut nursing home residents.
DESIGN
Cross-sectional analysis on Connecticut nursing home (n = 215) COVID-19 report, linked to other nursing home files and county counts of confirmed cases and deaths. Multivariable two-part models determined the associations of key nursing home characteristics with the likelihood of at least one confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least one confirmed case (death).
SETTING
All Connecticut nursing homes (n = 215).
PARTICIPANTS
None.
INTERVENTION
None.
MEASUREMENTS
Numbers of COVID-19 confirmed cases and deaths among residents.
RESULTS
The average number of confirmed cases was eight per nursing home (zero in 107 facilities), and the average number of confirmed deaths was 1.7 per nursing home (zero in 131 facilities). Among facilities with at least one confirmed case, every 20-minute increase in RN staffing (per resident day) was associated with 22% fewer confirmed cases (incidence rate ratio [IRR] = .78; 95% confidence interval [CI] = .68-.89; P < .001); compared with one- to three-star facilities, four- or five-star facilities had 13% fewer confirmed cases (IRR = .87; 95% CI = .78-.97; P < .015), and facilities with high concentration of Medicaid residents (IRR = 1.16; 95% CI = 1.02-1.32; P = .025) or racial/ethnic minority residents (IRR = 1.15; 95% CI = 1.03-1.29; P = .026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least one death, every 20-minute increase in RN staffing significantly predicted 26% fewer COVID-19 deaths (IRR = .74; 95% CI = I .55-1.00; P = .047). Other focused characteristics did not show statistically significant associations with deaths.
CONCLUSION
Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths. Nursing homes caring predominantly for Medicaid or racial and ethnic minority residents tend to have more confirmed cases.
背景/目的：本研究旨在确定注册护士（RN）人员配备、整体护理质量以及医疗补助计划（Medicaid）或少数族裔居民的集中程度与康涅狄格州疗养院居民 2019 年冠状病毒病（COVID-19）确诊病例和死亡人数之间的关联，这些数据截至 2020 年 4 月 16 日。
方法
对康涅狄格州疗养院（n=215）COVID-19 报告进行横断面分析，并与其他疗养院档案以及县确诊病例和死亡人数进行关联。多变量两部分模型确定了关键疗养院特征与以下情况的关联：设施中至少有一个确诊病例的可能性，以及在至少有一个确诊病例或死亡的设施中病例（死亡）的数量。
地点
康涅狄格州所有疗养院（n=215）。
参与者
无。
干预措施
无。
测量
居民中 COVID-19 确诊病例和死亡人数。
结果
平均每个疗养院的确诊病例数为 8 例（107 个设施中为零），平均每个疗养院的确诊死亡人数为 1.7 例（131 个设施中为零）。在至少有一个确诊病例的设施中，RN 人员配备（每居民日）每增加 20 分钟，确诊病例数就会减少 22%（发病率比 [IRR] =.78；95%置信区间 [CI] =.68-.89；P < .001）；与一至三星级设施相比，四星级或五星级设施的确诊病例数减少了 13%（IRR =.87；95% CI =.78-.97；P < .015）， Medicaid 居民（IRR = 1.16；95% CI = 1.02-1.32；P =.025）或少数族裔居民（IRR = 1.15；95% CI = 1.03-1.29；P =.026）高度集中的设施的确诊病例数分别比同类设施多 16%和 15%。在至少有一个死亡的设施中，RN 人员配备每增加 20 分钟，COVID-19 死亡人数就会显著减少 26%（IRR =.74；95% CI =.55-1.00；P =.047）。其他重点特征与死亡无统计学关联。
结论
RN 人员配备和质量评分较高的疗养院有可能更好地控制新型冠状病毒的传播并减少死亡人数。主要照顾 Medicaid 或少数族裔居民的疗养院往往有更多的确诊病例。
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