Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.
JAMA Netw Open. 2020 Oct 1;3(10):e2026702. doi: 10.1001/jamanetworkopen.2020.26702.
It is not known whether nursing homes with private equity (PE) ownership have performed better or worse than other nursing homes during the coronavirus disease 2019 (COVID-19) pandemic.
To evaluate the comparative performance of PE-owned nursing homes on COVID-19 outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of 11 470 US nursing homes used the Nursing Home COVID-19 Public File from May 17, 2020, to July 2, 2020, to compare outcomes of PE-owned nursing homes with for-profit, nonprofit, and government-owned homes, adjusting for facility characteristics.
Nursing home ownership status.
Self-reported number of COVID-19 cases and deaths and deaths by any cause per 1000 residents; possessing 1-week supplies of personal protective equipment (PPE); staffing shortages.
Of 11 470 nursing homes, 7793 (67.9%) were for-profit; 2523 (22.0%), nonprofit; 511 (5.3%), government-owned; and 543 (4.7%), PE-owned; with mean (SD) COVID-19 cases per 1000 residents of 88.3 [2.1], 67.0 [3.8], 39.8 [7.6] and 110.8 [8.1], respectively. Mean (SD) COVID-19 deaths per 1000 residents were 61.9 [1.6], 66.4 [3.0], 56.2 [7.3], and 78.9 [5.9], respectively; mean deaths by any cause per 1000 residents were 78.1 [1.3], 91.5 [2.2], 67.6 [4.5], and 87.9 [4.8], respectively. In adjusted analyses, government-owned homes had 35.5 (95% CI, -69.2 to -1.8; P = .03) fewer COVID-19 cases per 1000 residents than PE-owned nursing homes. Cases in PE-owned nursing homes were not statistically different compared with for-profit and nonprofit facilities; nor were there statistically significant differences in COVID-19 deaths or deaths by any cause between PE-owned nursing homes and for-profit, nonprofit, and government-owned facilities. For-profit, nonprofit, and government-owned nursing homes were 10.5% (9.1 percentage points; 95% CI, 1.8 to 16.3 percentage points; P = .006), 15.0% (13.0 percentage points; 95% CI, 5.5 to 20.6 percentage points; P < .001), and 17.0% (14.8 percentage points; 95% CI, 6.5 to 23.0 percentage points; P < .001), respectively, more likely to have at least a 1-week supply of N95 masks than PE-owned nursing homes. They were 24.3% (21.3 percentage points; 95% CI, 11.8 to 30.8 percentage points; P < .001), 30.7% (27.0 percentage points; 95% CI, 17.7 to 36.2 percentage points; P < .001), and 29.2% (25.7 percentage points; 95% CI, 16.1 to 35.3 percentage points; P < .001) more likely to have a 1-week supply of medical gowns than PE-owned nursing homes. Government nursing homes were more likely to have a shortage of nurses (6.9 percentage points; 95% CI, 0.0 to 13.9 percentage points; P = .049) than PE-owned nursing homes.
In this cross-sectional study, PE-owned nursing homes performed comparably on staffing levels, resident cases, and deaths with nursing homes with other types of ownership, although their shortages of PPE may warrant monitoring.
重要性：尚不清楚在 2019 年冠状病毒病（COVID-19）大流行期间，拥有私募股权（PE）的养老院的表现是否优于其他养老院。
目的：评估 PE 拥有的养老院在 COVID-19 结果方面的比较表现。
设计、环境和参与者：本项使用 2020 年 5 月 17 日至 7 月 2 日的美国养老院 COVID-19 公共文件的横断面研究，比较了私募股权拥有的养老院与营利性、非营利性和政府所有养老院的结果，调整了设施特征。
暴露：养老院所有权状况。
主要结果和措施：自我报告的 COVID-19 病例和死亡人数以及每千名居民的任何原因死亡人数；拥有 1 周个人防护设备（PPE）供应；人员短缺。
结果：在 11470 家养老院中，7793 家（67.9%）为营利性；2523 家（22.0%）为非营利性；511 家（5.3%）为政府所有；543 家（4.7%）为私募股权所有；每千名居民的 COVID-19 病例分别为 88.3[2.1]、67.0[3.8]、39.8[7.6]和 110.8[8.1]，每千名居民的 COVID-19 死亡人数分别为 61.9[1.6]、66.4[3.0]、56.2[7.3]和 78.9[5.9]，每千名居民的任何原因死亡人数分别为 78.1[1.3]、91.5[2.2]、67.6[4.5]和 87.9[4.8]。在调整分析中，与私募股权所有的养老院相比，政府所有的养老院每千名居民的 COVID-19 病例减少了 35.5（95%CI，-69.2 至-1.8；P = .03）。PE 所有的养老院与营利性和非营利性机构相比，病例数无统计学差异；PE 所有的养老院与营利性、非营利性和政府所有的养老院在 COVID-19 死亡或任何原因死亡方面也没有统计学差异。营利性、非营利性和政府所有的养老院拥有 N95 口罩至少 1 周供应量的可能性分别高 10.5%（9.1 个百分点；95%CI，1.8 至 16.3 个百分点；P = .006）、15.0%（13.0 个百分点；95%CI，5.5 至 20.6 个百分点；P < .001）和 17.0%（14.8 个百分点；95%CI，6.5 至 23.0 个百分点；P < .001），比 PE 所有的养老院分别高。它们分别有 24.3%（21.3 个百分点；95%CI，11.8 至 30.8 个百分点；P < .001）、30.7%（27.0 个百分点；95%CI，17.7 至 36.2 个百分点；P < .001）和 29.2%（25.7 个百分点；95%CI，16.1 至 35.3 个百分点；P < .001）更有可能拥有 1 周的医用长袍供应，比 PE 所有的养老院多。政府养老院的护士短缺情况更为严重（6.9 个百分点；95%CI，0.0 至 13.9 个百分点；P = .049），比 PE 所有的养老院多。
结论：在这项横断面研究中，与其他类型所有权的养老院相比，PE 拥有的养老院在人员配备水平、居民病例和死亡人数方面表现相当，尽管它们的个人防护设备短缺可能需要监测。
