Jones Aaron, Watts Alexander G, Khan Salah Uddin, Forsyth Jack, Brown Kevin A, Costa Andrew P, Bogoch Isaac I, Stall Nathan M
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada.
BlueDot, Toronto, Ontario, Canada.
J Am Med Dir Assoc. 2021 Mar;22(3):494-497. doi: 10.1016/j.jamda.2021.01.068. Epub 2021 Jan 26.
To assess changes in the mobility of staff between nursing homes in Ontario, Canada, before and after enactment of public policy restricting staff from working at multiple homes.
Pre-post observational study.
623 nursing homes in Ontario, Canada, between March 2020 and June 2020.
We used GPS location data from mobile devices to approximate connectivity between all 623 nursing homes in Ontario during the 7 weeks before (March 1-April 21) and after (April 22-June 13) the policy restricting staff movement was implemented. We constructed a network diagram visualizing connectivity between nursing homes in Ontario and calculated the number of homes that had a connection with another nursing home and the average number of connections per home in each period. We calculated the relative difference in these mobility metrics between the 2 time periods and compared within-home changes using McNemar test and the Wilcoxon rank-sum test.
In the period preceding restrictions, 266 (42.7%) nursing homes had a connection with at least 1 other home, compared with 79 (12.7%) homes during the period after restrictions, a drop of 70.3% (P < .001). Including all homes, the average number of connections in the before period was 3.90 compared to 0.77 in the after period, a drop of 80.3% (P < .001). In both periods, mobility between nursing homes was higher in homes located in larger communities, those with higher bed counts, and those part of a large chain.
Mobility between nursing homes in Ontario fell sharply after an emergency order by the Ontario government limiting long-term care staff to a single home, though some mobility persisted. Reducing this residual mobility should be a focus of efforts to reduce risk within the long-term care sector during the COVID-19 pandemic.
评估加拿大安大略省公共政策颁布前后，养老院工作人员在各养老院之间流动情况的变化。该政策限制工作人员在多家养老院工作。
前后对照观察性研究。
2020年3月至2020年6月期间，加拿大安大略省的623家养老院。
我们使用移动设备的GPS位置数据，估算在限制工作人员流动政策实施前（3月1日至4月21日）和实施后（4月22日至6月13日）这7周内，安大略省623家养老院之间的连通性。我们构建了一个网络图，直观显示安大略省各养老院之间的连通性，并计算了每个时期与其他养老院有连接的养老院数量以及每家养老院的平均连接数。我们计算了这两个时间段内这些流动指标的相对差异，并使用麦克尼马尔检验和威尔科克森秩和检验比较了机构内部的变化。
在限制措施实施前，266家（42.7%）养老院与至少1家其他养老院有连接，而在限制措施实施后，这一数字为79家（12.7%），下降了70.3%（P < 0.001）。纳入所有养老院后，实施前的平均连接数为3.90，实施后为0.77，下降了80.3%（P < 0.001）。在两个时期内，位于较大社区、床位较多以及属于大型连锁机构的养老院之间的人员流动更高。
安大略省政府发布紧急命令，将长期护理工作人员限制在一家养老院工作后，安大略省各养老院之间的人员流动大幅下降，不过仍存在一些人员流动。在新冠疫情期间，减少这种残余的人员流动应成为长期护理部门降低风险工作的重点。
