Department of Economics, Harvard University, Cambridge, Massachusetts.
Department of Economics and Health Care Management, Labovitz School of Business and Economics, University of Minnesota, Duluth.
JAMA Netw Open. 2021 Sep 1;4(9):e2122885. doi: 10.1001/jamanetworkopen.2021.22885.
Federal data underestimate the impact of COVID-19 on US nursing homes because federal reporting guidelines did not require facilities to report case and death data until the week ending May 24, 2020.
To assess the magnitude of unreported cases and deaths in the National Healthcare Safety Network (NHSN) and provide national estimates of cases and deaths adjusted for nonreporting.
DESIGN, SETTING, AND PARTICIPANTS: This is a cross-sectional study comparing COVID-19 cases and deaths reported by US nursing homes to the NHSN with those reported to state departments of health in late May 2020. The sample includes nursing homes from 20 states, with 4598 facilities in 12 states that required facilities to report cases and 7401 facilities in 19 states that required facilities to report deaths. Estimates of nonreporting were extrapolated to infer the national (15 397 facilities) unreported cases and deaths in both May and December 2020. Data were analyzed from December 2020 to May 2021.
Nursing home ownership (for-profit or not-for-profit), chain affiliation, size, Centers for Medicare & Medicaid Services star rating, and state.
The main outcome was the difference between the COVID-19 cases and deaths reported by each facility to their state department of health vs those reported to the NHSN.
Among 15 415 US nursing homes, including 4599 with state case data and 7405 with state death data, a mean (SE) of 43.7% (1.4%) of COVID-19 cases and 40.0% (1.1%) of COVID-19 deaths prior to May 24 were not reported in the first NHSN submission in sample states, suggesting that 68 613 cases and 16 623 deaths were omitted nationwide, representing 11.6% of COVID-19 cases and 14.0% of COVID-19 deaths among nursing home residents in 2020.
These findings suggest that federal NHSN data understated total cases and deaths in nursing homes. Failure to account for this issue may lead to misleading conclusions about the role of different facility characteristics and state or federal policies in explaining COVID outbreaks.
联邦数据低估了 COVID-19 对美国养老院的影响，因为联邦报告指南要求设施在 2020 年 5 月 24 日这一周之前才报告病例和死亡数据。
评估全国医疗保健安全网（NHSN）中未报告病例和死亡的数量，并提供针对未报告情况进行调整的全国病例和死亡估计数。
设计、设置和参与者：这是一项横断面研究，比较了美国养老院向 NHSN 报告的 COVID-19 病例和死亡人数与 2020 年 5 月下旬向州卫生部门报告的病例和死亡人数。样本包括来自 20 个州的养老院，其中 12 个州的 4598 家设施要求报告病例，19 个州的 7401 家设施要求报告死亡病例。未报告病例的估计数被推断出来，以推断 2020 年 5 月和 12 月全国（15397 家设施）未报告的病例和死亡人数。数据于 2020 年 12 月至 2021 年 5 月进行分析。
养老院所有权（营利性或非营利性）、连锁关系、规模、医疗保险和医疗补助服务中心星级评定以及州。
主要结果是每个设施向其州卫生部门报告的 COVID-19 病例和死亡人数与向 NHSN 报告的病例和死亡人数之间的差异。
在 15415 家美国养老院中，包括 4599 家有州病例数据和 7405 家有州死亡数据，在 NHSN 样本州首次提交报告之前，有 43.7%（1.4%）的 COVID-19 病例和 40.0%（1.1%）的 COVID-19 死亡病例未报告，表明全国遗漏了 68613 例病例和 16623 例死亡病例，占 2020 年养老院居民 COVID-19 病例的 11.6%和 COVID-19 死亡人数的 14.0%。
这些发现表明，联邦 NHSN 数据低估了养老院的总病例和死亡人数。如果不考虑这一问题，可能会导致对不同设施特征以及州或联邦政策在解释 COVID 爆发方面的作用产生误导性结论。
