Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
Health & Medicine Policy Research Group, Chicago, IL, USA.
Public Health Rep. 2022 May-Jun;137(3):564-572. doi: 10.1177/00333549221074381. Epub 2022 Feb 21.
The COVID-19 pandemic has had a devastating impact on older adults residing in skilled nursing facilities. This study examined the pathways through which community and facility factors may have affected COVID-19 cases and deaths in skilled nursing facilities.
We used structural equation modeling to examine the number of COVID-19 cases and deaths in skilled nursing facilities in Cook County, Illinois, from January 1 through September 30, 2020. We used data from the Centers for Medicare & Medicaid Services, the Illinois Department of Public Health, and the Cook County Medical Examiner's Office to determine the number of resident COVID-19 cases and deaths, number of staff cases, facility-level characteristics, and community-level factors.
Poorer facility quality ratings and higher numbers of staff COVID-19 cases were associated with increased numbers of resident COVID-19 cases and deaths. For-profit ownership was associated with larger facilities and higher resident-to-staff ratios, which increased the number of staff COVID-19 cases. Furthermore, skilled nursing facilities with a greater percentage of White residents were in areas with lower levels of social vulnerability and were less likely to be for-profit and, thus, were associated with higher quality.
For-profit ownership was associated with lower facility quality ratings and increases in the number of staff COVID-19 cases, leading to increased resident COVID-19 cases and deaths. Establishing enforceable regulations to ensure quality standards in for-profit skilled nursing facilities is critical to prevent future outbreaks and reduce health disparities in facilities serving racial and ethnic minority populations.
新冠疫情对居住在护理院的老年人造成了毁灭性的影响。本研究探讨了社区和机构因素可能通过哪些途径影响护理院的新冠病例和死亡。
我们使用结构方程模型来检验 2020 年 1 月 1 日至 9 月 30 日期间伊利诺伊州库克县护理院的新冠病例和死亡人数。我们使用了医疗保险和医疗补助服务中心、伊利诺伊州公共卫生部和库克县法医办公室的数据，以确定居民新冠病例和死亡人数、员工病例数量、机构层面特征和社区层面因素。
较差的机构质量评级和更多的员工新冠病例与居民新冠病例和死亡人数的增加有关。营利性所有权与更大的设施和更高的居民与员工比例有关，这增加了员工新冠病例的数量。此外，拥有更多白人居民的护理院位于社会脆弱性较低的地区，而且不太可能是营利性的，因此与更高的质量有关。
营利性所有权与机构质量评级的降低和员工新冠病例的增加有关，从而导致居民新冠病例和死亡人数的增加。制定可执行的法规，以确保营利性护理院的质量标准，对于防止未来的疫情爆发和减少服务于少数族裔人群的设施中的健康差距至关重要。
