Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
J Am Med Dir Assoc. 2023 Apr;24(4):441-446. doi: 10.1016/j.jamda.2023.01.028. Epub 2023 Feb 10.
To examine the nursing home to nursing home transfer rates before and during the early COVID-19 pandemic and to identify risk factors associated with those transfers in a state with a policy to create COVID-19-care nursing homes.
Cross-sectional cohorts of nursing home residents in prepandemic (2019) and COVID-19 (2020) periods.
Michigan long-term nursing home residents were identified from the Minimum Data Set.
Each year, we identified transfer events as a resident's first nursing home to nursing home transfer between March and December. We included residents' characteristics, health status, and nursing home characteristics to identify risk factors for transfer. Logistic regression models were conducted to determine risk factors for each period and changes in transfer rates between the 2 periods.
Compared to the prepandemic period, the COVID-19 period had a higher transfer rate per 100 (7.7 vs 5.3, P < .05). Age ≥80 years, female sex, and Medicaid enrollment were associated with a lower likelihood of transfer for both periods. During the COVID-19 period, residents who were Black, with severe cognitive impairment, or had COVID-19 infection were associated with a higher risk of transfer [adjusted odds ratio (AOR) (95% CI): 1.46 (1.01-2.11), 1.88 (1.11-3.16), and 4.70 (3.30-6.68), respectively]. After adjusting for resident characteristics, health status, and nursing home characteristics, residents had 46% higher odds [AOR (95% CI): 1.46 (1.14-1.88)] of being transferred to another nursing home during the COVID-19 period compared to the prepandemic period.
In the early COVID-19 pandemic, Michigan designated 38 nursing homes to care for residents with COVID-19. We found a higher transfer rate during the pandemic than during the prepandemic period, especially among Black residents, residents with COVID-19 infection, or residents with severe cognitive impairment. Further investigation is warranted to understand the transfer practice better and if any policies would mitigate the transfer risk for these subgroups.
在 COVID-19 大流行之前和期间，检查疗养院之间的转移率，并确定与密歇根州制定 COVID-19 护理疗养院政策相关的与这些转移相关的风险因素。
在大流行前（2019 年）和 COVID-19 期间（2020 年）的护理院居民的横断面队列。
密歇根州长期护理院居民从最低数据集中确定。
每年，我们将居民的第一次疗养院到疗养院转移识别为转移事件，这些转移事件发生在 3 月至 12 月之间。我们包括居民的特征、健康状况和疗养院的特征，以确定转移的风险因素。进行逻辑回归模型以确定每个时期的风险因素以及两个时期之间转移率的变化。
与大流行前时期相比，COVID-19 时期的转移率每 100 人更高（7.7 比 5.3，P <.05）。80 岁及以上、女性和医疗补助计划参与与两个时期的转移可能性降低相关。在 COVID-19 期间，黑人、严重认知障碍或感染 COVID-19 的居民与转移风险增加相关[调整后的优势比（AOR）（95%置信区间）：1.46（1.01-2.11）、1.88（1.11-3.16）和 4.70（3.30-6.68）]。在调整了居民特征、健康状况和疗养院特征后，与大流行前时期相比，COVID-19 期间居民被转移到另一家疗养院的可能性增加了 46%[AOR（95%置信区间）：1.46（1.14-1.88）]。
在 COVID-19 大流行早期，密歇根州指定了 38 家疗养院来照顾 COVID-19 患者。我们发现大流行期间的转移率高于大流行前时期，尤其是在黑人居民、感染 COVID-19 的居民或严重认知障碍的居民中。需要进一步调查以更好地了解转移实践情况，以及是否有任何政策可以减轻这些亚组的转移风险。
