Proactive palliative care consultation was associated with a significantly shorter MICU length of stay in this high-risk group without any significant differences in mortality rates or discharge disposition.

BACKGROUND/OBJECTIVES To determine the associations of nursing home registered nurse (RN) staffing, overall quality of care, and concentration of Medicaid or racial and ethnic minority residents with 2019 coronavirus disease (COVID‐19) confirmed cases and deaths by April 16, 2020, among Connecticut nursing home residents. DESIGN Cross‐sectional analysis on Connecticut nursing home (n = 215) COVID‐19 report, linked to other nursing home files and county counts of confirmed cases and deaths. Multivariable two‐part models determined the associations of key nursing home characteristics with the likelihood of at least one confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least one confirmed case (death). SETTING All Connecticut nursing homes (n = 215). PARTICIPANTS None. INTERVENTION None. MEASUREMENTS Numbers of COVID‐19 confirmed cases and deaths among residents. RESULTS The average number of confirmed cases was eight per nursing home (zero in 107 facilities), and the average number of confirmed deaths was 1.7 per nursing home (zero in 131 facilities). Among facilities with at least one confirmed case, every 20‐minute increase in RN staffing (per resident day) was associated with 22% fewer confirmed cases (incidence rate ratio [IRR] = .78; 95% confidence interval [CI] = .68–.89; P < .001); compared with one‐ to three‐star facilities, four‐ or five‐star facilities had 13% fewer confirmed cases (IRR = .87; 95% CI = .78–.97; P < .015), and facilities with high concentration of Medicaid residents (IRR = 1.16; 95% CI = 1.02–1.32; P = .025) or racial/ethnic minority residents (IRR = 1.15; 95% CI = 1.03–1.29; P = .026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least one death, every 20‐minute increase in RN staffing significantly predicted 26% fewer COVID‐19 deaths (IRR = .74; 95% CI = I .55–1.00; P = .047). Other focused characteristics did not show statistically significant associations with deaths. CONCLUSION Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths. Nursing homes caring predominantly for Medicaid or racial and ethnic minority residents tend to have more confirmed cases.

Context Varied nursing home quality improvement programs have been implemented over the last decade; their implications for racial disparities in quality are unknown. Objective To determine the longitudinal trend of racial disparities in pressure ulcer prevalence among long-term nursing home residents during 2003-2008, and whether persistent disparities are related to where residents received care. Design Using US nursing home resident assessment files, On-line Survey, Certification, and Reporting files, and Area Resource Files, we examined pressure ulcer rate for high-risk residents. We categorized nursing homes according to their proportions of black residents. We determined risk-adjusted racial disparities between and within sites of care, and the risk-adjusted odds of pressure ulcers for black and white residents receiving care in different facilities. Setting and participants Observational cohort of 2,136,764 white and 346,808 black residents in 12,473 certified nursing homes. Main outcome measure Risk-adjusted odds of pressure ulcers of stages 2 to 4. Results Overall pressure ulcer rates decreased over years but black residents showed persistently higher rates than white residents: 16.8% (95% confidence interval [CI] 16.6-17.0%) vs 11.4% (95% CI 11.3-11.5%) in 2003, and 14.6% (95% CI 14.4-14.8%) vs 9.6% (95% CI 9.5-9.7%) in 2008 (p>0.05 for trend of disparities). Both black (unadjusted rate 15.5% in 2008; adjusted odds ratio [OR]=1.59, 95% confidence interval [CI] 1.52-1.67) and white (unadjusted rate 12.1%; adjusted OR=1.33, 95% CI 1.26-1.40) residents in nursing homes with the highest concentrations of black residents (≥35%) showed higher risk of pressure ulcers than white residents (unadjusted rate 8.8%) in nursing homes serving essentially white residents (black residents<5%). Conclusions From 2003 to 2008, the prevalence of pressure ulcers among high-risk nursing home residents was higher in black residents that in white residents. This disparity was in part related to the site of nursing home care.

Several of the factors influencing team effectiveness in PACE are potentially modifiable and, therefore, could offer insights for improving team practice.