Association Between CMS Quality Ratings and COVID-19 Outbreaks in Nursing Homes — West Virginia, March 17–June 11, 2020

Bui, David; See, Isaac; Hesse, Elisabeth; Varela, Kate; Harvey, R. Reid; August, Euna M.; Winquist, Andrea; Mullins, Samantha H.; McBee, Shannon; Thomasson, Erica; Atkins, Amy

doi:10.15585/mmwr.mm6937a5

Cited by 55 publications

(74 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The descriptive information on all included research can be found in Table 2. Most of the included studies were peer-reviewed publications (22/28), with 2 government reports 24,25 and 4 preprints or working papers. The unit of analysis across all included studies was care homes.…”

Section: Resultsmentioning

confidence: 99%

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

Bach-Mortensen

Verboom

Esposti

2021

Preprint

View full text Add to dashboard Cite

BackgroundThe adult social care sector is being increasingly outsourced to for-profit providers, but the impacts of privatisation on service quality and resident outcomes are unclear. During the COVID-19 pandemic, for-profit providers have been accused of failing their residents by prioritising profits over care, prevention, and caution, which has been reported to result in a higher prevalence of COVID-19 infections and deaths in for-profit care homes. Although many of these reports are anecdotal or based on news reports, there is a growing body of academic research investigating ownership variation across COVID-19 outcomes, which has not been systematically appraised and synthesised.ObjectivesTo identify, appraise, and synthesise the available research on ownership variation in COVID-19 outcomes (outbreaks, infections, deaths, shortage of personal protective equipment (PPE) and staff) across for-profit, public, and non-profit care homes for older people, and to update our findings as new research becomes available.DesignLiving systematic review.MethodsThis review was prospectively registered with Prospero (CRD42020218673). We searched 17 databases and performed forward and backward citation tracking of all included studies. Search results were screened and reviewed in duplicate. Risk of bias (RoB) was assessed in duplicate according to the COSMOS-E guidance. The results were synthesised according to RoB, model adjustment, and country context and visualised using harvest plots.ResultsTwenty-eight studies across five countries were included, with 75% of included studies conducted in the Unites States. For-profit ownership was not consistently associated with a higher probability of COVID-19 outbreaks across included studies. However, there was compelling evidence of worse COVID-19 outcomes following an outbreak; with for-profit care homes having higher rates of accumulative infections and deaths. For-profit providers were also associated with shortages in PPE, which may have contributed to the higher incidence of infections and deaths.Chain affiliation was often found to be correlated with higher risk of outbreaks, but not consistently associated with an elevated number of deaths and infections. Private equity ownership was not consistently associated with worse COVID-19 outcomes.ConclusionFor-profit status was a consistent risk factor for higher cumulative COVID-19 infections and deaths. Thus, ownership among providers may be a key modifiable factor which can be regulated to improve health outcomes in vulnerable populations and reduce health disparities. This review will be updated as new research becomes published, which may change the conclusion of our synthesis.

show abstract

Section: Resultsmentioning

confidence: 99%

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

Bach-Mortensen

Verboom

Esposti

2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Poorly ventilated buildings were implicated in a study of a COVID-19 outbreak in a Dutch nursing home [ 5 , 36 ]. Studies of nursing home quality metrics also found a relationship between lower Center for Medicare and Medicaid Services’ (CMS) star quality ratings, specifically staffing deficiencies and for-profit ownership status of nursing homes, and COVID-19 outbreak risk and severity [ 37 , 38 , 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April–June 2020

et al. 2020

View full text Add to dashboard Cite

Long-term care facilities (LTCFs) have had a disproportionally high mortality rate due to COVID-19. We describe a rapidly escalating COVID-19 outbreak among 116 LTCF residents in Rhode Island, USA. Overall, 111 (95.6%) residents tested positive and, of these, 48 (43.2%) died. The most common comorbidities were hypertension (84.7%) and cardiovascular disease (84.7%). A small percentage (9%) of residents were asymptomatic, while 33.3% of residents were pre-symptomatic, with progression to symptoms within a median of three days following the positive test. While typical symptoms of fever (80.2%) and cough (43.2%) were prevalent, shortness of breath (14.4%) was rarely found despite common hypoxemia (95.5%). The majority of patients demonstrated atypical symptoms with the most common being loss of appetite (61.3%), lethargy (42.3%), diarrhea (37.8%), and fatigue (32.4%). Many residents had increased agitation (38.7%) and anxiety (5.4%), potentially due to the restriction measures or the underlying mental illness. The fever curve was characterized by an intermittent low-grade fever, often the first presenting symptom. Mortality was associated with a disease course beginning with a loss of appetite and lethargy, as well as one more often involving fever greater than 38 °C, loss of appetite, altered mental status, diarrhea, and respiratory distress. Interestingly, no differences in age or comorbidities were noted between survivors and non-survivors. Taking demographic factors into account, treatment with anticoagulation was still associated with reduced mortality (adjusted OR 0.16; 95% C.I. 0.06–0.39; p < 0.001). Overall, the clinical features of the disease in this population can be subtle and the symptoms are commonly atypical. However, clinical decline among those who did not survive was often rapid with patients expiring within 10 days from disease detection. Further studies are needed to better explain the variability in clinical course of COVID-19 among LTCF residents, specifically the factors affecting mortality, the differences observed in symptom presentation, and rate of clinical decline.

show abstract

“…Eleven analytic studies provided estimates of an effect measure for risk factors for laboratory-confirmed infections. [59,61, 62, 63, 64, 65, 66, 67, 68, 69, 70] Five of the eleven were conducted using a sample of the general population. These examined the frequency or particular demographics, [61] neighborhood deprivation/social vulnerability levels, [63,68] relationship to a confirmed case, [59] and recent social activities, including restaurant dining.…”

Section: Resultsmentioning

confidence: 99%

The Missing Science: Epidemiological data gaps for COVID-19 policy in the United States

Bhatia

I²,

Baral

2021

Preprint

View full text Add to dashboard Cite

We report on a scoping study of COVID-19 epidemiological data available for COVID-19 policy and management decisions for U.S. settings. We synthesize current US Centers for Disease and Control and Prevention (CDC) estimates for parameter of infectious transmission, infection severity, and disease burden, and summarize epidemiologic contributions to these parameters published by CDC-affiliated investigators through Oct 30, 2020. Authoritative estimates of most infectious transmission and infection severity parameters exist but rely primarily on data from studies conducted in non-U.S. populations. Estimates of secondary infection risks for household, workplace, school, or other community settings are lacking and estimates of the clinical fraction remain uncertain. The CDC reports multiple disease incidence and prevalence measures at national and state geographies, including some measures disaggregated by age group, race/ethnicity and sex; however, nationally uniform disease burden measures are not available at the sub-state level or for sub-populations defined by exposure setting, limiting opportunities for targeted interventions. CDC-affiliated investigators authored 133 quantitative studies on COVID-19 through Oct 30, 2020; however only 34 employed analytic methods. The remainder were descriptive. Of the 34 analytic studies, eleven reported on risk factors for infection, seven reported on risk factors for severe disease, three on symptomatic infections, three reported secondary infection risks, and four reported on indirect pandemic effects. Gaps remain in the epidemiological data required for an efficient and equitable public health policy response to COVID-19. The existence of these gaps one year after the onset of the COVID-19 pandemic underscores the need for standardizing data collection and research priorities and protocols in the context of a rapidly emerging infectious disease epidemics.

show abstract

Association Between CMS Quality Ratings and COVID-19 Outbreaks in Nursing Homes — West Virginia, March 17–June 11, 2020

Cited by 55 publications

References 8 publications

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April–June 2020

The Missing Science: Epidemiological data gaps for COVID-19 policy in the United States

Contact Info

Product

Resources

About