COVID-19 Test Result Turnaround Time for Residents and Staff in US Nursing Homes

McGarry, Brian E.; SteelFisher, Gillian K.; Grabowski, David C.; Barnett, Michael L.

doi:10.1001/jamainternmed.2020.7330

Cited by 50 publications

(47 citation statements)

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“…A cross-sectional study of healthcare workers in US nursing homes identified 13·5% of facilities had test turnaround times within 1 day, and 16·4% in hot-spot counties. 21 We observed a higher proportion of timely test turnaround in our cohort, as this may be more reflective of different strategies and testing resources available across jurisdictions. Urban areas were more likely to have timely test turnaround compared to rural ones.…”

Section: Discussionmentioning

confidence: 69%

Factors Associated with Timely Test Seeking, Test Turnaround, and Public Reporting of COVID-19: a retrospective analysis in Ontario, Canada

Joh¹,

Buchan

Daneman

et al. 2021

Preprint

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Background Minimizing delays in disease identification and reporting improves the timeliness of surveillance data, and can reduce transmission of COVID-19. Our study investigates factors associated with timely testing and reporting of COVID-19 during the first pandemic wave in one province of Canada. Methods We identified all persons with confirmed SARS-CoV-2 infection residing in private households across the largest province of Canada, Ontario from the date of the first confirmed case in Ontario (January 25) to July 19, 2020. Our primary outcomes consisted of: (1) specimen collection within 1 day of symptom onset (test seeking), (2) test result reported to local public health within 1 day of specimen collection (test turnaround), and (3) entry of case data into the provincial database within 1 day of reporting test results (reporting). We examined 14 covariates including eight case characteristics, and six neighborhood characteristics. In addition to descriptive measures, logistic regression models were fitted. Unadjusted models included the covariate alone, while adjusted models included age, gender, month, and region. Findings Among 27,198 COVID-19 cases from January 25 2020 to July 19 2020, 28.7% had timely test seeking, 40.2% had timely test turnaround, and 75.5% had timely reporting. Male gender had lower odds of timely test seeking (adjusted odds ratio [aOR] 0.79 [95% CI: 0.74-0.85]) compared to females. Healthcare worker status (aOR 2.77 [95% CI: 2.52-3.05] compared to non-healthcare workers), and age ≥80 years (aOR 1.59 [95% CI: 1.33-1.91] compared to 40-59 year olds) were associated with timely test seeking. Specimen collection on Fridays and Saturdays (aOR 0.88 [95% CI: 0.79-0.98], aOR 0.83 [95% CI: 0.74-0.92] respectively, compared to Wednesdays) had lower odds of timely test turnaround. Urban areas (aOR 1.55 [95% CI: 1.41-1.70] compared to rural areas) were associated with timely test turnaround. Urban areas (aOR 0.79 [95% CI: 0.70-0.89] compared to rural areas) were less likely to have timely reporting. Interpretation Individual, neighborhood, and administrative factors are associated with timely testing and reporting of SARS-CoV-2 infections. These findings present considerations for developing targeted strategies to minimize delays and improve timely testing and reporting of SARS-CoV-2 infections.

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Section: Discussionmentioning

confidence: 69%

Factors Associated with Timely Test Seeking, Test Turnaround, and Public Reporting of COVID-19: a retrospective analysis in Ontario, Canada

Joh¹,

Buchan

Daneman

et al. 2021

Preprint

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“…Last, throughout our risk of bias assessments, we assumed that the reporting of COVID-19 outcomes was not systematically related to ownership. However, there is some suggestive evidence of a longer turnaround period for resident test results among for-profit providers 58 , which if generally true, may bias the effect of FP status towards the null due to underreporting.…”

Section: Discussionmentioning

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

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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.

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“…Additionally, it includes a second line of defense, immediately activating the screening of all residents and employees, where a positive COVID-19 case is identi ed, enabling us to limit the extent of the outbreak. The PCR test results were reported directly to the LTCF medical directors, within 24 hours, and the response was immediately implemented out by the Senior Shield program headquarters, which stood by ready to take action on a 24/7 basis [23].…”

Section: Discussionmentioning

confidence: 99%

The Effect of National Weekly COVID-19 Screening Testing of All Workers in Long-Term Care Facilities: A Decrease in Mortality

Maimon

Hassan

et al. 2021

SSRN Journal

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Background Outbreaks of Coronavirus 2019 (COVID-19) in Long-Term Care Facilities (LTCFs) have resulted mainly from disease transmission by asymptomatic health care workers (HCW's). It is not known whether routine COVID-19 screening tests carried out on HCW's would reduce mortality of LTCF residents. Since mid-July 2020, the Israeli national LTCF defense program-"Senior Shield"-has used weekly COVID-19 PCR tests on all LTCF employees. Methods A nationwide, government funded, screening program on all LTCF personnel for four months during the second COVID-19 wave. We evaluated differences between the two waves in the national LTCF's system with regard to hospitalizations and mortality. Estimation of national health system predicted outcomes, in the absence of this weekly screening plan, was calculated. Results COVID-19 tests were taken weekly in all 1,107 LTCFs which includes 62,159 HCWs and 100,046 residents. A median of 55,282 (range-16,249) tests were performed each week. Turnaround time from sampling to result was less than 24 hours in 95% of tests. Compared to the rst wave, in which 45.3% of national mortality was attributed to the LTCF's, the second wave saw a 33.8% reduction in this mortality ratio. Estimation of national health system outcomes during the second wave showed that the activation of the screening program reduced hospital load by 35% and prevented 30% of national mortality from COVID-19. Conclusions Routine weekly COVID-19 PCR testing of all LTCF employees may reduce national hospitalizations and mortality.

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COVID-19 Test Result Turnaround Time for Residents and Staff in US Nursing Homes

Cited by 50 publications

References 1 publication

Factors Associated with Timely Test Seeking, Test Turnaround, and Public Reporting of COVID-19: a retrospective analysis in Ontario, Canada

Factors Associated with Timely Test Seeking, Test Turnaround, and Public Reporting of COVID-19: a retrospective analysis in Ontario, Canada

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

The Effect of National Weekly COVID-19 Screening Testing of All Workers in Long-Term Care Facilities: A Decrease in Mortality

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