Evaluating the Findings of the IMPACT-C Randomized Clinical Trial to Improve COVID-19 Vaccine Coverage in Skilled Nursing Facilities

Abstract

Identifying successful strategies to increase COVID-19 vaccination among skilled nursing facility (SNF) residents and staff is integral to preventing future outbreaks in a continually overwhelmed system. OBJECTIVE To determine whether a multicomponent vaccine campaign would increase vaccine rates among SNF residents and staff. DESIGN, SETTING, AND PARTICIPANTS This was a cluster randomized trial with a rapid timeline (December 2020-March 2021) coinciding with the Pharmacy Partnership Program (PPP). It included 133 SNFs in 4 health care systems across 16 states: 63 and 70 facilities in the intervention and control arms, respectively, and participants included 7496 long-stay residents (>100 days) and 17 963 staff. INTERVENTIONS Multicomponent interventions were introduced at the facility level that included: (1) educational material and electronic messaging for staff; (2) town hall meetings with frontline staff (nurses, nurse aides, dietary, housekeeping); (3) messaging from community leaders; (4) gifts (eg, T-shirts) with socially concerned messaging; (5) use of a specialist to facilitate consent with residents' proxies; and (6) funds for additional COVID-19 testing of staff/residents. MAIN OUTCOMES AND MEASURESThe primary outcomes of this study were the proportion of residents (from electronic medical records) and staff (from facility logs) who received a COVID-19 vaccine (any), examined as 2 separate outcomes. Mixed-effects generalized linear models with a binomial distribution were used to compare outcomes between arms, using intent-to-treat approach. Race was examined as an effect modifier in the resident outcome model. RESULTSMost facilities were for-profit (95; 71.4%), and 1973 (26.3%) of residents were Black. Among residents, 82.5% (95% CI, 81.2%-83.7%) were vaccinated in the intervention arm, compared with 79.8% (95% CI, 78.5%-81.0%) in the usual care arm (marginal difference 0.8%; 95% CI, −1.9% to 3.7%). Among staff, 49.5% (95% CI, 48.4%-50.6%) were vaccinated in the intervention arm, compared with 47.9% (95% CI, 46.9%-48.9%) in usual care arm (marginal difference: −0.4%; 95% CI, −4.2% to 3.1%). There was no association of race with the outcome among residents. CONCLUSIONS AND RELEVANCEA multicomponent vaccine campaign did not have a significant effect on vaccination rates among SNF residents or staff. Among residents, vaccination rates were high. However, half the staff remained unvaccinated despite these efforts. Vaccination campaigns to target SNF staff will likely need to use additional approaches.

Association of State COVID-19 Vaccine Mandates With Staff Vaccination Coverage and Staffing Shortages in US Nursing Homes

“…For example, a cluster-randomized trial evaluating a multicomponent vaccine campaign found no significant difference in staff vaccine coverage between intervention and control facilities. 20 This suggests that compelling staff vaccination through mandates may be the best available option to policy makers to achieve and maintain high levels of COVID-19 vaccination among this population.…”

“…The association of mandates with higher vaccination coverage stands in contrast with prior efforts to increase COVID-19 vaccine uptake among nursing home staff through education, outreach, and incentives. For example, a cluster-randomized trial evaluating a multicomponent vaccine campaign found no significant difference in staff vaccine coverage between intervention and control facilities . This suggests that compelling staff vaccination through mandates may be the best available option to policy makers to achieve and maintain high levels of COVID-19 vaccination among this population.…”

COVID-19 Vaccination Hesitancy among Healthcare Workers—A Review

“…Non-monetary incentives (such as t-shirts or granting freedoms) have also been effective [243,244]. Monetary incentives have had mixed results in the general population [245][246][247], and they can be complicated by ethical concerns [248].…”

COVID-19 Vaccination Attitude and Behavior among Nurses at a West Texas Regional Hospital

“…Healthcare worker vaccination status is of interest to hospitals and healthcare systems for patient and employee safety and meeting regulations regarding employee safety requirements. Several interventions have been studied for vaccine-hesitant HCWs, including email reminders, vaccine education, and monetary incentives and non-monetary incentives [ 15 , 16 , 17 ]. The hope is that these methods can address safety concerns, dispel misinformation, and provide incentives that can increase vaccination rates.…”