The role of the social vulnerability index in personal protective equipment shortages, number of cases, and associated mortality during the coronavirus disease 2019 (COVID-19) pandemic in Michigan skilled nursing facilities.
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ABSTRACT:
SUBMITTER: LeRose JJ
PROVIDER: S-EPMC7785317 | biostudies-literature | 2020 Nov
REPOSITORIES: biostudies-literature
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The role of the social vulnerability index in personal protective equipment shortages, number of cases, and associated mortality during the coronavirus disease 2019 (COVID-19) pandemic in Michigan skilled nursing facilities.
LeRose Jennifer J JJ Merlo Courtney C Duong Phong P Harden Kelsi K Rush Rebecca R Artzberger Adam A Sidhu Nikki N Sandhu Avnish A Chopra Teena T
Infection control and hospital epidemiology 20201113 7
The Social Vulnerability Index (SVI) is used to stratify community need for support during disasters. We evaluated relationships between the SVI and personal protective equipment shortages, COVID-19 caseload, and mortality rates in skilled nursing facilities (SNFs). In SVI quartile 4, personal protective equipment shortages were 2.3 times those in SNFs in quartile 1; COVID-19 case loads were 1.6 times those of SNFs in quartile 1; and mortality rates in were 1.9 times those of SNFs in SVI quartil ...[more]
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Project description:The coronavirus disease 2019 (COVID-19) pandemic continues to devastate US nursing homes. Adequate personal protective equipment (PPE) and staffing levels are critical to protect nursing home residents and staff. Despite the importance of these basic measures, few national data are available concerning the state of nursing homes with respect to these resources. This article presents results from a new national database containing data from 98 percent of US nursing homes. We find that more than one in five nursing homes reports a severe shortage of PPE and any shortage of staff. Rates of both staff and PPE shortages did not meaningfully improve from May to July 2020. Facilities with COVID-19 cases among residents and staff, as well as those serving more Medicaid recipients and those with lower quality scores, were more likely to report shortages. Policies aimed at providing resources to obtain additional direct care staff and PPE for these vulnerable nursing homes, particularly in areas with rising community COVID-19 case rates, are needed to reduce the national COVID-19 death toll.
| S-EPMC7598889 | biostudies-literature
Project description:BackgroundUS nursing homes are required to follow Centers for Disease Control guidance for COVID-19 transmission-based precautions (TBP) when admitting COVID-positive patients.ObjectiveTo assess how frequently nursing homes had shortages of personal protective equipment (PPE) or staffing in weeks when they admitted COVID-positive patients, which likely made it more difficult to follow TBP, and to compare facility characteristics by admissions practices.Design and settingFacility-level data from the Nursing Home COVID-19 Public File for the period between June 7, 2020 and March 7, 2021 was combined with additional data. The percentages of nursing homes that admitted COVID-positive patients and that had shortages when admitting were calculated for each week. Descriptive statistics and logistic regression models were used to examine the relationship between facility characteristics and the likelihood of admitting COVID-positive patients.MeasurementsFacilities were categorized as having admitted COVID-positive patients in a week if one or more admissions requiring TBP were reported for that week. Facilities that reported having less than a 1-week supply of any type of PPE or being short any type of staff in a week were defined, respectively, as having a PPE shortage or staffing shortage in that week.ResultsOver the 40-week study period, 39% of US nursing homes admitted COVID-positive patients in at least 1 week in which they were experiencing PPE or staffing shortages. Facilities that admitted COVID-positive patients with shortages generally had lower Centers for Medicare and Medicaid Services overall five-star ratings than other facilities. Only a small percentage of facilities that admitted COVID-positive patients while facing shortages were located in counties with severe shortages of PPE or staffing. In logistic regression models, shortages were not associated with COVID-positive admissions.ConclusionThe widespread practice of admitting COVID-positive patients while facing shortages may have put nursing home residents and staff at heightened risk of COVID-19 infection.
| S-EPMC8242553 | biostudies-literature
Project description:ImportanceTelemedicine in skilled nursing facilities (SNFs) has the potential to improve access and timeliness of care. During the COVID-19 pandemic in 2020 to 2022, telemedicine coverage expanded, but little is known about patterns of use in SNFs.ObjectiveTo describe patterns of telemedicine use in SNFs.Design, setting, and participantsThis cohort study used 2018 to 2022 Medicare fee-for-service claims and Minimum Data Set 3.0 records to identify short- and long-term care SNF residents. Clinician visits were grouped into routine SNF visits (ie, regular primary care within SNF) and other outpatient visits (ie, with non-SNF affiliated primary and specialty care clinicians). Using a difference-in-differences approach, assessments included whether off-hours visits (measured as weekend visits), new specialist visits, psychiatrist visits, or visits for residents with limited mobility changed differentially between 2018 to 2019 and 2020 to 2021 for SNFs with high compared with low telemedicine use in 2020.ExposureTelemedicine adoption at SNF after 2020.Main outcomes and measuresNumber and proportion of telemedicine SNF and outpatient visits.ResultsAcross 15 434 SNFs and 4 463 591 residents from the period January 2019 through June 2022 (mean [SD] age, 79.7 [11.6] years; 61% female in 2020), telemedicine visits increased from 0.15% in January 2019 to February 2020 to 15% SNF visits and 25% outpatient visits in May 2020. By 2022, telemedicine dropped to 2% of SNF visits and 8% of outpatient visits. The proportion of SNFs with any telemedicine visits annually dropped from 91% in 2020 to 61% in 2022. The facilities with high telemedicine use were more likely to be rural (adjusted odds ratio vs urban, 2.06; 95% CI, 1.77 to 2.40). Psychiatry visits differentially increased in high vs low telemedicine-use SNFs (20.2% relative increase; 95% CI, 1.2% to 39.2%). In contrast, there was little change in outpatient visits for residents with limited mobility (7.2%; 95% CI, -0.1% to 14.6%) or new specialist visits (-0.7%; 95% CI, -2.5% to 1.2%).Conclusions and relevanceIn this cohort study of SNF residents, telemedicine was rapidly adopted in early 2020 but subsequently stabilized at a low use rate that was nonetheless higher than before 2020. Higher telemedicine use in SNFs was associated with improved access to psychiatry visits in SNFs. A policy to encourage continued telemedicine use may facilitate further access to important services as the technology matures.
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Project description:This study investigates the forces that contributed to severe shortages in personal protective equipment in the US during the COVID-19 crisis. Problems from a dysfunctional costing model in hospital operating systems were magnified by a very large demand shock triggered by acute need in healthcare and panicked marketplace behavior that depleted domestic PPE inventories. The lack of effective action on the part of the federal government to maintain and distribute domestic inventories, as well as severe disruptions to the PPE global supply chain, amplified the problem. Analysis of trade data shows that the US is the world's largest importer of face masks, eye protection, and medical gloves, making it highly vulnerable to disruptions in exports of medical supplies. We conclude that market prices are not appropriate mechanisms for rationing inputs to health because health is a public good. Removing the profit motive for purchasing PPE in hospital costing models, strengthening government capacity to maintain and distribute stockpiles, developing and enforcing regulations, and pursuing strategic industrial policy to reduce US dependence on imported PPE will help to better protect healthcare workers with adequate supplies of PPE.
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Project description:The COVID-19 outbreak put healthcare systems across the globe under immense pressure to meet the unprecedented demand for critical supplies and personal protective equipment (PPE). The traditional cost-effective supply chain paradigm failed to respond to the increased demand, putting healthcare workers (HCW) at a much higher infection risk relative to the general population. Recognizing PPE shortages and high infection risk for HCWs, the World Health Organization (WHO) recommends allocations based on ethical principles. In this paper, we model the infection risk for HCWs as a function of usage and use it as the basis for distribution planning that balances government procurement decisions, hospitals' PPE usage policies, and WHO ethical allocation guidelines. We propose an infection risk model that integrates PPE allocation decisions with disease progression estimates to quantify infection risk among HCWs. The proposed risk function is used to derive closed-form allocation decisions under WHO ethical guidelines in both deterministic and stochastic settings. The modelling is then extended to dynamic distribution planning. Although nonlinear, we reformulate the resulting model to make it solvable using off-the-shelf software. The risk function successfully accounts for virus prevalence in space and in time and leads to allocations that are sensitive to the differences between regions. Comparative analysis shows that the allocation policies lead to significantly different levels of infection risk, especially under high virus prevalence. The best-outcome allocation policy that aims to minimize the total infected cases outperforms other policies under this objective and that of minimizing the maximum number of infections per period.
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Project description:ObjectiveTo understand how hospital-based clinicians evaluate older adults in the hospital and decide who will be transferred to a skilled nursing facility (SNF) for postacute care.DesignSemistructured interviews paired with a qualitative analytical approach informed by Social Constructivist theory.SettingInpatient care units in three hospitals. Purposive sampling was used to maximize variability in hospitals, units within hospitals, and staff on those units.ParticipantsClinicians (hospitalists, nurses, therapists, social workers, case managers) involved in evaluation and decision-making regarding postacute care (N = 25).MeasurementsCentral themes related to clinician evaluation and discharge decision-making.ResultsClinicians described pressure to expedite evaluation and discharge decisions, resulting in the use of SNFs as a "safety net" for older adults being discharged from the hospital. The lack of hospital-based clinician knowledge of SNF care practices, quality, or patient outcomes resulted in lack of a standardized evaluation process or a clear primary decision-maker.ConclusionHospital clinician evaluation and decision-making about postacute care in SNFs may be characterized as rushed, without a clear system or framework for making decisions and uninformed by knowledge of SNF or patient outcomes in those discharged to SNFs. This leads to SNFs being used as a "safety net" for many older adults. As hospitals and SNFs are increasingly held jointly accountable for outcomes of individuals transitioning between hospitals and SNFs, novel solutions for improving evaluation and decision-making are urgently needed.
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Project description:Personal protective equipment (PPE) shortages represent a persistent and critical challenge during the COVID-19 pandemic. Communities of 3D printing hobbyists and experts responded by designing and producing homemade, 3D-printed PPE. This report discusses the design, manufacturing and validation of the Kansas City Mask (KC Mask). Once printed and assembled, masks were fit tested at Truman Medical Center in Kansas City, MO. The KC Mask was approved for use by pandemic response administration staff at the hospital. Fortunately, due to adequate PPE supply at the time of this publication, wide utilization of the KC mask has not been required. The authors endorse the KC Mask as a stopgap measure, proven to be effective in situations of critical PPE shortage based on Centers for Disease Control and Prevention (CDC) guidelines.
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Project description:BackgroundDual eligibles, persons who qualify for both Medicare and Medicaid coverage, often receive poorer quality care relative to other Medicare beneficiaries.ObjectivesTo determine whether dual eligibles are discharged to lower quality post-acute skilled nursing facilities (SNFs) compared with Medicare-only beneficiaries.Research designFollowing the random utility maximization model, we specified a discharge function using a conditional logit model and tested how this discharge rule varied by dual-eligibility status.SubjectsA total of 692,875 Medicare fee-for-service patients (22% duals) who were discharged for Medicare paid SNF care between July 2004 and June 2005.MeasuresMedicare enrollment and the Medicaid Analytic Extract files were used to determine dual eligibility. The proportion of Medicaid patients and nursing staff characteristics provided measures of SNF quality.ResultsDuals are more likely to be discharged to SNFs with a higher share of Medicaid patients and fewer nurses. These results are robust to estimation with an alternative subsample of patients based on primary diagnoses, propensity of being dual eligible, and likelihood of remaining in the nursing home.ConclusionsDisparities exist in access to quality SNF care for duals. Strategies to improve discharge planning processes are required to redirect patients to higher quality providers, regardless of Medicaid eligibility.
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Project description:Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009-13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March-October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice.
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