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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 9 of 9 Research Studies DisplayedCrnich CJ
Reimagining infection control in U.S. nursing homes in the era of COVID-19.
This paper provides an overview of nursing home (NH) infection and control, reviews the 2016 CMS changes to federal regulations, and proposes recommendations to sustain improvements. COVID-19 put further pressure on nursing homes who were already strained by rising numbers of infections from C. difficile and multidrug-resistant organisms. The author puts out a call for reimagining infection prevention and control using the Systems Engineering Initiative for Patient Safety framework. Additional recommendations are made to enhance NH infection prevention and control programs in the areas of people, tasks, tools, organization, built environment, and external environment.
AHRQ-funded; HS022465.
Citation: Crnich CJ .
Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc 2022 Dec;23(12):1909-15. doi: 10.1016/j.jamda.2022.10.022..
Keywords: Elderly, COVID-19, Public Health, Infectious Diseases, Nursing Homes, Healthcare-Associated Infections (HAIs), Prevention
Dube WC, Kellogg JT, Adams C
Quantifying risk for SARS-CoV-2 infection among nursing home workers for the 2020-2021 winter surge of the COVID-19 pandemic in Georgia, USA.
This study’s objective was to estimate incidence of risks for COVID-19 infection among nursing home staff in the state of Georgia during the 2020-2021 Winter surge in the US. Staff at fourteen nursing homes were given a survey and serologic testing at 2 time points with 3-month interval exposure assessment. At the first time point, 203 study eligible contracted or employed staff members from these participating nursing homes were seronegative. At the second time point, 72 (35.5%) had evidence of interval infection. Among unvaccinated staff, infection rates were significantly higher among nurses and certified nursing assistants accounting for race and interval infection incidence in both the community and facility.
AHRQ-funded; HS025987.
Citation: Dube WC, Kellogg JT, Adams C .
Quantifying risk for SARS-CoV-2 infection among nursing home workers for the 2020-2021 winter surge of the COVID-19 pandemic in Georgia, USA.
J Am Med Dir Assoc 2022 Jun;23(6):942-46.e1. doi: 10.1016/j.jamda.2022.02.014..
Keywords: COVID-19, Nursing Homes, Provider: Health Personnel, Risk, Public Health
Li Y, Cheng Z, Cai X
State social distancing restrictions and nursing home outcomes.
This study examined how state orders for social distancing to curb COVID-19 morbidity and mortality affected nursing home patients and what potential negative health consequences they may have had. The authors examined state social distancing restrictions from June to August of 2020 and their associations with the weekly numbers of new COVID cases, new COVID deaths, and new non-COVID deaths in nursing homes across the US. They found that stronger state social distancing measures were associated with improved outcomes, reduced across-facility disparities in COVID outcomes, and somewhat increased non-COVID-19 death rates. The estimates for non-COVID-19 deaths were sensitive to alternative model specifications.
AHRQ-funded; HS026893; HS024923.
Citation: Li Y, Cheng Z, Cai X .
State social distancing restrictions and nursing home outcomes.
Sci Rep 2022 Jan 20;12(1):1058. doi: 10.1038/s41598-022-05011-6..
Keywords: COVID-19, Nursing Homes, Prevention, Public Health
Jones K, Mantey J, Washer L
When planning meets reality: COVID-19 interpandemic survey of Michigan nursing homes.
This survey examined conditions at Michigan nursing homes (NHs) during the COVID-19 pandemic period. This survey evaluated preparedness, staffing, testing, and adaptations made due to COVID. Of 452 Michigan NHs contacted via email, 145 opened the survey of those,143 responded from May 1-12, 2020. Two-thirds reported shortages of personal protective equipment. Half lacked sufficient testing resources with only 36% able to test residents and staff when needed. A majority (55%) experienced staffing shortages, with 63% experiencing resignations with front-line clinical staff more likely to resign. Facilities showed rapid adaptation, with 78% creating COVID-19 units to care for patients on site. To reduce isolation, most NHs facilitated communication via phone calls, videoconferencing, and window visits. The majority continued to provide normal required therapies (90%).
AHRQ-funded; HS025451.
Citation: Jones K, Mantey J, Washer L .
When planning meets reality: COVID-19 interpandemic survey of Michigan nursing homes.
Am J Infect Control 2021 Nov;49(11):1343-49. doi: 10.1016/j.ajic.2021.03.016..
Keywords: COVID-19, Nursing Homes, Public Health, Emergency Preparedness
Montoya A, Jenq G, Mills JP
Partnering with local hospitals and public health to manage COVID-19 outbreaks in nursing homes.
In this study, the authors described, among short-term and long-term residents at three nursing homes (NHs) in Michigan, the outbreak identification process, universal testing, point prevalence of COVID-19, and subsequent containment efforts, outcomes, and challenges. They found that proactive and coordinated steps between NH medical directors and administrators, referral hospitals including their laboratories, and local public health officials were necessary to respond rapidly to an outbreak and to limit the transmission of COVID-19. They suggested that this coordinated public health approach may save lives, minimize the burden to the healthcare system, and reduce healthcare costs.
AHRQ-funded; HS025451.
Citation: Montoya A, Jenq G, Mills JP .
Partnering with local hospitals and public health to manage COVID-19 outbreaks in nursing homes.
J Am Geriatr Soc 2021 Jan;69(1):30-36. doi: 10.1111/jgs.16869..
Keywords: Hospitals, Nursing Homes, Long-Term Care, Public Health, COVID-19, Elderly, Infectious Diseases
Temkin-Greener H, Guo W, Mao Y
COVID-19 pandemic in assisted living communities: results from seven states.
The purpose of this observational study was to describe variations in COVID-19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. The investigators concluded that ALs with a higher proportion of minorities had more COVID-19 cases. Many of the previously identified individual risk factors were also present in this vulnerable population.
AHRQ-funded; HS024923; HS026893; HS026893.
Citation: Temkin-Greener H, Guo W, Mao Y .
COVID-19 pandemic in assisted living communities: results from seven states.
J Am Geriatr Soc 2020 Dec;68(12):2727-34. doi: 10.1111/jgs.16850..
Keywords: Elderly, Public Health, COVID-19, Nursing Homes, Vulnerable Populations, Risk
White EM, Kosar CM, Feifer RA
Variation in SARS-CoV-2 prevalence in U.S. skilled nursing facilities.
The objective of this study was to identify county and facility factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks in skilled nursing facilities (SNFs). The investigators concluded that larger SNFs and SNFs in areas of high SARS-CoV-2 prevalence were at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications.
AHRQ-funded; HS000011.
Citation: White EM, Kosar CM, Feifer RA .
Variation in SARS-CoV-2 prevalence in U.S. skilled nursing facilities.
J Am Geriatr Soc 2020 Oct;68(10):2167-73. doi: 10.1111/jgs.16752..
Keywords: COVID-19, Elderly, Nursing Homes, Long-Term Care, Public Health, Infectious Diseases
Jones KM, Mantey J, Mills JP
COVID-19 preparedness in Michigan nursing homes.
The objectives of this study were to understand preparedness among Michigan nursing homes (NHs) in the midst of an ongoing pandemic and to compare with a 2007 survey on pandemic influenza preparedness in Michigan NHs. Findings showed that, in 2020, NHs were able to make policy and procedure changes within 1 week in response to urgent guidance from CMS and the CDC, which likely helped the facilities prepare for the COVID-19 pandemic. Most NHs had a dedicated staff member responsible for preparedness and were willing to accept patients from hospitals to assist in their surge capacity planning, particularly for non-COVID patients. NHs did express concerns about staffing shortages and PPE supply constraints as cases rose.
AHRQ-funded; HS025451.
Citation: Jones KM, Mantey J, Mills JP .
COVID-19 preparedness in Michigan nursing homes.
J Am Geriatr Soc 2020 May;68(5):937-39. doi: 10.1111/jgs.16490..
Keywords: COVID-19, Elderly, Nursing Homes, Long-Term Care, Emergency Preparedness, Public Health
Adams C, Young D, Gastanaduy PA
Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks.
Norovirus transmissibility is poorly understood and the goal of this study was to examine transmission via vomiting, diarrhea, and patient exposures. Six nursing home outbreaks in South Carolina were examined from 2014 to 2016. Vomiting infected 2.12 times the number of individuals as non-vomiters, diarrhea 1.39 times, and resident cases infected 1.53 times the number of individuals as staff cases. This finding is important for not just nursing homes, but other sites of norovirus outbreaks such as cruise ships.
AHRQ-funded; HS025987.
Citation: Adams C, Young D, Gastanaduy PA .
Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks.
PLoS Comput Biol 2020 Mar;16(3):e1007271. doi: 10.1371/journal.pcbi.1007271..
Keywords: Elderly, Nursing Homes, Long-Term Care, Infectious Diseases, Healthcare-Associated Infections (HAIs), Prevention, Public Health