Nursing homes' visitation bans during the COVID-19 pandemic: Effectiveness and consequences.

COVID-19 大流行期间疗养院的探视禁令：有效性和后果。

• 批准号: 10635829
• 负责人: Huiwen Xu
• 金额: $ 35.65万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10635829
• 关键词: Address; Adverse effects; Adverse event; Affect; Alzheimer' s disease related dementia; Behavior; COVID-19; COVID-19 mortality; COVID-19 pandemic; COVID-19 prevention; Caregivers; Caring; Cessation of life; Characteristics; Communities; Commuting; County; Data; Data Set; Effectiveness; Ensure; Family; Family member; Focus Groups; Friends; General Population; Group Interviews; Health; Health Personnel; Home visitation; Hospitalization; Hour; Individual; Infection; Infection Control; Intervention; Knowledge; Laws; Lifting; Link; Masks; Measures; Medicare claim; Mental Depression; Methods; Modeling; Moods; Nurses' Aides; Nursing Homes; Ohio; Outcome; Pathway interactions; Physical Function; Physicians; Policies; Policy Maker; Published Comment; Recommendation; Rights; SARS-CoV-2 infection; SARS-CoV-2 transmission; Social isolation; Surveys; Time; Travel; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Variant; Visit; Work; adverse event risk; adverse outcome; case control; design; effectiveness evaluation; falls; functional decline; future pandemic; hospice environment; infection rate; informal care; informal caregiver; pandemic disease; pandemic response; prevent; response; routine care; satisfaction; transmission process; viral transmission

PROJECT SUMMARY/ABSTRACT As of May 2022, there have been over 1 million COVID-19 cases and over 150,000 COVID-19 deaths among U.S. nursing home residents. One of the most widespread mitigation measures implemented by nursing homes was a visitation ban. In March and April 2020, 31 states issued state-wide visitation bans, affecting at least 66% of facilities and 70% of residents in the U.S. Visitation bans may prevent transmission between facilities and the community. Yet, any ban is incomplete because of staff who travel between the facility and the community. To our knowledge, there is no empirical study examining the effectiveness of visitation bans on preventing COVID- 19 infection rates, hospitalizations, and deaths. What also matters are the adverse effects of visitation bans on residents. Visitation bans can substantially reduce informal care, increase social isolation, and disrupt routine care, resulting in adverse events such as decreased function and increases in depression, falls, and hospitalization. Residents with Alzheimer's Disease & Related Dementias (ADRD), who rely more on caregivers, may have a greater risk of adverse events than those without ADRD. Our team has collected visitation data at both the state and facility levels, which document the dates when states initiated and lifted bans, as well as weekly bans data at the facility level in Ohio. We also collect open-ended comments from family members from a state-wide family satisfaction survey in Ohio. By linking data on visitation bans with national Medicare claims and assessment data, we propose a convergent parallel mixed methods study to examine the effectiveness and adverse consequences of visitation bans in nursing homes. We will study the 9,876 nursing homes in the 31 states that banned indoor visitation in March 2020, then lifted those bans between June and November 2020. We will also study the 701 nursing homes in Ohio, where we have weekly data on the presence of bans for each facility. Matched case-control design on prior infection rates and Hierarchical Generalized Linear Mixed Models will examine the association of lifting visitation bans with COVID-19 and health outcomes. Focus group interviews with direct care staff and analyses of family comments will be conducted to examine the effects of visitation bans on daily care practices and resident health outcomes. Understanding both the benefits and harms of visitation bans can inform future pandemic responses in nursing homes. The specific aims of this project are: 1) To assess the effectiveness of visitation bans on preventing COVID-19 infection (primary), hospitalization, and deaths among nursing home residents; 2) To evaluate the association of visitation bans with changes in function (primary), mood/behaviors, and adverse events among long-stay residents with or without ADRD; and 3) To understand how visitation bans affected daily care practices within nursing homes and resident health outcomes.

项目摘要/摘要 截至2022年5月，已有超过100万个1900案，超过150,000次共同死亡。 美国疗养院居民。由疗养院实施的最广泛的缓解措施之一 是访问禁令。在2020年3月和4月，31个州发布了全州访问禁令，影响至少66％ 美国访问禁令中的设施和70％的居民可能会阻止设施之间的传播 社区。然而，由于设施和社区之间旅行的工作人员，任何禁令都是不完整的。到 我们的知识，没有经验研究来研究探视禁令在防止相互企业方面的有效性 19感染率，住院和死亡。重要的是探视禁令的不利影响 居民。访问禁令可以大大减少非正式护理，增加社会隔离并破坏例程 护理，导致不良事件，例如功能降低和抑郁症，下降和 住院。患有阿尔茨海默氏病和相关痴呆症（ADRD）的居民，他们更多地依赖照顾者， 与没有ADRD的事件相比，发生不良事件的风险可能更大。我们的团队已收集了访问数据 国家和设施级别都记录了何时发起和取消禁令的日期以及 每周禁止在俄亥俄州的设施级别进行数据。我们还收集了家人的开放评论 俄亥俄州的全州家庭满意度调查。通过将访问禁令的数据与国家医疗保险索赔联系起来 和评估数据，我们提出了一项收敛的平行混合方法研究，以检查 疗养院中探访禁令的有效和不利后果。我们将研究9,876 2020年3月禁止室内访问的31个州的疗养院，然后在6月之间取消了这些禁令 和2020年11月。我们还将研究俄亥俄州的701家疗养院 每个设施都存在禁令。匹配的病例对照设计在先前的感染率和分层上 广义线性混合模型将检查举重禁令与Covid-19和Health的关联 结果。与直接护理人员的焦点小组访谈和家庭评论的分析将进行 检查禁令对日常护理实践和居民健康结果的影响。了解两者 探视禁令的好处和危害可以告知疗养院未来的大流行反应。 该项目的具体目的是：1）评估访问禁令对防止Covid-19的有效性 养老院居民的感染（主要），住院和死亡； 2）评估关联 探视禁令随着功能变化（主要），情绪/行为和不良事件的变化 有或没有ADRD的居民； 3）了解访问禁令如何影响内部的日常护理实践 疗养院和居民健康成果。