Integration of hospital with congregate care homes in response to the COVID-19 pandemic.

Christina K Chan, Mercedes Magaz, Victoria R Williams, Julie Wong, Monica Klein-Nouri, Sid Feldman, Jaclyn O'Brien, Natasha Salt, Andrew E Simor, Jocelyn Charles, Brian M Wong, Steve Shadowitz, Karen Fleming, Adrienne K Chan, Jerome A Leis
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Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need to improve the safety of the environments where we care for older adults in Canada. After providing assistance during the first wave, many Ontario hospitals formally partnered with local congregate care homes in a "hub and spoke" model during second pandemic wave onward. The objective of this article is to describe the implementation and longitudinal outcomes of residents in one hub and spoke model composed of a hospital partnered with 18 congregate care homes including four long-term care and 14 retirement or other congregate care homes.

Intervention: Homes were provided continuous seven-day per week access to hospital support, including infection prevention and control (IPAC), testing, vaccine delivery and clinical support as needed. Any COVID-19 exposure or transmission triggered a same-day meeting to implement initial control measures. A minimum of weekly on-site visits occurred for long-term care homes and biweekly for other congregate care homes, with up to daily on-site presence during outbreaks.

Outcomes: Case detection among residents increased following implementation in context of increased testing, then decreased post-immunization until the Omicron wave when it peaked. After adjusting for the correlation within homes, COVID-related mortality decreased following implementation (OR=0.51, 95% CI, 0.30-0.88; p=0.01). In secondary analysis, homes without pre-existing IPAC programs had higher baseline COVID-related mortality rate (OR=19.19, 95% CI, 4.66-79.02; p<0.001) and saw a larger overall decrease during implementation (3.76% to 0.37%-0.98%) as compared to homes with pre-existing IPAC programs (0.21% to 0.57%-0.90%).

Conclusion: The outcomes for older adults residing in congregate care homes improved steadily throughout the COVID-19 pandemic. While this finding is multifactorial, integration with a local hospital partner supported key interventions known to protect residents.

为应对 COVID-19 大流行,将医院与集中护理院相结合。
背景:2019 年冠状病毒病(COVID-19)大流行凸显了改善加拿大老年人护理环境安全的必要性。安大略省的许多医院在第一波大流行期间提供了援助之后,在第二波大流行期间又以 "中心辐射 "模式与当地的集中护理院正式建立了合作关系。本文旨在介绍一种 "中心辐射 "模式的实施情况和居民的纵向结果,该模式由一家医院与 18 家集中护理院(包括 4 家长期护理院和 14 家退休或其他集中护理院)合作组成:干预措施:护理院每周七天持续获得医院的支持,包括感染预防与控制 (IPAC)、检测、疫苗接种以及所需的临床支持。任何 COVID-19 暴露或传播都会引发当天的会议,以实施初步控制措施。对长期护理院至少每周进行一次现场访问,对其他集中护理院至少每两周进行一次现场访问,在疫情爆发时最多每天进行一次现场访问:结果:在增加检测的情况下,居民病例检出率在实施计划后有所上升,但在免疫接种后有所下降,直到 Omicron 疫潮时达到高峰。在对家庭内部的相关性进行调整后,实施 COVID 后与 COVID 相关的死亡率有所下降(OR=0.51,95% CI,0.30-0.88;P=0.01)。在二次分析中,未实施 IPAC 计划的养老院与 COVID 相关的基线死亡率较高(OR=19.19,95% CI,4.66-79.02;P=0.01):在 COVID-19 大流行期间,居住在集中护理院的老年人的治疗效果稳步改善。虽然这一发现是多因素的,但与当地医院合作伙伴的整合支持了已知的保护居民的关键干预措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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