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Association of Nursing Home Ratings on Health Inspections, Quality of Care, and Nurse Staffing With COVID-19 Cases

Educational Objective
To understand the association of Nursing Home Ratings on Health Inspections, Quality of Care, and Nurse Staffing with COVID-19 outbreaks
1 Credit CME

In the US, approximately 27% of deaths due to coronavirus disease 2019 (COVID-19) have occurred among residents of nursing homes (NHs).1 However, why some facilities have been more successful at limiting the spread of infection than others is unclear. For example, those with greater staffing or higher performance on quality measures may be better at containing the spread of COVID-19 among staff and residents.

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Article Information

Corresponding Author: Jose F. Figueroa, MD, MPH, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Kresge Room 413, Boston, MA 02115 (jfigueroa@hsph.harvard.edu).

Accepted for Publication: July 22, 2020.

Published Online: August 10, 2020. doi:10.1001/jama.2020.14709

Author Contributions: Drs Figueroa and Zheng had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Figueroa, Wadhera, Papanicolas, Jha.

Acquisition, analysis, or interpretation of data: Figueroa, Wadhera, Riley, Zheng, Orav.

Drafting of the manuscript: Figueroa, Riley.

Critical revision of the manuscript for important intellectual content: Figueroa, Wadhera, Papanicolas, Zheng, Orav, Jha.

Statistical analysis: Papanicolas, Zheng, Orav.

Obtained funding: Figueroa.

Administrative, technical, or material support: Figueroa, Riley, Jha.

Supervision: Figueroa, Jha.

Conflict of Interest Disclosures: Dr Figueroa reported receiving research support for other work not related to this topic by the Commonwealth Fund, the Robert Wood Johnson Foundation, and the Harvard Center for AIDS Research. Dr Wadhera reported receiving research grant K23HL148525-1 from the National Heart, Lung, and Blood Institute and previously serving as a consultant for Regeneron. Dr Jha reported receiving funding from the Commonwealth Fund, the Robert Wood Johnson Foundation, and the Bill and Melinda Gates Foundation for other work. No other disclosures were reported.

References
1.
Chidambaram  P . State reporting of cases and deaths due to COVID-19 in long-term care facilities. Kaiser Family Foundation. Published April 23, 2020. Accessed June 30, 2020. https://www.kff.org/coronavirus-covid-19/issue-brief/state-reporting-of-cases-and-deaths-due-to-covid-19-in-long-term-care-facilities/
2.
Centers for Medicare & Medicaid Services. Design for Nursing Home Compare Five-Star Quality Rating System: Technical Users’ Guide. Published April 2020. Accessed June 30, 2020. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/usersguide.pdf
3.
Grabowski  DC , Joynt Maddox  KE .  Postacute care preparedness for COVID-19: thinking ahead.   JAMA. 2020;323(20):2007-2008. doi:10.1001/jama.2020.4686PubMedGoogle ScholarCrossref
4.
Davidson  PM , Szanton  SL .  Nursing homes and COVID-19: we can and should do better.   J Clin Nurs. 2020;29(15-16):2758-2759. doi:10.1111/jocn.15297PubMedGoogle ScholarCrossref
5.
Grabowski  DC , Mor  V .  Nursing home care in crisis in the wake of COVID-19.   JAMA. Published online May 20, 2020. doi:10.1001/jama.2020.8524PubMedGoogle Scholar
6.
Abbasi  J .  “Abandoned” nursing homes continue to face critical supply and staff shortages as COVID-19 toll has mounted.   JAMA. Published online June 11, 2020. doi:10.1001/jama.2020.10419PubMedGoogle Scholar
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