EFFECTIVENESS OF A ON-SITE MEDICALIZATION PROGRAM FOR NURSING HOMES WITH COVID-19 OUTBREAKS
Bernabeu-Wittel, MD, PhD Ternero-Vega Je, MD Nieto-Martín, MD, PhD Conde-Guzmán, MD, PhD J Delgado-Cuesta, MD, PhD M Rincón-Gómez, MD, PhD Díaz-Jiménez, MD Lomas-Cabezas Jm, MD, PhD), Muñoz-García Mm, MD S Calzón-Fernández, MD, PhD M Ollero-Baturone, Máximo Bernabeu-Wittel
doi:10.1093/gerona/glaa192/5879759
BACKGROUND: Nursing homes are highly vulnerable to the occurrence of COVID-19 outbreaks, which result in high lethality rates. Most of them are not prepared to SARS-CoV-2 pandemic.
METHODS: A coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in four nursing homes was organized, with the objectives of improving survival, offering humanistic palliative care to residents in their natural environment, and reducing hospital referrals. Ten key processes and interventions were established (provision of informatics infrastructure, medical equipment, and human resources, universal testing, separation of 'clean' and 'contaminated' areas, epidemiological surveys, and unified protocols stratifying for active or palliative care approach, among others). Main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to hospital. RESULTS: 272 out of 457 (59.5%) residents and 85 out of 320 (26.5%) staff members were affected. The SOPC, survival, and referrals to hospital, occurred in 77%, 72.5%, and 29% of patients diagnosed before MP start, with respect to 97%, 83.7% and 17% of those diagnosed during the program, respectively. The SOPC was independently associated to MP (OR=15 [3-81]); and survival in patients stratified to active approach, to the use of any antiviral treatment (OR=28 ). All outbreaks were controlled in 39 [37-42] days.
CONCLUSIONS: A coordinated on-site medicalization program of nursing homes with COVID-19 outbreaks achieved a higher survival or optimal palliative care rate, and a reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care to residents.
A c c e p t e d M a n u s c r i p t 17 deeper integration of health and social care (11, 23, 33) . Second, we learned, that health care resources re-allocation is an effective strategy to manage this pandemic, and that decisive and anticipated actions save lives and prevent unfortunate consequences; one may think, that this mobilization was exaggerated and expensive, but otherwise at least two hundred of these residents would have needed hospital care, so in this scenario the same health care resources would have been used, but in a overcrowded and saturated hospital. And at last we learned, that a true synergistic coordination between Primary and Hospital Care is possible and it works. We all have read a lot about this issue, and know, however, the daily difficulties in its implementation (37) . In these extraordinary circumstances integration worked wonderfully, because it emerged from professionalism values: willingness to serve people, altruism, generosity, and mutual respect. This study has some limitations, that should be remarked. First, the retrospective collection of the cohort's data, which could introduce some biases, as it is already known for this kind of approaches. Second, the confidence intervals for some of the findings are wide, reflecting limits in study power for some analyses. And third, the possible regression to the mean, which is present in most health care initiatives directed towards high-risk populations, could have played a role in the results;..
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:sec>\n'
' <jats:title>Background</jats:title>\n'
' <jats:p>Nursing homes are highly vulnerable to the occurrence of COVID-19 '
'outbreaks, which result in high lethality rates. Most of them are not prepared to severe '
'acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Method</jats:title>\n'
' <jats:p>A coordinated on-site medicalization program (MP) in response to a '
'sizeable COVID-19 outbreak in 4 nursing homes was organized, with the objectives of improving '
'survival, offering humanistic palliative care to residents in their natural environment, and '
'reducing hospital referrals. Ten key processes and interventions were established (provision '
'of informatics infrastructure, medical equipment, and human resources, universal testing, '
'separation of “clean” and “contaminated” areas, epidemiological surveys, and unified '
'protocols stratifying for active or palliative care approach, among others). Main outcomes '
'were a composite endpoint of survival or optimal palliative care (SOPC), survival, and '
'referral to hospital.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Results</jats:title>\n'
' <jats:p>Two hundred and seventy-two of 457 (59.5%) residents and 85 of 320 '
'(26.5%) staff members were affected. The SOPC, survival, and referrals to hospital occurred '
'in 77%, 72.5%, and 29% of patients diagnosed before the start of MP, with respect to 97%, '
'83.7%, and 17% of those diagnosed during the program, respectively. The SOPC was '
'independently associated to MP (OR = 15 [3–81]); and survival in patients stratified to '
'active approach, to the use of any antiviral treatment (OR = 28 [5–160]). All outbreaks were '
'controlled in 39 [37–42] days.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Conclusions</jats:title>\n'
' <jats:p>A coordinated on-site MP of nursing homes with COVID-19 outbreaks '
'achieved a higher SOPC rate, and a reduction in referrals to hospital, thus ensuring rigorous '
'but also humanistic and gentle care to residents.</jats:p>\n'
' </jats:sec>',
'DOI': '10.1093/gerona/glaa192',
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