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

作者：Christina K. Chan, Mercedes Magaz, Victoria Williams, Julie M. Wong, Monica Klein-Nouri, Sid Feldman, Jaclyn O'Brien, Natasha Salt, Andrew E. Simor, Jocelyn Charles, Brian M. Wong, Steve Shadowitz, Karen G. Fleming, Adrienne K. Chan, Jerome A. Leis · 发表于：Canada Communicable Disease Report · 年份：2023 · DOI：10.14745/ccdr.v49i23a06 · 被引用次数：7 · 研究领域：Geriatric Care and Nursing Homes、Frailty in Older Adults、Interprofessional Education and Collaboration

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 ba...