Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic.
Background defining features of the COVID-19 pandemic in many countries were the tragic extent to which care home residents were affected and the difficulty in preventing the introduction and subsequent spread of infection. Management of risk in care homes requires good evidence on the most importan...
| Publicado en: | Age & Ageing Vol. 51; no. 5; pp. 1 - 8 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
May2022
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=157263553&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 157263553 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: May2022 vid: 51 iid: 5 pid: 622 pub: Oxford University Press / USA artinfo: ui: 157263553 10.1093/ageing/afac072 ppf: 1 ppct: 7 formats: tig: atl: Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic. aug: au: Hollinghurst, Joe North, Laura Emmerson, Chris Akbari, Ashley Torabi, Fatemeh Williams, Chris Lyons, Ronan A Hawkes, Alan G Bennett, Ed Gravenor, Mike B Fry, Richard affil: Population Data Science and Health Data Research UK, Swansea University , Swansea SA2 8PP, UK Public Health Wales , Cardiff SA2 8PP, UK Hawkes Centre for Empirical Finance, Swansea University , Swansea SA2 8PP, UK Computer Science, Swansea University , Swansea SA2 8PP, UK Swansea University Medical School, Swansea University , Swansea SA2 8PP, UK su: United Kingdom Nursing Nursing care facilities Infectious disease transmission COVID-19 pandemic Disease risk factors COVID-19 Confidence intervals Multiple regression analysis Health facility administration Risk assessment Descriptive statistics Odds ratio Discharge planning sug: subj: Nursing Nursing care facilities Infectious disease transmission COVID-19 pandemic Disease risk factors United Kingdom Nursing Care Facilities (Skilled Nursing Facilities) Community care facilities for the elderly COVID-19 Confidence intervals Multiple regression analysis Health facility administration Risk assessment Descriptive statistics Odds ratio Discharge planning keyword: care homes Hawkes process hospital discharge linked data multi-level model older people care homes Hawkes process hospital discharge linked data multi-level model older people ab: Background defining features of the COVID-19 pandemic in many countries were the tragic extent to which care home residents were affected and the difficulty in preventing the introduction and subsequent spread of infection. Management of risk in care homes requires good evidence on the most important transmission pathways. One hypothesised route at the start of the pandemic, prior to widespread testing, was the transfer of patients from hospitals that were experiencing high levels of nosocomial events. Methods we tested the hypothesis that hospital discharge events increased the intensity of care home cases using a national individually linked health record cohort in Wales, UK. We monitored 186,772 hospital discharge events over the period from March to July 2020, tracking individuals to 923 care homes and recording the daily case rate in the homes populated by 15,772 residents. We estimated the risk of an increase in case rates following exposure to a hospital discharge using multi-level hierarchical logistic regression and a novel stochastic Hawkes process outbreak model. Findings in regression analysis, after adjusting for care home size, we found no significant association between hospital discharge and subsequent increases in care home case numbers (odds ratio: 0.99, 95% CI: 0.82, 1.90). Risk factors for increased cases included care home size, care home resident density and provision of nursing care. Using our outbreak model, we found a significant effect of hospital discharge on the subsequent intensity of cases. However, the effect was small and considerably less than the effect of care home size, suggesting the highest risk of introduction came from interaction with the community. We estimated that approximately 1.8% of hospital discharged patients may have been infected. Interpretation there is growing evidence in the UK that the risk of transfer of COVID-19 from the high-risk hospital setting to the high-risk care home setting during the early stages of the pandemic was relatively small. Although access to testing was limited to initial symptomatic cases in each care home at this time, our results suggest that reduced numbers of discharges, selection of patients and action taken within care homes following transfer all may have contributed to the mitigation. The precise key transmission routes from the community remain to be quantified. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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