![]() The CMS COVID-19 Nursing Home dataset includes the weekly number of admissions due to COVID-19 and weekly deaths (for any reason). We derived an alternative measure to capture cumulative cases/deaths from May 25 through August 16 scaled by the estimated number of residents over that same period. The final analytic sample size was 11,115 (study flow in Supplementary Figure 1).Įstimated Number of Nursing Facility Residents and Proposed Alternative Measure Special focus facilities have been flagged for prolonged quality concerns and do not receive a star rating. We created a 3-level variable for nursing home rating: below average (Special Focus Facility or 1 or 2 stars), average (3 stars), and above average (4 or 5 stars). We also used Nursing Home Compare, which includes overall star ratings, state, ownership type, and adjusted total nurse staffing hours per resident per day. We estimated county-level COVID-19 cases per capita for the same reporting period (May 31, 2020, to August 16, 2020) using confirmed cases and population estimates from. For each facility, we calculated a coefficient of variation (CV, a standardized measure indicating variation of data) for the total number of occupied beds and excluded facilities in the top 5% to remove facilities with any potential data quality concerns. Facilities reported the number of occupied beds each week, thus reflecting changes in the resident census. Using the COVID-19 Nursing Home Dataset released on August 25, 2020, we limited the study to facilities with data passing the CMS quality assurance check for all 12 weekly reporting periods May 31, 2020, to August 16, 2020. In this study, we propose an alternative statistic that more accurately illustrates the burden of COVID-19 cases and deaths in nursing facilities. Using inflated statistics to inform policy decisions may potentially lead to misallocation of limited resources. This inconsistency in the time periods for calculating the cumulative numbers of residents and cases/deaths yields inflated statistics. 3 However, there are 2 reasons the measures are unsuitable for comparing COVID-19 burden across facilities: the variables are (1) calculated using counts of cases/deaths over inconsistent time periods across facilities, and (2) scaled by the number of occupied beds at a point in time, and not as the variable name suggests, the cumulative number of residents the facility has served. These statistics inform CMS pandemic-related policy in nursing homes, as alluded to in a CMS press release. ![]() Two important derived statistics that attempt to scale the number of cases and deaths to the size of the facility are also provided: Total Resident Confirmed COVID-19 Cases per 1000 Residents and Total Resident COVID-19 Deaths per 1000 Residents. ![]() The dataset contains facility-reported statistics from Medicare- and/or Medicaid-certified nursing facilities on the weekly and cumulative number of COVID-19 confirmed resident cases COVID-19 resident deaths and total number of currently occupied beds. 2 On June 4, 2020, the Centers for Medicare & Medicaid Services (CMS) released the first installment of the COVID-19 Nursing Home Dataset. 1 Addressing the enormous risk of COVID-19 to nursing home residents and what can be done to mitigate this risk requires adequate data, largely missing early in the pandemic. Nursing facility residents comprise fewer than 1% of the US population, yet they accounted for more than 40% of deaths due to COVID-19 in 2020.
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