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Aryal K, Mowbray FI, Miroshnychenko A, Strum RP, Dash D, Hillmer MP, Malikov K, Costa AP, Jones A. Evaluating methods for risk prediction of Covid-19 mortality in nursing home residents before and after vaccine availability: a retrospective cohort study. BMC Med Res Methodol 2024; 24:77. [PMID: 38539074 PMCID: PMC10976701 DOI: 10.1186/s12874-024-02189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/22/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND SARS-CoV-2 vaccines are effective in reducing hospitalization, COVID-19 symptoms, and COVID-19 mortality for nursing home (NH) residents. We sought to compare the accuracy of various machine learning models, examine changes to model performance, and identify resident characteristics that have the strongest associations with 30-day COVID-19 mortality, before and after vaccine availability. METHODS We conducted a population-based retrospective cohort study analyzing data from all NH facilities across Ontario, Canada. We included all residents diagnosed with SARS-CoV-2 and living in NHs between March 2020 and July 2021. We employed five machine learning algorithms to predict COVID-19 mortality, including logistic regression, LASSO regression, classification and regression trees (CART), random forests, and gradient boosted trees. The discriminative performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC) for each model using 10-fold cross-validation. Model calibration was determined through evaluation of calibration slopes. Variable importance was calculated by repeatedly and randomly permutating the values of each predictor in the dataset and re-evaluating the model's performance. RESULTS A total of 14,977 NH residents and 20 resident characteristics were included in the model. The cross-validated AUCs were similar across algorithms and ranged from 0.64 to 0.67. Gradient boosted trees and logistic regression had an AUC of 0.67 pre- and post-vaccine availability. CART had the lowest discrimination ability with an AUC of 0.64 pre-vaccine availability, and 0.65 post-vaccine availability. The most influential resident characteristics, irrespective of vaccine availability, included advanced age (≥ 75 years), health instability, functional and cognitive status, sex (male), and polypharmacy. CONCLUSIONS The predictive accuracy and discrimination exhibited by all five examined machine learning algorithms were similar. Both logistic regression and gradient boosted trees exhibit comparable performance and display slight superiority over other machine learning algorithms. We observed consistent model performance both before and after vaccine availability. The influence of resident characteristics on COVID-19 mortality remained consistent across time periods, suggesting that changes to pre-vaccination screening practices for high-risk individuals are effective in the post-vaccination era.
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Affiliation(s)
- Komal Aryal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
- ICES, Hamilton, ON, Canada.
| | - Fabrice I Mowbray
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Ryan P Strum
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Michael P Hillmer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Capacity Planning and Analytics, Ontario Ministry of Health, Toronto, Canada
| | - Kamil Malikov
- Capacity Planning and Analytics, Ontario Ministry of Health, Toronto, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- ICES, Hamilton, ON, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- ICES, Hamilton, ON, Canada
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Habbous S, Ford M, Bar-Ziv S, Donovan T, Hellsten E. The impact of the COVID-19 pandemic on longitudinal trends of surgical mortality and inpatient quality of care in Ontario, Canada. J Adv Nurs 2024. [PMID: 38491720 DOI: 10.1111/jan.16136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/27/2023] [Accepted: 02/18/2024] [Indexed: 03/18/2024]
Abstract
AIMS Previous studies have shown the COVID-19 pandemic was associated with reductions in volume across a spectrum of non-SARS-CoV-2 hospitalizations. In the present study, we examine the impact of the pandemic on patient safety and quality of care. DESIGN This is a retrospective population-based study of discharge abstracts. METHODS We applied a set of nationally validated indicators for measuring the quality of inpatient care to hospitalizations in Ontario, Canada between January 2010 and December 2022. We measured 90-day mortality after selected types of higher risk admissions (such as cancer surgery and cardiovascular emergency) and the rate of patient harm events (such as delirium, pressure injuries and hospital-acquired infections) occurring during the hospital stay. RESULTS A total 13,876,377 hospitalization episodes were captured. Compared with the pre-pandemic period, and independent of SARS-CoV-2 infection, the pandemic period was associated with higher rates of mortality after bladder cancer resection (adjusted risk ratio [aRR] 1.20 (1.07-1.34)) and open repair for abdominal aortic aneurysm (aRR 1.45 (1.06-1.99)). The pandemic was also associated with higher rates of delirium (adjusted odds ratio [aOR] 1.04 (1.02-1.06)), venous thromboembolism (aOR 1.10 (1.06-1.13)), pressure injuries (aOR 1.28 (1.24-1.33)), aspiration pneumonitis (aOR 1.15 (1.12-1.18)), urinary tract infections (aOR 1.02 (1.01-1.04)), Clostridiodes difficile infection (aOR 1.05 (1.02-1.09)), pneumothorax (aOR 1.08 (1.03-1.13)), and use of restraints (aOR 1.12 (1.10-1.14)), but was associated with lower rates of viral gastroenteritis (aOR 0.22 (0.18-0.28)). During the pandemic, SARS-CoV-2-positive admissions were associated with a higher likelihood of various harm events. CONCLUSION The COVID-19 pandemic was associated with higher rates of patient harm for a wide range of non-SARS-CoV-2 inpatient populations. IMPACT Understanding which quality measures are improving or deteriorating can help health systems prioritize quality improvement initiatives. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Strategic Analytics), Toronto, Ontario, Canada
- Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Maggie Ford
- Ontario Health (Clinical Institutes and Quality Programs), Toronto, Ontario, Canada
| | - Stacey Bar-Ziv
- Ontario Health (Clinical Institutes and Quality Programs), Toronto, Ontario, Canada
| | - Terri Donovan
- Ontario Health (Clinical Institutes and Quality Programs), Toronto, Ontario, Canada
| | - Erik Hellsten
- Ontario Health (Strategic Analytics), Toronto, Ontario, Canada
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Habbous S, Lambrinos A, Ming K, Hellsten E. A cohort study of patients hospitalised with SARS-CoV-2 infection in Ontario: patient characteristics and outcomes by wave. Swiss Med Wkly 2024; 154:3636. [PMID: 38579312 DOI: 10.57187/s.3636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Each wave of the COVID-19 pandemic exhibited a unique combination of epidemiological, social and structural characteristics. We explore similarities and differences in wave-over-wave characteristics of patients hospitalised with COVID-19. METHODS This was a population-based study in Ontario province, Canada. Patients hospitalised with SARS-CoV-2 between 26 February 2020 and 31 March 2022 were included. An admission was considered related to SARS-CoV-2 infection if the provincial inpatient or outpatient hospital databases contained the ICD-10 diagnostic codes U071/U072 or the Ontario Laboratories Information System indicated a positive SARS-CoV-2 test result (PCR or rapid antigen testing) during the admission or up to two weeks prior. The primary outcome was 90-day mortality (modified Poisson regression). Secondary outcomes were use of critical care during the admission (logistic regression) and total length-of-stay (linear regression with heteroskedastic-consistent standard-error estimators). All models were adjusted for demographic characteristics, neighbourhood socioeconomic factors and indicators of illness severity. RESULTS There were 73,201 SARS-CoV-2-related admissions: 6127 (8%) during wave 1 (wild-type), 14,371 (20%) during wave 2 (wild-type), 16,653 (23%) during wave 3 (Alpha), 5678 (8%) during wave 4 (Delta) and 30,372 (42%) during wave 5 (Omicron). SARS-CoV-2 was the most responsible diagnosis for 70% of admissions during waves 1-2 and 42% in wave 5. The proportion of admitted patients who were long-term care residents was 18% (n = 1111) during wave 1, decreasing to 10% (n = 1468) in wave 2 and <5% in subsequent waves. During waves 1-3, 46% of all admitted patients resided in a neighbourhood assigned to the highest ethnic diversity quintile, which declined to 27% during waves 4-5. Compared to wave 1, 90-day mortality was similar during wave 2 (adjusted risk ratio [aRR]: 1.00 [95% CI: 0.95-1.04]), but lower during wave 3 (aRR: 0.89 [0.85-0.94]), wave 4 (aRR: 0.85 [0.79-0.91]) and wave 5 (aRR: 0.83 [0.80-0.88]). Improvements in survival over waves were observed among elderly patients (p-interaction <0.0001). Critical care admission was significantly less likely during wave 5 than previous waves (adjusted odds ratio: 0.50 [0.47-0.54]). The length of stay was a median of 8.5 (3.6-23.8) days during wave 1 and 5.3 (2.2-12.6) during wave 5. After adjustment, the mean length of stay was on average -10.4 (-11.1 to -9.8) days, i.e. shorter, in wave 5 vs wave 1. CONCLUSION Throughout the pandemic, sociodemographic characteristics of patients hospitalised with SARS-CoV-2 changed over time, particularly in terms of ethnic diversity, but still disproportionately affected patients from more marginalised regions. Improved survival and reduced use of critical care during the Omicron wave are reassuring.
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Affiliation(s)
- Steven Habbous
- Ontario Health, Toronto, Ontario, Canada
- Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Garnett A, Pollock H, Floriancic N, Prentice K, Donelle L, Hand C, Oudshoorn A, Babenko-Mould Y, Forchuk C. Social Connectedness Between Family Caregivers and Older Adults Living in Long-Term Care Homes in the Context of COVID-19. Can J Aging 2024; 43:33-44. [PMID: 37727879 DOI: 10.1017/s0714980823000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic and resulting restrictions on physical access to long-term care homes culminated in health declines for older adults living there and their families. Knowledge gaps exist regarding maintaining social connectedness when physically separated. The study aimed to explore family members' perceptions of the impact that restrictions on physical access to long-term care homes had on the experience of social connectedness between family members and older adults living in long-term care. The method used was a qualitative description, using in-depth semi-structured interviews. Themes arising from inductive qualitative content analysis of 21 interviews with family members included: (a) lack of connection threatening mental, emotional health, and physical health; (b) navigating trust in the unknown; (c) feelings of stress and anxiety for family members; and (d) technology - an asset, but not for everyone. Study findings suggest more emphasis should be placed on supporting social connections between older adults and their families in the context of long-term care beyond COVID-19.
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Affiliation(s)
- Anna Garnett
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Hannah Pollock
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Natalie Floriancic
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Kristin Prentice
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Lorie Donelle
- Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Carri Hand
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Abe Oudshoorn
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Yolanda Babenko-Mould
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Cheryl Forchuk
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
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Wyer L, Guterman Y, Ewa V, Lang E, Faris P, Holroyd-Leduc J. The impact of the COVID-19 pandemic on transfers between long-term care and emergency departments across Alberta. BMC Emerg Med 2024; 24:9. [PMID: 38185672 PMCID: PMC10773029 DOI: 10.1186/s12873-023-00926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Long-term care (LTC) was overwhelmingly impacted by COVID-19 and unnecessary transfer to emergency departments (ED) can have negative health outcomes. This study aimed to explore how the COVID-19 pandemic impacted LTC to ED transfers and hospitalizations, utilization of community paramedics and facilitated conversations between LTC and ED physicians during the first four waves of the pandemic in Alberta, Canada. METHODS In this retrospective population-based study, administrative databases were linked to identify episodes of care for LTC residents who resided in facilities in Alberta, Canada. This study included data from January 1, 2018 to December 31, 2021 to capture outcomes prior to the onset of the pandemic and across the first four waves. Individuals were included if they visited an emergency department, received care from a community paramedic or whose care involved a facilitated conversation between LTC and ED physicians during this time period. RESULTS Transfers to ED and hospitalizations from LTC have been gradually declining since 2018 with a sharp decline seen during wave 1 of the pandemic that was greatest in the lowest-priority triage classification (CTAS 5). Community paramedic visits were highest during the first two waves of the pandemic before declining in subsequent waves; facilitated calls between LTC and ED physicians increased during the waves. CONCLUSIONS There was a reduction in number of transfers from LTC to EDs and in hospitalizations during the first four waves of the pandemic. This was supported by increased conversations between LTC and ED physicians, but was not associated with increased community paramedic visits. Additional work is needed to explore how programs such as community paramedics and facilitated conversations between LTC and ED providers can help to reduce unnecessary transfers to hospital.
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Affiliation(s)
- Leanna Wyer
- Alberta Health Services, Calgary, AB, Canada.
| | | | - Vivian Ewa
- Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eddy Lang
- Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Peter Faris
- Alberta Health Services, Calgary, AB, Canada
| | - Jayna Holroyd-Leduc
- Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Boamah SA, Weldrick R, Yous ML, Gao H, Garnett A, Dal Bello-Haas V, Kaasalainen S. "Picturing a Way Forward": Strategies to Manage the Effects of COVID-19-Related Isolation on Long-Term Care Residents and Their Informal Caregivers. THE GERONTOLOGIST 2024; 64:gnad035. [PMID: 36999914 PMCID: PMC10733125 DOI: 10.1093/geront/gnad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Strategies to manage the coronavirus disease 2019 (COVID-19) pandemic included widespread use of physical distancing measures. These well-intended strategies adversely affected long-term care (LTC) residents' socialization and their caregiving arrangements, leading to exacerbation of social isolation and emotional distress for both residents and their caregivers. This study aimed to understand how these measures affected informal caregivers of people living in LTC homes in Ontario. Strategies to increase socialization and promote social connection during and post-COVID-19 were also explored. RESEARCH DESIGN AND METHODS This qualitative study used descriptive and photovoice approaches. Of the 9 potential caregivers identified, 6 participated in the study and shared their experiences and photographic reflections in virtual focus group sessions. RESULTS Findings highlighted the increased social isolation experienced by people living in LTC and their caregivers during COVID-19. Caregivers reported pronounced declines in residents' well-being and were frustrated by challenges connecting with their family members during quarantine. Attempts made by LTC homes to maintain social connections, such as window visits and video calls, did not fulfill the social needs of residents and their caregivers. DISCUSSION AND IMPLICATIONS Findings underscore a need for better social support and resources for both LTC residents and their caregivers going forward to prevent further isolation and disengagement. Even in times of lockdown, LTC homes must implement policies, services, and programs that promote meaningful engagement for older adults and their families.
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Affiliation(s)
- Sheila A Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Weldrick
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Marie-Lee Yous
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Harrison Gao
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Havaei F, Staempfli S, Ma A, Sims-Gould J, Franke T, Park M. Resident Impact of the Single Site Order Restricting Staff Mobility across Long-Term Care Homes in British Columbia, Canada. Healthcare (Basel) 2023; 11:3190. [PMID: 38132080 PMCID: PMC10742518 DOI: 10.3390/healthcare11243190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
The Single Site Order (SSO)-a policy restricting staff from working at multiple long-term care (LTC) homes-was mandated by the Public Health Agency of Canada to control the spread of COVID-19 in LTC homes, where nearly 70% of COVID-19-related deaths in Canada occurred. This mixed methods study assesses the impact of the SSO on LTC residents in British Columbia. Interviews were conducted (residents (n = 6), family members (n = 9), staff (n = 18), and leadership (n = 10) from long-term care homes (n = 4)) and analyzed using thematic analysis. Administrative data were collected between April 2019 and March 2020 and between April 2020 and March 2021 and analyzed using descriptive statistics and data visualization. Qualitative and quantitative data were triangulated and demonstrated that staffing challenges became worse during the implementation of the SSO, resulting in the mental and physical health deterioration of LTC residents. Qualitative data demonstrated decreased time for personalized and proactive care, increased communication challenges, and increased loneliness and isolation. Quantitative data showed a decline in activities of daily living, increased antipsychotic medication use, pressure ulcers, behavioural symptoms, and an increase in falls. Addressing staff workload and staffing shortages during SSO-related policy implementation is essential to avoid resident health deterioration.
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Affiliation(s)
- Farinaz Havaei
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (F.H.); (A.M.); (M.P.)
| | - Sabina Staempfli
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (F.H.); (A.M.); (M.P.)
| | - Andy Ma
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (F.H.); (A.M.); (M.P.)
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Thea Franke
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Minjeong Park
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (F.H.); (A.M.); (M.P.)
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8
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Wu SA, Morrison-Koechl JM, McAiney C, Middleton L, Lengyel C, Slaughter S, Carrier N, Yoon MN, Keller HH. Multi-Level Factors Associated with Relationship-Centred and Task-Focused Mealtime Practices in Long-Term Care: A Secondary Data Analysis of the Making the Most of Mealtimes Study. Can J Aging 2023; 42:696-709. [PMID: 37278323 DOI: 10.1017/s0714980823000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Mealtimes in long-term care (LTC) can reinforce relationships between staff and residents through relationship-centred care (RCC) practices; however, meals are often task-focused (TF). This cross-sectional study explores multi-level contextual factors that contribute to RCC and TF mealtime practices. Secondary data from residents in 32 Canadian LTC homes were analyzed (n = 634; mean age 86.7 ± 7.8; 31.1% male). Data included resident health record review, standardized mealtime observation tools, and valid questionnaires. A higher average number of RCC (9.6 ± 1.4) than TF (5.6 ± 2.1) practices per meal were observed. Multi-level regression revealed that a significant proportion of variation in the RCC and TF scores was explained at the resident- (intraclass correlation coefficient [ICC]RCC = 0.736; ICCTF = 0.482), dining room- (ICCRCC = 0.210; ICCTF = 0.162), and home- (ICCRCC = 0.054; ICCTF = 0.356) levels. For-profit status and home size modified the associations between functional dependency and practices. Addressing multi-level factors can reinforce RCC practices and reduce TF practices.
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Affiliation(s)
- Sarah A Wu
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Laura Middleton
- Kinesiology and Health Sciences, University of Waterloo, Waterlo, ON, Canada
| | - Christina Lengyel
- Department of Food and Human Nutrition Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Slaughter
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Natalie Carrier
- École des sciences des aliments, de nutrition et d'études familiales, Université de Moncton, Moncton, NB, Canada
| | - Minn-Nyoung Yoon
- Department of Dentistry & Dental Hygiene, University of Alberta, Calgary, AB, Canada
| | - Heather H Keller
- Kinesiology and Health Sciences, University of Waterloo, Waterlo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Shahidi F, Rennert-May E, D'Souza AG, Crocker A, Faris P, Leal J. Machine learning risk estimation and prediction of death in continuing care facilities using administrative data. Sci Rep 2023; 13:17708. [PMID: 37853045 PMCID: PMC10584843 DOI: 10.1038/s41598-023-43943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023] Open
Abstract
In this study, we aimed to identify the factors that were associated with mortality among continuing care residents in Alberta, during the coronavirus disease 2019 (COVID-19) pandemic. We achieved this by leveraging and linking various administrative datasets together. Then, we examined pre-processing methods in terms of prediction performance. Finally, we developed several machine learning models and compared the results of these models in terms of performance. We conducted a retrospective cohort study of all continuing care residents in Alberta, Canada, from March 1, 2020, to March 31, 2021. We used a univariable and a multivariable logistic regression (LR) model to identify predictive factors of 60-day all-cause mortality by estimating odds ratios (ORs) with a 95% confidence interval. To determine the best sensitivity-specificity cut-off point, the Youden index was employed. We developed several machine learning models to determine the best model regarding performance. In this cohort study, increased age, male sex, symptoms, previous admissions, and some specific comorbidities were associated with increased mortality. Machine learning and pre-processing approaches offer a potentially valuable method for improving risk prediction for mortality, but more work is needed to show improvement beyond standard risk factors.
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Affiliation(s)
- Faezehsadat Shahidi
- Electrical and Software Engineering, University of Calgary, Calgary, AB, Canada
| | - Elissa Rennert-May
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
- AMR - One Health Consortium, University of Calgary, Calgary, AB, Canada
| | - Adam G D'Souza
- Centre for Health Informatics, University of Calgary, Calgary, AB, Canada
- Analytics, Alberta Health Services, Calgary, AB, Canada
| | - Alysha Crocker
- Clinical Information Systems, Alberta Health Services, Calgary, AB, Canada
| | - Peter Faris
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Analytics, Alberta Health Services, Calgary, AB, Canada
| | - Jenine Leal
- Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, AB, Canada.
- AMR - One Health Consortium, University of Calgary, Calgary, AB, Canada.
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.
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Orhierhor M, Pringle W, Halperin D, Parsons J, Halperin SA, Bettinger JA. Lessons learned from the experiences and perspectives of frontline healthcare workers on the COVID-19 response: a qualitative descriptive study. BMC Health Serv Res 2023; 23:1074. [PMID: 37805603 PMCID: PMC10559616 DOI: 10.1186/s12913-023-10062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, healthcare systems and healthcare workers (HCWs) faced significant demands and unique challenges. In this qualitative study, we explore the effects of the COVID-19 public health policies on British Columbia's frontline HCWs, describe what worked in the management of the pandemic, and elucidate the lessons learned that could be applied to future pandemic preparedness, recovery and response. METHODS This qualitative descriptive study is part of a larger, national multi-case study on pandemic policy communication and uptake. Semi-structured interviews were conducted from November 2020- June 2021 with fourteen HCWs working in long-term care (LTC), acute care and public health settings. Data were inductively coded, and analyzed following a resilience framework for public health emergency preparedness, which emphasizes the essential elements of a public health system, vital to all phases of health emergency management, readiness, response and recovery. RESULTS HCWs experienced confusion, frustration, uncertainty, anxiety, fatigue and stress, during the pandemic and detailed challenges that affected policy implementation. This included communication and coordination inconsistencies between the province and regional health authorities; lack of involvement of frontline staff in pandemic planning; inadequate training and support; inadequate personal protective equipment resource capacity and mobilization; and staffing shortages. HCWs recommended increased collaboration between frontline staff and policy makers, investment in preparing and practicing pandemic plans, and the need for training in emergency management and infection prevention and control. CONCLUSIONS Pandemic planning, response and recovery should include inputs from actors/key stakeholders at the provincial, regional and local levels, to facilitate better coordination, communication and outcomes. Also, given the critical roles of frontline HCWs in policy implementation, they should be adequately supported and consideration must be given to how they interpret and act on policies. Bi-directional communication channels should be incorporated between policymakers and frontline HCWs to verify the appropriate adoption of policies, reflective learning, and to ensure policy limitations are being communicated and acted upon by policy makers.
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Affiliation(s)
- Marian Orhierhor
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, A5-950 West 28th Street, Vancouver, BC, V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Wendy Pringle
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, A5-950 West 28th Street, Vancouver, BC, V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Donna Halperin
- Rankin School of Nursing, St. Francis Xavier University, 4130 University Ave, Antigonish, Nova Scotia, B2G 2W5, Canada
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Janet Parsons
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
- Department of Occupational Science & Occupational Therapy, Department of Physical Therapy, and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Nova Scotia, B3K 6R8, Canada
- Departments of Pediatrics and Microbiology & Immunology, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, A5-950 West 28th Street, Vancouver, BC, V5Z 4H4, Canada.
- Department of Pediatrics, University of British Columbia, Vancouver, Canada.
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11
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Sun AH, Ménard A, Farrell E, Filip A, Katz A, Orosz Z, Hsu AT. Perceptions of Palliative and End-Of-Life Care Capacity Among Frontline Staff and Administrators in Long-Term Care Homes During the COVID-19 Pandemic in Ontario, Canada: A Mixed-Methods Evaluation. J Am Med Dir Assoc 2023; 24:1586-1593. [PMID: 37488030 PMCID: PMC10293894 DOI: 10.1016/j.jamda.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/18/2023] [Accepted: 06/12/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has greatly affected the morbidity and mortality of residents in long-term care (LTC) homes. However, not much is known about its impact on staff's perception of their capacity to provide palliative and end-of-life (EOL) care for LTC residents over the course of the pandemic. We investigated changes in self-reported confidence among LTC workers and their experience in providing palliative and EOL care to residents before and during the COVID-19 pandemic. DESIGN Mixed-methods evaluation using a survey (n = 19) and semistructured interviews (n = 28). SETTING AND PARTICIPANTS Frontline workers from 9 LTC homes who participated in Communication at End-of-Life Program in Ontario, Canada, between August 2019 and March 2020. METHODS The survey captured LTC staff's confidence level, including attitudes toward death and dying; relationships with residents and families; and participation in palliative and EOL care. The interviews identified facilitators and barriers to providing palliative and EOL care during the pandemic. RESULTS The COVID-19 pandemic negatively impacted frontline LTC staff's confidence in their role as palliative care providers. Participants also reported notable challenges to providing resident-centered palliative and EOL care. Specifically, visitation restriction has led to increased loneliness and isolation of residents and impeded staff's ability to build supportive relationships with families. Furthermore, staffing shortages due to the single-site work restriction and illness increased workload. Psychological stress caused by a fear of COVID-19 infection and transmission also hindered staff's capacity to provide good palliative and EOL care. CONCLUSIONS AND IMPLICATIONS Frontline LTC staff-even those who felt competent in their knowledge and skills in providing palliative and EOL care after receiving training-reported notable difficulties in providing resident-centered palliative and EOL care during the COVID-19 pandemic.
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Affiliation(s)
- Annie H Sun
- Bruyère Research Institute, Ottawa, Ontario, Canada; Ontario Centres for Learning, Research and Innovation in Long-Term Care at Bruyère, Ottawa, Ontario, Canada
| | - Alixe Ménard
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Emily Farrell
- Ontario Centres for Learning, Research and Innovation in Long-Term Care at Bruyère, Ottawa, Ontario, Canada
| | - Angelina Filip
- Ontario Centres for Learning, Research and Innovation in Long-Term Care at Bruyère, Ottawa, Ontario, Canada
| | - Andrea Katz
- Ontario Centres for Learning, Research and Innovation in Long-Term Care at Bruyère, Ottawa, Ontario, Canada
| | - Zsofia Orosz
- Ontario Centres for Learning, Research and Innovation in Long-Term Care at Bruyère, Ottawa, Ontario, Canada
| | - Amy T Hsu
- Bruyère Research Institute, Ottawa, Ontario, Canada; Ontario Centres for Learning, Research and Innovation in Long-Term Care at Bruyère, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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12
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Martin CM, Slessarev M, Campbell E, Basmaji J, Ball I, Fraser DD, Leligdowicz A, Mele T, Priestap F, Tschirhart BJ, Bentall T, Lu X, Feng Q. Annexin A5 in Patients With Severe COVID-19 Disease: A Single-Center, Randomized, Double-Blind, Placebo-Controlled Feasibility Trial. Crit Care Explor 2023; 5:e0986. [PMID: 37811130 PMCID: PMC10558223 DOI: 10.1097/cce.0000000000000986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES To evaluate the study design and feasibility of drug administration and safety in a randomized clinical trial of recombinant human annexin A5 (SY-005), a constitutively expressed protein with anti-inflammatory, antiapoptotic, and anticoagulant properties, in patients with severe coronavirus disease 2019 (COVID-19). DESIGN Double-blind, randomized clinical trial. SETTING Two ICUs at an academic medical center. PATIENTS/SUBJECTS Adults admitted to the ICU with a confirmed diagnosis of COVID-19 and requiring ventilatory or vasopressor support. INTERVENTIONS SY-005, a recombinant human annexin A5, at 50 or 100 µg/kg IV every 12 hours for 7 days. MEASUREMENTS AND MAIN RESULTS We enrolled 18 of the 55 eligible patients (33%) between April 21, 2021, and February 3, 2022. We administered 82% (196/238) of the anticipated doses of study medication and 86% (169/196) were given within 1 hour of the scheduled time. There were no drug-related serious adverse events. We captured 100% of the data that would be required for measuring clinical outcomes in a phase 2 or 3 trial. LIMITATIONS The small sample size was a result of decreasing admissions of patients with COVID-19, which triggered a stopping rule for the trial. CONCLUSIONS Although enrollment was low, administration of SY-005 to critically ill patients with COVID-19 every 12 hours for up to 7 days was feasible and safe. Further clinical trials of annexin A5 for the treatment of COVID-19 are warranted. Given reduction of severe COVID-19 disease, future studies should explore the safety and effectiveness of SY-005 use in non-COVID-related sepsis.
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Affiliation(s)
- Claudio M Martin
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Marat Slessarev
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Eileen Campbell
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - John Basmaji
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Ian Ball
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Douglas D Fraser
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Aleksandra Leligdowicz
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Tina Mele
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Fran Priestap
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Brent J Tschirhart
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Dentistry and Medicine, Western University, London, ON, Canada
| | - Tracey Bentall
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Xiangru Lu
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Qingping Feng
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Dentistry and Medicine, Western University, London, ON, Canada
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13
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Strauss K. Beyond crisis? Using rent theory to understand the restructuring of publicly funded seniors' care in British Columbia, Canada. ENVIRONMENT & PLANNING A 2023; 55:1506-1527. [PMID: 37810991 PMCID: PMC10555532 DOI: 10.1177/0308518x20983152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Crises of seniors' care in countries like the UK and Canada, further highlighted by the COVID-19 pandemic, have been connected to processes of privatization and financialization. In this paper I argue that rent theory is important for disaggregating mechanisms, including of accumulation by dispossession, the devaluation of labour, and assetization, that underpin the process of financialization in the sector. Work on rents often divides between critical approaches, especially to land rent, and mainstream institutionalist and public choice approaches to rent-seeking. Critical rent theory is evolving beyond this divide to understand a broader range of types of rent. Yet, despite attention to the increasing importance of economic rents and forms of rentierism, labour and social reproduction are often excluded from the analysis of how rent relations arise. This paper demonstrates the problems with these exclusions. The argument is illustrated through an analysis of the restructuring of eldercare in British Columbia, Canada, in the last two decades, and employs a feminist political economy approach to examine the social production of rent relations.
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14
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Arya N. How do South Asian seniors in a large Canadian city perceive long-term care? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:e181-e188. [PMID: 37704237 PMCID: PMC10498910 DOI: 10.46747/cfp.6909e181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To understand how community-dwelling South Asian older adults understand and envision long-term care (LTC). DESIGN Descriptive qualitative study. SETTING The Region of Waterloo in Ontario. PARTICIPANTS Participants included 3 key informants (geriatrician, social worker, and medical translator, all South Asian), 1 family caregiver, and 15 community-dwelling South Asian adults aged 65 and older. METHODS In-depth interviews and focus groups were recorded, transcribed verbatim, and analyzed using a framework analysis approach. MAIN FINDINGS High-level themes included the emotional impacts of failure to provide culturally competent care, such as fear and isolation; a desire for a model of culturally competent care with an emphasis on food and language; and the need for LTC to be more integrated with the broader community and connected to families. CONCLUSION As the delivery of LTC is rethought in this country, there is the potential to deliver on the promise of culturally competent care for this growing population. These findings are among the first to communicate the LTC care needs of South Asian older adults in their own words.
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Affiliation(s)
- Neil Arya
- Assistant Clinical Professor at McMaster University in Hamilton, Ont; Fellow at the Balsillie School of International Affairs in Waterloo, Ont; and Director of the Centre for Family Medicine Refugee Health Clinic in Kitchener, Ont
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15
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Affiliation(s)
| | - Vivian Ewa
- Department of Family Medicine, University of Calgary, Alberta, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Nova Scotia, Canada
| | - Sharon E Straus
- KT Program, Li Ka Shing Knowledge Institute, St Michael's Hospital-Unity Health Toronto, Toronto, Ontario Canada
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16
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Havaei F, Sims-Gould J, Staempfli S, Franke T, Park M, Ma A, Kaulius M. Impact of the single site order in LTC: exacerbation of an overburdened system. BMC Health Serv Res 2023; 23:666. [PMID: 37340438 DOI: 10.1186/s12913-023-09670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The long-term care (LTC) sector has been at the epicentre of COVID-19 in Canada. This study aimed to understand the impact that the Single Site Order (SSO) had on staff and leadership in four LTC homes in the Lower Mainland of British Columbia, Canada. METHODS A mixed method study was conducted by analyzing administrative staffing data. Overtime, turnover, and job vacancy data were extracted and analyzed from four quarters before (April 2019 - March 2020) and four quarters during the pandemic (April 2020 - March 2021) using scatterplots and two-part linear trendlines across total direct care nursing staff and by designation (i.e., registered nurses (RNs), licenced practical nurses (LPNs) and care aids (CAs)). Virtual interviews were conducted with a purposive sample of leadership (10) and staff (18) from each of the four partner care homes (n = 28). Transcripts were analyzed in NVivo 12 using thematic analysis. RESULTS Quantitative data indicated that the total overtime rate increased from before to during the pandemic, with RNs demonstrating the steepest rate increase. Additionally, while rates of voluntary turnover showed an upward trend before the pandemic for all direct care nursing staff, the rate for LPNs and, most drastically, for RNs was higher during the pandemic, while this rate decreased for CAs. Qualitative analysis identified two main themes and sub-themes: (1) overtime (loss of staff, mental health, and sick leave) and (2) staff turnover (the need to train new staff, and gender/race) as the most notable impacts associated with the SSO. CONCLUSIONS The results of this study indicate that the outcomes due to COVID-19 and the SSO are not equal across nursing designations, with the RN shortage in the LTC sector highly evident. Quantitative and qualitative data underscore the substantial impact the pandemic and associated policies have on the LTC sector, namely, that staff are over-worked and care homes are understaffed.
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Affiliation(s)
- Farinaz Havaei
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada.
| | - Joanie Sims-Gould
- Center for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Sabina Staempfli
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada
| | - Thea Franke
- Center for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Minjeong Park
- Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
| | - Andy Ma
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada
| | - Megan Kaulius
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada
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17
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Turcotte LA, McArthur C, Poss JW, Heckman G, Mitchell L, Morris J, Foebel AD, Hirdes JP. Long-Term Care Resident Health and Quality of Care During the COVID-19 Pandemic: A Synthesis Analysis of Canadian Institute for Health Information Data Tables. Health Serv Insights 2023; 16:11786329231174745. [PMID: 37220547 PMCID: PMC10196682 DOI: 10.1177/11786329231174745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Objective Long-term care (LTC) homes ("nursing homes") were challenged during the first year of the COVID-19 pandemic in Canada. The objective of this study was to measure the impact of the COVID-19 pandemic on resident admission and discharge rates, resident health attributes, treatments, and quality of care. Design Synthesis analysis of "Quick Stats" standardized data table reports published yearly by the Canadian Institute for Health Information. These reports are a pan-Canadian scorecard of LTC services rendered, resident health characteristics, and quality indicator performance. Setting and participants LTC home residents in Alberta, British Columbia, Manitoba, and Ontario, Canada that were assessed with the interRAI Minimum Data Set 2.0 comprehensive health assessment in fiscal years 2018/2019, 2019/2020 (pre-pandemic period), and 2020/2021 (pandemic period). Methods Risk ratio statistics were calculated to compare admission and discharge rates, validated interRAI clinical summary scale scores, medication, therapy and treatment provision, and seventeen risk-adjusted quality indicator rates from the pandemic period relative to prior fiscal years. Results Risk of dying in the LTC home was greater in all provinces (risk ratio [RR] range 1.06-1.18) during the pandemic. Quality of care worsened substantially on 6 of 17 quality indicators in British Columbia and Ontario, and 2 quality indicators in Manitoba and Alberta. The only quality indicator where performance worsened during the pandemic in all provinces was the percentage of residents that received antipsychotic medications without a diagnosis of psychosis (RR range 1.01-1.09). Conclusions and implications The COVID-19 pandemic has unveiled numerous areas to strengthen LTC and ensure that resident's physical, social, and psychological needs are addressed during public health emergencies. Except an increase in potentially inappropriate antipsychotic use, this provincial-level analysis indicates that most aspects of resident care were maintained during the first year of the COVID-19 pandemic.
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Affiliation(s)
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Jeff W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lori Mitchell
- Home Care Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | | | - Andrea D Foebel
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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18
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Kuhlmann E, Denis JL, Côté N, Lotta G, Neri S. Comparing Health Workforce Policy during a Major Global Health Crisis: A Critical Conceptual Debate and International Empirical Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5035. [PMID: 36981946 PMCID: PMC10049040 DOI: 10.3390/ijerph20065035] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The health workforce is central to healthcare systems and population health, but marginal in comparative health policy. This study aims to highlight the crucial relevance of the health workforce and contribute comparative evidence to help improve the protection of healthcare workers and prevention of inequalities during a major public health crisis. METHODS Our integrated governance framework considers system, sector, organizational and socio-cultural dimensions of health workforce policy. The COVID-19 pandemic serves as the policy field and Brazil, Canada, Italy, and Germany as illustrative cases. We draw on secondary sources (literature, document analysis, public statistics, reports) and country expert information with a focus on the first COVID-19 waves until the summer of 2021. RESULTS Our comparative investigation illustrates the benefits of a multi-level governance approach beyond health system typologies. In the selected countries, we found similar problems and governance gaps concerning increased workplace stress, lack of mental health support, and gender and racial inequalities. Health policy across countries failed to adequately respond to the needs of HCWs, thus exacerbating inequalities during a major global health crisis. CONCLUSIONS Comparative health workforce policy research may contribute new knowledge to improve health system resilience and population health during a crisis.
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Affiliation(s)
- Ellen Kuhlmann
- Clinic for Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30265 Hannover, Germany
- Sociology of Health and Health Systems, Faculty I, University of Siegen, Adolf-Reichwein-Strasse 1, 57068 Siegen, Germany
| | - Jean-Louis Denis
- Département de Gestion, D’évaluation et de Politique de Santé École de Santé Publique, Université de Montréal, C.P. 6128 Succursale A, Montréal, QC H3C 3J7, Canada
| | - Nancy Côté
- Département de Sociologie, Université Laval, Pavillon Charles-De Koninck, 1030, Avenue des Sciences-Humaines, Bureau 3469, Québec, QC G1V 0A6, Canada
| | - Gabriela Lotta
- Department of Public Administration, Getulio Vargas Foundation, Av Nove de Julho 2029, São Paulo 01313-902, Brazil
- Center of Metropolitan Studies, Cidade Universitária, 109, São Paulo 05508-060, Brazil
| | - Stefano Neri
- Department of Social and Political Sciences, University of Milan, Via Conservatorio 7, 20122 Milan, Italy
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19
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Connelly DM, Snobelen N, Garnett A, Guitar N, Flores-Sandoval C, Sinha S, Calver J, Pearson D, Smith-Carrier T. Report on fraying resilience among the Ontario Registered Practical Nurse Workforce in long-term care homes during COVID-19. Nurs Open 2023. [PMID: 36840935 DOI: 10.1002/nop2.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/21/2022] [Accepted: 02/05/2023] [Indexed: 02/26/2023] Open
Abstract
AIM Registered Practical Nurses (RPNs) are frontline healthcare providers in Ontario long-term care (LTC) homes. Throughout COVID-19, RPNs working in LTC homes experienced prolonged lockdowns, challenging working conditions, and inadequate resource allocation. This study aimed to describe the personal and professional resilience of RPNs working in LTC during the COVID-19 pandemic. DESIGN An open cross-sectional online survey containing the Connor-Davidson Resilience Scale, Resilience at Work Scale®, and Resilience at Work Team Scale®. METHODS The survey was distributed by the RPN Association of Ontario (WeRPN) to approximately 5000 registered members working in Ontario LTC homes. RESULTS A total of 434 respondents participated in the survey (completion rate = 88.0%). Study respondents scored low on measures of resilience and reported extreme levels of job (54.5%) and personal (37.8%) stress. Resources to support self-care and work-life balance, build capacity for team-based care practice(s) are needed.
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Affiliation(s)
- Denise M Connelly
- School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Nicole Guitar
- School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - Samir Sinha
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Tracy Smith-Carrier
- School of Humanitarian Studies, Royal Roads University, Canada Research Chair (Tier 2), Victoria, British Columbia, Canada
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20
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Khowaja A, Syed N, Michener K, Mechelse K, Koning H. Managers' and Administrators' Perspectives on Digital Technology Use in Regional Long-Term Care Homes During the COVID-19 Pandemic. Gerontol Geriatr Med 2023; 9:23337214221146665. [PMID: 36644686 PMCID: PMC9837260 DOI: 10.1177/23337214221146665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 01/13/2023] Open
Abstract
In this paper, we explore managers' and administrators' perspectives on digital technology use for residents during province-wide lockdowns (June-August 2021) during the COVID-19 pandemic in seven regional long-term care homes (LTC) in Niagara, Canada. Fifteen semi-structured interviews were conducted with participants representing operational, financial, and recreational departments where we discussed their needs and factors influencing the use of digital technology during the phases of increased restrictions on visitors and social isolation. Our findings indicate extensive use of cellular devices including smartphones, however additional iPads were needed to meet the ever-rising demand for virtual connections. Almost all participants revealed supportive leadership, redeployed staff, and community donations as main facilitators for technology use. Barriers related to managing varying elderly cognitive capacities and technical issues affected technology use. Based on our findings, we conclude that financial commitment and community support are integral for future-proofing LTC homes with technological innovations.
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Affiliation(s)
- Asif Khowaja
- Brock University, St. Catharines, ON, Canada,Asif Khowaja, Faculty of Applied Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1, Canada.
| | - Nawal Syed
- Brock University, St. Catharines, ON, Canada
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21
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Tingvold L, Moholt JM, Førland O, Jacobsen FF, Tranvåg O. Intended, Unintended, Unanticipated? Consequences of Social Distancing Measures for Nursing Home Residents During the Covid-19 Pandemic. Glob Qual Nurs Res 2023; 10:23333936231176204. [PMID: 37261277 PMCID: PMC10227487 DOI: 10.1177/23333936231176204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
During the outbreak of the COVID-19 pandemic, Norwegian health authorities introduced social distancing measures in nursing homes. The aim was to protect vulnerable residents from contracting the potentially deadly infection. Drawing on individual interviews with nursing home managers and physicians, and focus groups with nursing staff, we explore and describe consequences the social distancing measures had on nursing home residents' health and wellbeing. The analysis indicates that most residents became socially deprived, while some became calmer during the nursing home lockdown. Nursing home staff, physicians and managers witnessed that residents' health and functional capacity declined when services to maintain health, such as physiotherapy, were put on hold. In conclusion, we argue that although Norwegian health authorities managed to keep the infection rates low in nursing homes, this came at a high price for the residents however, as the social distancing measures also negatively impacted their health and wellbeing.
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Affiliation(s)
- Laila Tingvold
- Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | | | - Oddvar Førland
- Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Oscar Tranvåg
- Western Norway University of Applied Sciences, Bergen, Norway
- Norwegian Research Centre for Women’s Health, University Hospital, Oslo, Norway
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Armstrong P, Armstrong H, Bourgeault IL. Teaming up for long-term care: Recognizing all long-term care staff contribute to quality care. Healthc Manage Forum 2023; 36:26-29. [PMID: 36112848 DOI: 10.1177/08404704221115811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
When looking to promising international approaches to improve quality care in long-term care, it is necessary to avoid cherry-picking specific dimensions ignoring the integrated nature of what makes these approaches promising in the first place. In looking at promising Scandinavian or Green House models, attention is often paid to the size of facility. This often overlooks the importance of higher level of staffing, mix, and compensation of direct care staff and the integration of dietary, laundry, and housekeeping staff to care teams. Other overlooked considerations include recognition of family and friends and policies supporting care continuity.
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23
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Chu CH, Yee AV, Stamatopoulos V. “It’s the worst thing I’ve ever been put through in my life”: the trauma experienced by essential family caregivers of loved ones in long-term care during the COVID-19 pandemic in Canada. Int J Qual Stud Health Well-being 2022; 17:2075532. [PMID: 35638169 PMCID: PMC9176373 DOI: 10.1080/17482631.2022.2075532] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Essential family caregivers (EFCs) of relatives living in long-term care homes (LTCHs) experienced restricted access to their relatives due to COVID-19 visitation policies. Residents’ experiences of separation have been widely documented; yet, few have focused on EFCs’ traumatic experiences during the pandemic. Objective: This study aims to explore the EFCs’ trauma of being locked out of LTCHs and unable to visit their loved ones in-person during COVID-19. Methods Seven online focus groups with a total of 30 EFCs from Ontario and British Columbia, Canada were conducted as part of a larger mixed-method study. We used an inductive approach to thematic analysis to understand the lived experiences of trauma. Results Four trauma-related themes emerged: 1) trauma from prolonged separation from loved ones; 2) trauma from uncompassionate interactions with the LTCH’s staff and administrators; 3) trauma from the inability to provide care to loved ones, and 4) trauma from experiencing prolonged powerlessness and helplessness. Discussion The EFCs experienced a collective trauma that deeply impacted their relationships with their relatives as well as their perception of the LTC system. Experiences endured by EFCs highlighted policy and practice changes, including the need for trauma-centred approaches to repair relational damage and post-pandemic decision-making that collaborates with EFCs.
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Affiliation(s)
- Charlene H. Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Amanda V. Yee
- Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Stamatopoulos
- Faculty of Social Science and Humanities, Ontario Tech University, Oshawa, Ontario, Canada
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Gill P, Gutman G, Karbakhsh M, Beringer R, de Vries B. COVID-19 Pandemic Experiences across the Shelter-Care Continuum in Older Adults. JOURNAL OF AGING AND ENVIRONMENT 2022. [DOI: 10.1080/26892618.2022.2153958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Paneet Gill
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gloria Gutman
- Gerontology Research Centre, Simon Fraser University at Harbour Centre, Vancouver, Canada
| | - Mojgan Karbakhsh
- Gerontology Research Centre, Simon Fraser University at Harbour Centre, Vancouver, Canada
| | - Robert Beringer
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Brian de Vries
- Gerontology Program, San Francisco State University, San Francisco, CA, USA
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Hilal W, Chislett MG, Snider B, McBean EA, Yawney J, Gadsden SA. Use of AI to assess COVID-19 variant impacts on hospitalization, ICU, and death. Front Artif Intell 2022; 5:927203. [DOI: 10.3389/frai.2022.927203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
The rapid spread of COVID-19 and its variants have devastated communities worldwide, and as the highly transmissible Omicron variant becomes the dominant strain of the virus in late 2021, the need to characterize and understand the difference between the new variant and its predecessors has been an increasing priority for public health authorities. Artificial Intelligence has played a significant role in the analysis of various facets of COVID-19 since the early stages of the pandemic. This study proposes the use of AI, specifically an XGBoost model, to quantify the impact of various medical risk factors (or “population features”) on the possibility of a patient outcome resulting in hospitalization, ICU admission, or death. The results are compared between the Delta and Omicron COVID-19 variants. Results indicated that older age and an unvaccinated patient status most consistently correspond as the most significant population features contributing to all three scenarios (hospitalization, ICU, death). The top 15 features for each variant-outcome scenario were determined, which most frequently included diabetes, cardiovascular disease, chronic kidney disease, and complications of pneumonia as highly significant population features contributing to serious illness outcomes. The Delta/Hospitalization model returned the highest performance metric scores for the area under the receiver operating characteristic (AUROC), F1, and Recall, while Omicron/ICU and Omicron/Hospitalization had the highest accuracy and precision values, respectively. The recall was found to be above 0.60 in most cases (with only two exceptions), indicating that the total number of false positives was generally minimized (accounting for more of the people who would theoretically require medical care).
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Culture Change in Long-Term Care-Post COVID-19: Adapting to a New Reality Using Established Ideas and Systems. Can J Aging 2022; 42:351-358. [PMID: 36349718 DOI: 10.1017/s0714980822000344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
The response to the COVID-19 pandemic in long-term care (LTC) has threatened to undo efforts to transform the culture of care from institutionalized to de-institutionalized models characterized by an orientation towards person- and relationship-centred care. Given the pandemic’s persistence, the sustainability of culture-change efforts has come under scrutiny. Drawing on seven culture-change models implemented in Canada, we identify organizational prerequisites, facilitatory mechanisms, and frontline changes relevant to culture change that can strengthen the COVID-19 pandemic response in LTC homes. We contend that a reversal to institutionalized care models to achieve public health goals of limiting COVID-19 and other infectious disease outbreaks is detrimental to LTC residents, their families, and staff. Culture change and infection control need not be antithetical. Both strategies share common goals and approaches that can be integrated as LTC practitioners consider ongoing interventions to improve residents’ quality of life, while ensuring the well-being of staff and residents’ families.
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Moosavi A, Ozturk O, Patrick J. Staff scheduling for residential care under pandemic conditions: The case of COVID-19. OMEGA 2022; 112:102671. [PMID: 35530747 PMCID: PMC9065499 DOI: 10.1016/j.omega.2022.102671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/30/2022] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic severely impacted residential care delivery all around the world. This study investigates the current scheduling methods in residential care facilities in order to enhance them for pandemic conditions. We first define the basic problem that addresses decisions associated with the assignment and scheduling of staff members, who perform a set of tasks required by residents during a planning horizon. This problem includes the minimization of costs associated with the salary of part-time staff members, total overtime, and violations of service time windows. Subsequently, we adapt the basic problem to pandemic conditions by considering the impacts of communal spaces (e.g., shared rooms) and a cohorting policy (classification of residents based on their risk of infection) on the spread of infectious diseases. We introduce a new objective function that minimizes the number of distinct staff members serving each room of residents. Likewise, we propose a new objective function for the cohorting policy that aims to minimize the number of distinct cohorts served by each staff member. A new constraint is incorporated that forces staff members to serve only one cohort within a shift. We present a population-based heuristic algorithm to solve this problem. Through a comparison with two benchmark solution approaches (a mathematical programme and a non-dominated archiving ant colony optimization algorithm), the superiority of the heuristic algorithm is shown regarding solution quality and CPU time. Finally, we conduct numerical analyses to present managerial implications.
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Affiliation(s)
- Amirhossein Moosavi
- University of Ottawa, Telfer School of Management, 55 Laurier Avenue East, Ottawa, Ontario K1N 6N5, Canada
| | - Onur Ozturk
- University of Ottawa, Telfer School of Management, 55 Laurier Avenue East, Ottawa, Ontario K1N 6N5, Canada
| | - Jonathan Patrick
- University of Ottawa, Telfer School of Management, 55 Laurier Avenue East, Ottawa, Ontario K1N 6N5, Canada
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Létourneau J, Bélanger E, Sia D, Beogo I, Robins S, Kruglova K, Jubinville M, Tchouaket EN. Identifying performance factors of long-term care facilities in the context of the COVID-19 pandemic: a scoping review protocol. Syst Rev 2022; 11:203. [PMID: 36151556 PMCID: PMC9502645 DOI: 10.1186/s13643-022-02069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) have been severely affected by the COVID-19 pandemic with serious consequences for the residents. Some LTCFs performed better than others, experiencing lower case and death rates due to COVID-19. A comprehensive understanding of the factors that have affected the transmission of COVID-19 in LTCFs is lacking, as no published studies have applied a multidimensional conceptual framework to evaluate the performance of LTCFs during the pandemic. Much research has focused on infection prevention and control strategies or specific disease outcomes (e.g., death rates). To address these gaps, our scoping review will identify and analyze the performance factors that have influenced the management of COVID-19 in LTCFs by adopting a multidimensional conceptual framework. METHODS We will query the CINAHL, MEDLINE (Ovid), CAIRN, Science Direct, and Web of Science databases for peer-reviewed articles written in English or French and published between January 1, 2020 and December 31, 2021. We will include articles that focus on the specified context (COVID-19), population (LTCFs), interest (facilitators and barriers to performance of LTCFs), and outcomes (dimensions of performance according to a modified version of the Ministère de la santé et des services sociaux du Québec conceptual framework). Each article will be screened by at least two co-authors independently followed by data extraction of the included articles by one co-author and a review by the principal investigator. RESULTS We will present the results both narratively and with visual aids (e.g., flowcharts, tables, conceptual maps). DISCUSSION Our scoping review will provide a comprehensive understanding of the factors that have affected the performance of LTCFs during the COVID-19 pandemic. This knowledge can help inform the development of more effective infection prevention and control measures for future pandemics and outbreaks. The results of our review may lead to improvements in the care and safety of LTCF residents and staff. SCOPING REVIEW REGISTRATION: Research Registry researchregistry7026.
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Affiliation(s)
- Josiane Létourneau
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Emilie Bélanger
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Idrissa Beogo
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephanie Robins
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Katya Kruglova
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Maripier Jubinville
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Eric Nguemeleu Tchouaket
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada.
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Hanney SR, Straus SE, Holmes BJ. Saving millions of lives but some resources squandered: emerging lessons from health research system pandemic achievements and challenges. Health Res Policy Syst 2022; 20:99. [PMID: 36088365 PMCID: PMC9464102 DOI: 10.1186/s12961-022-00883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
During the SARS-CoV-2 pandemic, astonishingly rapid research averted millions of deaths worldwide through new vaccines and repurposed and new drugs. Evidence use informed life-saving national policies including non-pharmaceutical interventions. Simultaneously, there was unprecedented waste, with many underpowered trials on the same drugs. We identified lessons from COVID-19 research responses by applying WHO's framework for research systems. It has four functions-governance, securing finance, capacity-building, and production and use of research-and nine components. Two linked questions focused the analysis. First, to what extent have achievements in knowledge production and evidence use built on existing structures and capacity in national health research systems? Second, did the features of such systems mitigate waste? We collated evidence on seven countries, Australia, Brazil, Canada, Germany, New Zealand, the United Kingdom and the United States, to identify examples of achievements and challenges.We used the data to develop lessons for each framework component. Research coordination, prioritization and expedited ethics approval contributed to rapid identification of new therapies, including dexamethasone in the United Kingdom and Brazil. Accelerated vaccines depended on extensive funding, especially through the Operation Warp Speed initiative in the United States, and new platforms created through long-term biomedical research capacity in the United Kingdom and, for messenger ribonucleic acid (mRNA) vaccines, in Canada, Germany and the United States. Research capacity embedded in the United Kingdom's healthcare system resulted in trial acceleration and waste avoidance. Faster publication of research saved lives, but raised challenges. Public/private collaborations made major contributions to vastly accelerating new products, available worldwide, though unequally. Effective developments of living (i.e. regularly updated) reviews and guidelines, especially in Australia and Canada, extended existing expertise in meeting users' needs. Despite complexities, effective national policy responses (less evident in Brazil, the United Kingdom and the United States) also saved lives by drawing on health research system features, including collaboration among politicians, civil servants and researchers; good communications; and willingness to use evidence. Comprehensive health research strategies contributed to success in research production in the United Kingdom and in evidence use by political leadership in New Zealand. In addition to waste, challenges included equity issues, public involvement and non-COVID research. We developed recommendations, but advocate studies of further countries.
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Affiliation(s)
- Stephen R Hanney
- Health Economics Research Group, Department of Health Sciences, Brunel University London, London, United Kingdom.
| | - Sharon E Straus
- St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Bev J Holmes
- Michael Smith Health Research BC, Vancouver, BC, Canada
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Zunzunegui MV, Béland F, Rico M, López FJG. Long-Term Care Home Size Association with COVID-19 Infection and Mortality in Catalonia in March and April 2020. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:369-390. [PMID: 36417245 PMCID: PMC9620903 DOI: 10.3390/epidemiologia3030029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/26/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
We aim to assess how COVID-19 infection and mortality varied according to facility size in 965 long-term care homes (LTCHs) in Catalonia during March and April 2020. We measured LTCH size by the number of authorised beds. Outcomes were COVID-19 infection (at least one COVID-19 case in an LTCH) and COVID-19 mortality. Risks of these were estimated with logistic regression and hurdle models. Models were adjusted for county COVID-19 incidence and population, and LTCH types. Sixty-five per cent of the LTCHs were infected by COVID-19. We found a strong association between COVID-19 infection and LTCH size in the adjusted analysis (from 45% in 10-bed homes to 97.5% in those with over 150 places). The average COVID-19 mortality in all LTCHs was 6.8% (3887 deaths) and 9.2% among the COVID-19-infected LTCHs. Very small and large homes had higher COVID-19 mortality, whereas LTCHs with 30 to 70 places had the lowest level. COVID-19 mortality sharply increased with LTCH size in counties with a cumulative incidence of COVID-19 which was higher than 250/100,000, except for very small homes, but slightly decreased with LTCH size when the cumulative incidence of COVID-19 was lower. To prevent infection and preserve life, the optimal size of an LTCH should be between 30 and 70 places.
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Affiliation(s)
- Maria Victoria Zunzunegui
- École de Santé Publique, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Correspondence: ; Tel.: +34-692-064-134
| | - François Béland
- École de Santé Publique, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Institut Lady Davis, Montreal Jewish Hospital, McGill University, Montreal, QC H3C 3J7, Canada
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31
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Giebel C, Hanna K, Cannon J, Shenton J, Mason S, Tetlow H, Marlow P, Rajagopal M, Gabbay M. Taking the 'care' out of care homes: The moral dilemma of institutional long-term care provision during COVID-19. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2127-e2136. [PMID: 34806233 PMCID: PMC9011824 DOI: 10.1111/hsc.13651] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/15/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
Little is known on how the pandemic has changed care home care delivery. The aim of this study was to explore the impact of COVID-19 on care provision and visits in care homes from staff and family members' perspectives. For this purpose, we conducted a telephone- and zoom-based qualitative semi-structured interview study. Care home staff and family carers of people living with dementia (PLWD) across the UK were recruited via convenience sampling and participated via telephone or online. Participants took part in a semi-structured remote interview. Data were collected between October and November 2020. Anonymised transcripts were analysed separately by two research team members using thematic analysis, with codes discussed and themes generated jointly, supported by research team input. 42 participants (26 family carers and 16 care home staff) took part. Five themes were generated: (a) Care home reputation and financial implications; (b) Lack of care; (c) Communication or lack thereof; (d) Visiting rights/changes based on residents' needs; (e) Deterioration of residents. With a lack of clear guidance throughout the pandemic, care homes delivered care differently with disparities in the levels and types of visiting allowed for family members. Lack of communication between care homes and family members, but also government and care homes, led to family carers feeling excluded and concerned about the well-being of their relative. Improved communication and clear guidance for care homes and the public are required to negate the potentially damaging effects of COVID-19 restrictions upon residents, their families and the carers who support them.
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Affiliation(s)
- Clarissa Giebel
- Department of Primary Care & Mental HealthUniversity of LiverpoolLiverpoolUK
- NIHR ARC NWCLiverpoolUK
| | - Kerry Hanna
- Department of Primary Care & Mental HealthUniversity of LiverpoolLiverpoolUK
| | | | | | - Stephen Mason
- Palliative Care UnitUniversity of LiverpoolLiverpoolUK
| | | | | | | | - Mark Gabbay
- Department of Primary Care & Mental HealthUniversity of LiverpoolLiverpoolUK
- NIHR ARC NWCLiverpoolUK
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A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada. Antibiotics (Basel) 2022; 11:antibiotics11081001. [PMID: 35892391 PMCID: PMC9330385 DOI: 10.3390/antibiotics11081001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 12/04/2022] Open
Abstract
The COVID-19 pandemic affected access to care, and the associated public health measures influenced the transmission of other infectious diseases. The pandemic has dramatically changed antibiotic prescribing in the community. We aimed to determine the impact of the COVID-19 pandemic and the resulting control measures on oral antibiotic prescribing in long-term care facilities (LTCFs) in Alberta and Ontario, Canada using linked administrative data. Antibiotic prescription data were collected for LTCF residents 65 years and older in Alberta and Ontario from 1 January 2017 until 31 December 2020. Weekly prescription rates per 1000 residents, stratified by age, sex, antibiotic class, and selected individual agents, were calculated. Interrupted time series analyses using SARIMA models were performed to test for changes in antibiotic prescription rates after the start of the pandemic (1 March 2020). The average annual cohort size was 18,489 for Alberta and 96,614 for Ontario. A significant decrease in overall weekly prescription rates after the start of the pandemic compared to pre-pandemic was found in Alberta, but not in Ontario. Furthermore, a significant decrease in prescription rates was observed for antibiotics mainly used to treat respiratory tract infections: amoxicillin in both provinces (Alberta: −0.6 per 1000 LTCF residents decrease in weekly prescription rate, p = 0.006; Ontario: −0.8, p < 0.001); and doxycycline (−0.2, p = 0.005) and penicillin (−0.04, p = 0.014) in Ontario. In Ontario, azithromycin was prescribed at a significantly higher rate after the start of the pandemic (0.7 per 1000 LTCF residents increase in weekly prescription rate, p = 0.011). A decrease in prescription rates for antibiotics that are largely used to treat respiratory tract infections is in keeping with the lower observed rates for respiratory infections resulting from pandemic control measures. The results should be considered in the contexts of different LTCF systems and provincial public health responses to the pandemic.
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Wilson MG, Gauvin FP, DeMaio P, Alam S, Drakos A, Soueidan S, Costa A, Reid R, Simeonov D, Sixsmith A, Sveistrup H, Lavis JN. Enhancing the use of technology in the long-term care sector in Canada: Insights from citizen panels and a national stakeholder dialogue. Healthc Manage Forum 2022; 35:310-317. [PMID: 35830436 PMCID: PMC9425718 DOI: 10.1177/08404704221108466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Enhancing the use of technology in long-term care has been identified as a key part of broader efforts to strengthen the sector in the wake of the COVID-19 pandemic. To inform such efforts, we convened a series of citizen panels, followed by a national stakeholder dialogue with system leaders focused on reimagining the long-term care sector using technology. Key actions prioritized through the deliberations convened included: developing an innovation roadmap/agenda (including national standards and guidelines); using co-design approaches for the strengthening the long-term care sector and for technological innovation; identifying and coordinating existing innovation projects to support scale and spread; enabling rapid-learning and improvement cycles to support the development, evaluation, and implementation of new technologies; and using funding models that enable the flexibility needed for such rapid-learning cycles.
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Affiliation(s)
| | | | - Peter DeMaio
- 3710McMaster University, Hamilton, Ontario, Canada
| | - Saif Alam
- 3710McMaster University, Hamilton, Ontario, Canada
| | | | | | - Andrew Costa
- 3710McMaster University, Hamilton, Ontario, Canada
| | - Rob Reid
- 5543Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Andrew Sixsmith
- 1763Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - John N Lavis
- 3710McMaster University, Hamilton, Ontario, Canada.,University of Johannesburg, Johannesburg, South Africa
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Tsui TCO, Zeitouny S, Bremner KE, Cheung DC, Mulder C, Croxford R, Del Giudice L, Lapointe-Shaw L, Mendlowitz A, Wong WWL, Perlis N, Sander B, Teckle P, Tomlinson G, Walker JD, Malikov K, McGrail KM, Peacock S, Kulkarni GS, Pataky RE, Krahn MD. Initial health care costs for COVID-19 in British Columbia and Ontario, Canada: an interprovincial population-based cohort study. CMAJ Open 2022; 10:E818-E830. [PMID: 36126976 PMCID: PMC9497846 DOI: 10.9778/cmajo.20210328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COVID-19 imposed substantial health and economic burdens. Comprehensive population-based estimates of health care costs for COVID-19 are essential for planning and policy evaluation. We estimated publicly funded health care costs in 2 Canadian provinces during the pandemic's first wave. METHODS In this historical cohort study, we linked patients with their first positive SARS-CoV-2 test result by June 30, 2020, in 2 Canadian provinces (British Columbia and Ontario) to health care administrative databases and matched to negative or untested controls. We stratified patients by highest level of initial care: community, long-term care, hospital (without admission to the intensive care unit [ICU]) and ICU. Mean publicly funded health care costs for patients and controls, mean net (attributable to COVID-19) costs and total costs were estimated from 30 days before to 120 days after the index date, or to July 31, 2020, in 30-day periods for patients still being followed by the start of each period. RESULTS We identified 2465 matched people with a positive test result for SARS-CoV-2 in BC and 28 893 in Ontario. Mean age was 53.4 (standard deviation [SD] 21.8) years (BC) and 53.7 (SD 22.7) years (Ontario); 55.7% (BC) and 56.1% (Ontario) were female. Net costs in the first 30 days after the index date were $22 010 (95% confidence interval [CI] 19 512 to 24 509) and $15 750 (95% CI 15 354 to 16 147) for patients admitted to hospital, and $65 828 (95% CI 58 535 to 73 122) and $56 088 (95% CI 53 721 to 58 455) for ICU patients in BC and Ontario, respectively. In the community and long-term care settings, net costs were near 0. Total costs for all people, from 30 days before to 30 days after the index date, were $22 128 330 (BC) and $175 778 210 (Ontario). INTERPRETATION During the first wave, we found that mean costs attributable to COVID-19 were highest for patients with ICU admission and higher in BC than Ontario. Reducing the number of people who acquire COVID-19 and severity of illness are required to mitigate the economic impact of COVID-19.
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Affiliation(s)
- Teresa C O Tsui
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Seraphine Zeitouny
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Douglas C Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Carol Mulder
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Ruth Croxford
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Lisa Del Giudice
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Lauren Lapointe-Shaw
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Andrew Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - William W L Wong
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Nathan Perlis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Paulos Teckle
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - George Tomlinson
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Jennifer D Walker
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Kamil Malikov
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Kimberlyn M McGrail
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Stuart Peacock
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Girish S Kulkarni
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Reka E Pataky
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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Staempfli S, Havaei F, Phinney A, MacPhee M. Unintended Consequences of Pandemic Management Strategies on Residents and Family in One Long-term Care Home in British Columbia: A Patient-Supported Qualitative Study. Innov Aging 2022; 6:igac036. [PMID: 35812793 PMCID: PMC9262035 DOI: 10.1093/geroni/igac036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives In March 2020, pandemic management strategies were mandated across long-term care homes in British Columbia, Canada, to control the effects of COVID-19. This study describes and contextualizes the impact of visitation, infection prevention and control, and staffing strategies on the perceived health and well-being of residents and families. Research Design and Methods This interpretive description study was part of a larger mixed-methods study at a publicly funded not-for-profit long-term care home in British Columbia, Canada. Eleven family members and 10 residents were interviewed between October and December 2020, and resident and family partners participated in a steering committee throughout all stages of the research. Findings Early pandemic management strategies had an adverse impact on the perceived health and well-being of families and residents. Visitation restrictions eliminated care routinely provided by families and prevented in-person communication between residents, families, and care providers. Other infection prevention and control strategies isolated residents; group enrichment programs were stopped, and lockdowns created a perception of incarceration. Donning and doffing personal protective equipment took time away from staff–resident interactions and the single-site order reduced staff numbers, placing additional time restraints on residents’ care. Discussion and Implications Unintended adverse consequences of pandemic management strategies demonstrate the risks of creating policies based on a medicalized definition of health. Clear lines of communication are vital to increase a sense of control for families and residents. Elimination of care provided by families and paid companions exposed a gap in Canada’s public long-term care system. This care gap raises concerns about equitable care access for residents without families or financial means to pay for additional care.
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Affiliation(s)
- Sabina Staempfli
- Department of Applied Science, School of Nursing, University of British Columbia , Vancouver, British Columbia , Canada
| | - Farinaz Havaei
- Department of Applied Science, School of Nursing, University of British Columbia , Vancouver, British Columbia , Canada
| | - Alison Phinney
- Department of Applied Science, School of Nursing, University of British Columbia , Vancouver, British Columbia , Canada
| | - Maura MacPhee
- Department of Applied Science, School of Nursing, University of British Columbia , Vancouver, British Columbia , Canada
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36
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The Impact of Long-Term Care Home Ownership and Administration Type on All-Cause Mortality from March to April 2020 in Madrid, Spain. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:323-336. [PMID: 36417241 PMCID: PMC9620910 DOI: 10.3390/epidemiologia3030025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
Our aim is to assess whether long-term care home (LTCH) ownership and administration type were associated with all-cause mortality in 470 LTCHs in the Community of Madrid (Spain) during March and April 2020, the first two months of the COVID-19 pandemic. There are eight categories of LTCH type, including various combinations of ownership type (for-profit, nonprofit, and public) and administration type (completely private, private with places rented by the public sector, administrative management by procurement, and completely public). Multilevel regression was used to examine the association between mortality and LTCH type, adjusting for LTCH size, the spread of the COVID-19 infection, and the referral hospital. There were 9468 deaths, a mortality rate of 18.3%. Public and private LTCHs had lower mortality than LTCHs under public-private partnership (PPP) agreements. In the fully adjusted model, mortality was 7.4% (95% CI, 3.1-11.7%) in totally public LTCHs compared with 21.9% (95% CI, 17.4-26.4%) in LTCHs which were publicly owned with administrative management by procurement. These results are a testimony to the fatal consequences that pre-pandemic public-private partnerships in long-term residential care led to during the first months of the COVID-19 pandemic in the Community of Madrid, Spain.
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McLean J, Clark C, McKee A, Legue S, Cocking J, Lamarche A, Heerschap C, Morris S, Fletcher T, McKee C, Kennedy K, Gross L, Broeren A, Forder M, Barner W, Tebbutt C, Kings S, DiDiodato G. Pandemic Responsiveness in an Acute Care Setting: A Community Hospital's Utilization of Operational Resources During COVID-19. J Multidiscip Healthc 2022; 15:1309-1321. [PMID: 35726265 PMCID: PMC9206458 DOI: 10.2147/jmdh.s361896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background To ensure continuity of services while mitigating patient surge and nosocomial infections during the coronavirus disease 2019 (COVID-19) pandemic, acute care hospitals have been required to make significant operational adjustments. Here, we identify and discuss key administrative priorities and strategies utilized by a large community hospital located in Ontario, Canada. Methods Guided by a qualitative descriptive approach, we performed a thematic analysis of all COVID-19-related documentation discussed by the hospital’s emergency operation centre (EOC) during the pandemic’s first wave. We then solicited operational strategies from a multidisciplinary group of hospital leaders to construct a narrative for each theme. Results Seven recurrent themes critical to the hospital’s pandemic response emerged: 1) Organizational structure: a modified EOC structure was adopted to increase departmental interoperability and situational awareness; 2) Capacity planning: Design Thinking guided rapid infrastructure decisions to meet surge requirements; 3) Occupational health and workplace safety: a multidisciplinary team provided respirator fit-testing, critical absence adjudication, and wellness needs; 4) Human resources/workforce planning: new workforce planning, recruitment, and redeployment strategies addressed staffing shortages; 5) Personal protective equipment (PPE): PPE conservation required proactive sourcing from traditional and non-traditional suppliers; 6) Community response: local partnerships were activated to divert patients through a non-referral-based assessment and treatment centre, support long-term care and retirement homes, and establish a 70-bed field hospital; and 7) Corporate communication: a robust communication strategy provided timely and transparent access to rapidly evolving information. Conclusion A community hospital’s operational preparedness for COVID-19 was supported by inter-operability, leveraging internal and external expertise and partnerships, creative problem solving, and developing novel tools to support occupational health and community initiatives.
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Affiliation(s)
- Jesse McLean
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Cathy Clark
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Aidan McKee
- Royal Victoria Regional Health Centre, Barrie, ON, Canada.,School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Suzanne Legue
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Jane Cocking
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | | | | | - Sarah Morris
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | | | - Corey McKee
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | | | - Leigh Gross
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Andrew Broeren
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Matthew Forder
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Wendy Barner
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Chris Tebbutt
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Suzanne Kings
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Giulio DiDiodato
- Royal Victoria Regional Health Centre, Barrie, ON, Canada.,Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
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Friedman SM, Davidow AL, Gurumurthy M, Peymani R, Webb J, Desai K, Siderits R, Nepomich A, Lifshitz E, Thomas PA. Antibody Seroprevalence, Infection and Surveillance for SARS-CoV-2 in Residents and Staff of New Jersey Long-Term Care Facilities. J Community Health 2022; 47:774-782. [PMID: 35704225 PMCID: PMC9199456 DOI: 10.1007/s10900-022-01104-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
Early in the pandemic, New Jersey (NJ) long-term care facilities (LTCFs) witnessed severe COVID-19 illness. With limited surveillance to characterize the scope of infection, we estimated the prevalence of antibody to the SARS-CoV-2 nucleocapsid protein among residents and staff, to describe the epidemiology, and to measure antibody distribution by prior PCR/antigen status and symptomatology. 10 NJ LTCFs of 20 solicited with diverse geography and bed-capacities were visited between October 2020 and March 2021. A single serum was tested for total N-antibody (ELISA) by the state laboratory. Residents' demographics and clinical history were transcribed from the patient record. For staff, this information was solicited directly from employees, supplemented by prior PCR/antigen results from facilities. 62% of 332 residents and 46% of 661 staff tested N-antibody positive. In a multivariable logistic regression in residents, odds ratios for older age and admission prior before March 1, 2020 were significant. Among the staff, odds ratios for older age, ethnic-racial group, nursing-related job, and COVID-19 symptoms were significantly associated with N-antibody positivity. In a sub-analysis in five better record-keeping LTCFs, 90% of residents and 85% of staff with positive PCR/antigen results were seropositive for N-antibody, yet 25% of residents and 22% of staff were N-antibody positive but PCR/antigen and symptoms negative. The high rate of clinically unsuspected infections likely contributed to the spread. These findings argue for robust surveillance, regular screening of asymptomatic individuals, and vaccinating both residents and staff to abate the pandemic. The data also provide guidance to prevent future outbreaks.
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Affiliation(s)
- Stephen M Friedman
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
- , Livingston, USA.
| | - Amy L Davidow
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA
| | - Manisha Gurumurthy
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Reza Peymani
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - John Webb
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Keya Desai
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Richard Siderits
- New Jersey Department of Health, Public Health and Environmental Laboratory, Trenton, USA
| | - Anna Nepomich
- New Jersey Department of Health, Public Health and Environmental Laboratory, Trenton, USA
| | - Edward Lifshitz
- New Jersey Department of Health, Public Health and Environmental Laboratory, Trenton, USA
| | - Pauline A Thomas
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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39
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Benbow WB. COVID-19 in Long-Term Care: The Built Environment Impact on Infection Control. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:287-298. [PMID: 35684993 DOI: 10.1177/19375867221101897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this article is to review available literature for evidence-based impact of the built environment upon the prevention and management of COVID-19 with a view to emphasizing lessons learned for future infection control of pandemics. BACKGROUND This is urgently needed given the devastation brought upon long-term care residents worldwide. Long-term care (LTC) facilities face a battle to protect their residents. Previous studies of infection control design issues have focused generally on Fomites: that is, contaminated objects and surfaces. As COVID-19 has been shown to be largely spread through the air, this article will broaden the focus to include engineering controls that effect this type of transmission. METHOD A literature search was conducted using key words such as long-term care facilities, built environment, COVID-19, infection control, and nursing homes. RESULTS Results were sorted using an engineering controls pyramid developed by the author to stratify approaches to LTC infrastructure. Basically, six elements were supported: ventilation, spatial separation, physical barriers, hand hygiene stations, resident room zones, and private rooms. IMPLICATIONS Conclusions were that the built environment has a major impact on infection control that can be deleterious or beneficial. Substantial changes need to be made to protect the very vulnerable LTC population from future pandemics and infectious diseases.
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40
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Kirkham J, Shorey CL, Iaboni A, Quirt H, Grigorovich A, Astell A, Lin E, Maxwell CJ. Staff perceptions of the consequences of COVID-19 on quality of dementia care for residents in Ontario long-term care homes. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5725. [PMID: 35510483 PMCID: PMC9087411 DOI: 10.1002/gps.5725] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/20/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The first wave of the COVID-19 pandemic necessitated extensive infection control measures in long-term care (LTC) and had a significant impact on staffing and services. Anecdotal reports indicate that this negatively affected LTC residents' quality of care and wellbeing, but there is scarce evidence on the effects of COVID-19 on quality of dementia care in LTC. METHODS From December 2020 to March 2021, we conducted a cross-sectional online survey among staff who worked in LTC homes in Ontario, Canada. Survey questions examined staffs' perceptions of the impact of COVID-19 on dementia quality of care during the initial wave of the COVID-19 pandemic (beginning 1 March 2020). RESULTS There were a total of 227 survey respondents; more than half reported both worsened overall quality of care (51.3%) and worsening of a majority of specific quality of care measures (55.5%). Measures of cognitive functioning, mobility and behavioural symptoms were most frequently described as worsened. Medical and allied/support staff had the highest odds of reporting overall worsened quality of care, while specialized behavioural care staff and those with more experience in LTC were less likely to. LTC home factors including rural location and smaller size, staffing challenges, higher number of outbreaks and less COVID-19 preparedness were associated with increased odds of perceived worsening of quality of dementia care outcomes. CONCLUSIONS These findings suggest that COVID-19 pandemic restrictions and related effects such as inadequate staffing may have contributed to poor quality of care and outcomes for those with dementia in LTC.
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Affiliation(s)
- Julia Kirkham
- Department of PsychiatryCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Carrie L. Shorey
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Andrea Iaboni
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada,Department of PsychiatryTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Hannah Quirt
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Alisa Grigorovich
- Recreation and Leisure StudiesBrock UniversitySt CatharinesOntarioCanada
| | - Arlene Astell
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada,Department of PsychiatryTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Esther Lin
- Department of PsychiatryCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Colleen J. Maxwell
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada,School of PharmacyUniversity of WaterlooWaterlooOntarioCanada
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41
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Sadri H, Sadri S. Is long-term care a building or a societal moral philosophy? Healthc Manage Forum 2022; 35:140-146. [PMID: 35363084 DOI: 10.1177/08404704221083554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The number of Older Adults (OA) in Ontario will double in two decades. The COVID-19 pandemic demonstrated that the model of subsidized Long-Term Care (LTC) homes does not reflect the care needs of OAs. Many nations have implemented LTC models as a continuum of care for OAs promoting independent home/community living. These models help delay admission to LTC homes and achieve a higher quality-of-life for OAs. Current financial pressure on the healthcare system and inadequacies of LTC homes necessitate a broader social welfare policy. One viable option for sustainable LTC is implementing Ontario's mandatory public long-term care insurance policy.
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Affiliation(s)
- Hamid Sadri
- 549576Medtronic of Canada Ltd., Brampton, Ontario, Canada
| | - Salar Sadri
- 7938University of Toronto, Toronto, Ontario, Canada
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42
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Hansford R, Ouellette-Kuntz H, Martin L. Short Report: The influence of congregate setting on positive COVID-19 tests among a high-risk sample of adults with intellectual and developmental disability in Ontario. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 122:104178. [PMID: 35063714 PMCID: PMC8765059 DOI: 10.1016/j.ridd.2022.104178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/02/2021] [Accepted: 01/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND For a number of reasons, persons with intellectual and developmental disability (IDD) are at increased risk of contracting COVID-19. AIMS This study explored the influence of congregate setting on testing positive for COVID-19 among adults with IDD in Ontario. METHODS AND PROCEDURES 833 home care recipients with IDD were included, 204 were tested at least once for COVID-19. These data were linked to the homecare assessment data. The association between living in a congregate setting and receiving a positive COVID-19 test was explored using a logistic regression model among the total sample and those tested for COVID-19. OUTCOMES AND RESULTS 77 individuals tested positive for COVID-19 (9.24 %). Congregate setting, age, aggression, and mobility were significantly associated with receiving a positive COVID-19 test in the total sample. Among the subgroup, congregate setting and age were significant. CONCLUSION AND IMPLICATIONS Adults with IDD have an increased risk for positive COVID-19 tests at younger ages than other high-risk populations, such as elderly persons. These findings confirm the vulnerability of adults with IDD living in group settings to COVID-19. As such, they should be prioritized when COVID-19 prevention and public health strategies, including vaccination and boosters, are introduced.
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Affiliation(s)
- Rebecca Hansford
- Queen's University, 99 University Avenue, Kingston, ON, K7L 3N6, Canada; MAPS, Canada
| | | | - Lynn Martin
- Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B 5E1, Canada; InterRAI, USA.
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Pengid S, Peltzer K, de Moura Villela EF, Fodjo JNS, Siau CS, Chen WS, Bono SA, Jayasvasti I, Hasan MT, Wanyenze RK, Hosseinipour MC, Dolo H, Sessou P, Ditekemena JD, Colebunders R. Using Andersen's model of health care utilization to assess factors associated with COVID-19 testing among adults in nine low-and middle-income countries: an online survey. BMC Health Serv Res 2022; 22:265. [PMID: 35227263 PMCID: PMC8882718 DOI: 10.1186/s12913-022-07661-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/21/2022] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to investigate, using Andersen’s model of health care utilization, factors associated with COVID-19 testing among adults in nine low- and middle- income countries. Methods In between 10 December 2020 and 9 February 2021, an online survey was organized in nine low- and middle-income countries. In total 10,183 adults (median age 45 years, interquartile range 33–57 years, range 18–93 years), including 6470 from Brazil, 1738 Malaysia, 1124 Thailand, 230 Bangladesh, 219 DR Congo, 159 Benin, 107 Uganda, 81 Malawi and 55 from Mali participated in the study. COVID-19 testing/infection status was assessed by self-report. Results Of the 10,183 participants, 40.3% had ever tested for COVID-19, 7.3% tested positive, and 33.0% tested negative. In an adjusted logistic regression model, predisposing factors (residing in Brazil, postgraduate education), enabling/disabling factors (urban residence, higher perceived economic status, being a student or worker in the health care sector, and moderate or severe psychological distress), and need factors (having at least one chronic condition) increased the odds of COVID-19 testing. Among those who were tested, participants residing in Bangladesh, those who had moderate to severe psychological distress were positively associated with COVID-19 positive diagnosis. Participants who are residing in Malaysia and Thailand, and those who had higher education were negatively associated with a COVID-19 positive diagnosis. Considering all participants, higher perceived economic status, being a student or worker in the health sector, and moderate or severe psychological distress were positively associated with a COVID-19 positive diagnosis, and residing in Malaysia, Thailand or five African countries was negatively associated with a COVID-19 positive diagnosis. Conclusion A high rate of COVID-19 testing among adults was reported in nine low-and middle-income countries. However, access to testing needs to be increased in Africa. Moreover, COVID-19 testing programmes need to target persons of lower economic status and education level who are less tested but most at risk for COVID-19 infection.
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Affiliation(s)
- Supa Pengid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, 10400, Thailand.,Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
| | - Karl Peltzer
- Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa. .,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Edlaine Faria de Moura Villela
- Disease Control Coordination, São Paulo State Health Department, São Paulo, 01246-000, Brazil.,Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, 74690-900, Brazil
| | | | - Ching Sin Siau
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Won Sun Chen
- Department of Health Science and Biostatistics, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Suzanna A Bono
- School of Social Science, Universiti Sains Malaysia, 11800, Gelugor, Malaysia
| | | | - M Tasdik Hasan
- Jeeon Bangladesh Ltd., Dhaka, Bangladesh.,Department of Public Health, State University of Bangladesh (SUB), Dhaka, Bangladesh.,Department of Primary Care & Mental Health, University of Liverpool, Liverpool, L69 3BX, UK
| | - Rhoda K Wanyenze
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Housseini Dolo
- International Center of Excellence in Research, Faculty of Medicine and OdontoStomatology, Bamako, Mali.,Lymphatic Filariasis Research Unit/International Center of Excellence in Research, Bamako, Mali
| | - Philippe Sessou
- Research Unit on Communicable Diseases, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Cotonou 01, BP, 526, Benin
| | - John D Ditekemena
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, 7948, Democratic Republic of the Congo
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Akhtar-Danesh N, Baumann A, Crea-Arsenio M, Antonipillai V. COVID-19 excess mortality among long-term care residents in Ontario, Canada. PLoS One 2022; 17:e0262807. [PMID: 35051237 PMCID: PMC8775534 DOI: 10.1371/journal.pone.0262807] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/05/2022] [Indexed: 12/03/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) has had devastating consequences worldwide, including a spike in global mortality. Residents of long-term care homes have been disproportionately affected. We conducted a retrospective cohort study to determine the scale of pandemic-related deaths of long-term care residents in the province of Ontario, Canada, and to estimate excess mortality due to a positive COVID-19 test adjusted for demographics and regional variations. Crude mortality rates for 2019 and 2020 were compared, as were predictors of mortality among residents with positive and negative tests from March 2020 to December 2020. We found the crude mortality rates were higher from April 2020 to June 2020 and from November 2020 to December 2020, corresponding to Wave 1 and Wave 2 of the pandemic in Ontario. There were also substantial increases in mortality among residents with a positive COVID-19 test. The significant differences in excess mortality observed in relation to long-term care home ownership category and geographic region may indicate gaps in the healthcare system that warrant attention from policymakers. Further investigation is needed to identify the most relevant factors in explaining these differences.
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Affiliation(s)
- Noori Akhtar-Danesh
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Andrea Baumann
- Global Health, McMaster University, Hamilton, Ontario, Canada
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Bronskill SE, Maclagan LC, Maxwell CJ, Iaboni A, Jaakkimainen RL, Marras C, Wang X, Guan J, Harris DA, Emdin A, Jones A, Sourial N, Godard-Sebillotte C, Vedel I, Austin PC, Swartz RH. Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic. JAMA HEALTH FORUM 2022; 3:e214599. [PMID: 35977228 PMCID: PMC8903126 DOI: 10.1001/jamahealthforum.2021.4599] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/07/2021] [Indexed: 12/15/2022] Open
Abstract
Question Was the COVID-19 pandemic associated with changes in health service use and mortality among community-dwelling persons with dementia and Parkinson disease compared with older adults? Findings In this population-based repeated cross-sectional analysis, large declines in hospital use and nursing home admission were experienced across all cohorts. After the first wave, most services returned to historical levels, with physician visits elevated and mostly virtual, nursing home admissions reduced, and excess all-cause mortality. Meaning The pandemic was associated with meaningful health service disruptions for persons with dementia and Parkinson disease, highlighting that continued support for virtual care is needed to ensure optimal health outcomes. Importance Persons with dementia and Parkinson disease (PD) are vulnerable to disruptions in health care and services. Objective To examine changes in health service use among community-dwelling persons with dementia, persons with PD, and older adults without neurodegenerative disease during the first wave of the COVID-19 pandemic. Design, Setting, and Participants Repeated cross-sectional analysis using population-based administrative data among community-dwelling persons with dementia, persons with PD, and adults 65 years and older at the start of each week from March 1 through the week of September 20, 2020 (pandemic period), and March 3 through the week of September 22, 2019 (historical period), in Ontario, Canada. Exposures COVID-19 pandemic as of March 1, 2020. Main Outcomes and Measures Main outcomes were weekly rates of emergency department visits, hospitalizations, nursing home admissions, home care, virtual and in-person physician visits, and all-cause mortality. Poisson regression models were used to calculate weekly rate ratios (RRs) with 95% CIs comparing pandemic weeks with historical levels. Results Among those living in the community as of March 1, 2020, persons with dementia (n = 131 466; mean [SD] age, 80.1 [10.1] years) were older than persons with PD (n = 30 606; 73.7 [10.2] years) and older adults (n = 2 363 742; 74.0 [7.1] years). While all services experienced declines, the largest drops occurred in nursing home admissions (RR for dementia: 0.10; 95% CI, 0.07-0.15; RR for PD: 0.03; 95% CI, 0.00-0.21; RR for older adults: 0.11; 95% CI, 0.06-0.18) and emergency department visits (RR for dementia: 0.45; 95% CI, 0.41-0.48; RR for PD: 0.40; 95% CI, 0.34-0.48; RR for older adults: 0.45; 95% CI, 0.44-0.47). After the first wave, most services returned to historical levels except physician visits, which remained elevated (RR for dementia: 1.07; 95% CI, 1.05-1.09; RR for PD: 1.10, 95% CI, 1.06-1.13) and shifted toward virtual visits. Older adults continued to experience lower hospitalizations. All-cause mortality was elevated across cohorts. Conclusions and Relevance In this population-based repeated cross-sectional study in Ontario, Canada, those with dementia, those with PD, and older adults sought hospital care far less than usual, were not admitted to nursing homes, and experienced excess mortality during the first wave of the pandemic. Most services returned to historical levels, but virtual physician visits remained a feature of care. While issues of equity and quality of care are still emerging among persons with neurodegenerative diseases, policies to support virtual care are necessary.
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Affiliation(s)
- Susan E. Bronskill
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Colleen J. Maxwell
- ICES, Toronto, Ontario, Canada
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - R. Liisa Jaakkimainen
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Connie Marras
- ICES, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson Disease, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | | | - Daniel A. Harris
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abby Emdin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Jones
- ICES, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | | | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Peter C. Austin
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Richard H. Swartz
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
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46
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Maharaj AS, Parker J, Hopkins JP, Gournis E, Bogoch II, Rader B, Astley CM, Ivers NM, Hawkins JB, Lee L, Tuite AR, Fisman DN, Brownstein JS, Lapointe-Shaw L. Comparison of longitudinal trends in self-reported symptoms and COVID-19 case activity in Ontario, Canada. PLoS One 2022; 17:e0262447. [PMID: 35015778 PMCID: PMC8754059 DOI: 10.1371/journal.pone.0262447] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Limitations in laboratory diagnostic capacity impact population surveillance of COVID-19. It is currently unknown whether participatory surveillance tools for COVID-19 correspond to government-reported case trends longitudinally and if it can be used as an adjunct to laboratory testing. The primary objective of this study was to determine whether self-reported COVID-19-like illness reflected laboratory-confirmed COVID-19 case trends in Ontario Canada. METHODS We retrospectively analyzed longitudinal self-reported symptoms data collected using an online tool-Outbreaks Near Me (ONM)-from April 20th, 2020, to March 7th, 2021 in Ontario, Canada. We measured the correlation between COVID-like illness among respondents and the weekly number of PCR-confirmed COVID-19 cases and provincial test positivity. We explored contemporaneous changes in other respiratory viruses, as well as the demographic characteristics of respondents to provide context for our findings. RESULTS Between 3,849-11,185 individuals responded to the symptom survey each week. No correlations were seen been self-reported CLI and either cases or test positivity. Strong positive correlations were seen between CLI and both cases and test positivity before a previously documented rise in rhinovirus/enterovirus in fall 2020. Compared to participatory surveillance respondents, a higher proportion of COVID-19 cases in Ontario consistently came from low-income, racialized and immigrant areas of the province- these groups were less well represented among survey respondents. INTERPRETATION Although digital surveillance systems are low-cost tools that have been useful to signal the onset of viral outbreaks, in this longitudinal comparison of self-reported COVID-like illness to Ontario COVID-19 case data we did not find this to be the case. Seasonal respiratory virus transmission and population coverage may explain this discrepancy.
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Affiliation(s)
- Arjuna S Maharaj
- Doctor of Medicine Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Parker
- Doctor of Medicine Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jessica P Hopkins
- Public Health Ontario, Toronto, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Effie Gournis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Toronto Public Health, City of Toronto, Toronto, Canada
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
| | - Benjamin Rader
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States of America
- Department of Epidemiology, Boston University, Boston, MA, United States of America
| | - Christina M Astley
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States of America
- Division of Endocrinology, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States of America
- Broad Institute of Harvard and MIT, Cambridge, MA, United States of America
| | - Noah M Ivers
- Women's College Research Institute, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Jared B Hawkins
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States of America
| | - Liza Lee
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David N Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - John S Brownstein
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States of America
- Department of Pediatrics and Biomedical Informatics, Harvard Medical School, Boston, MA, United States of America
| | - Lauren Lapointe-Shaw
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
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47
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Monteferrante E, Weiss Tremblay A, Payment JP, Laliberté M. La proche aidance et ses enjeux éthiques, cliniques et organisationnels en période de pandémie : l’expérience d’un Commissariat aux plaintes. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1092958ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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48
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Stockdale JE, Anderson SC, Edwards AM, Iyaniwura SA, Mulberry N, Otterstatter MC, Janjua NZ, Coombs D, Colijn C, Irvine MA. Quantifying transmissibility of SARS-CoV-2 and impact of intervention within long-term healthcare facilities. ROYAL SOCIETY OPEN SCIENCE 2022; 9:211710. [PMID: 35242355 PMCID: PMC8753163 DOI: 10.1098/rsos.211710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/02/2021] [Indexed: 05/03/2023]
Abstract
Estimates of the basic reproduction number (R 0) for COVID-19 are particularly variable in the context of transmission within locations such as long-term healthcare (LTHC) facilities. We sought to characterize the heterogeneity of R 0 across known outbreaks within these facilities. We used a unique comprehensive dataset of all outbreaks that occurred within LTHC facilities in British Columbia, Canada as of 21 September 2020. We estimated R 0 in 18 LTHC outbreaks with a novel Bayesian hierarchical dynamic model of susceptible, exposed, infected and recovered individuals, incorporating heterogeneity of R 0 between facilities. We further compared these estimates to those obtained with standard methods that use the exponential growth rate and maximum likelihood. The total size of outbreaks varied dramatically, with range of attack rates 2%-86%. The Bayesian analysis provided an overall estimate of R 0 = 2.51 (90% credible interval 0.47-9.0), with individual facility estimates ranging between 0.56 and 9.17. Uncertainty in these estimates was more constrained than standard methods, particularly for smaller outbreaks informed by the population-level model. We further estimated that intervention led to 61% (52%-69%) of all potential cases being averted within the LTHC facilities, or 75% (68%-79%) when using a model with multi-level intervention effect. Understanding of transmission risks and impact of intervention are essential in planning during the ongoing global pandemic, particularly in high-risk environments such as LTHC facilities.
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Affiliation(s)
| | - Sean C. Anderson
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
- Pacific Biological Station, Fisheries and Oceans Canada, Nanaimo, Canada
| | - Andrew M. Edwards
- Pacific Biological Station, Fisheries and Oceans Canada, Nanaimo, Canada
- Department of Biology, University of Victoria, Victoria, Canada
| | - Sarafa A. Iyaniwura
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Nicola Mulberry
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Michael C. Otterstatter
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Naveed Z. Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada
| | - Caroline Colijn
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Michael A. Irvine
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
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49
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Allin S, Fitzpatrick T, Marchildon GP, Quesnel-Vallée A. The federal government and Canada's COVID-19 responses: from 'we're ready, we're prepared' to 'fires are burning'. HEALTH ECONOMICS, POLICY, AND LAW 2022; 17:76-94. [PMID: 34154692 PMCID: PMC8326669 DOI: 10.1017/s1744133121000220] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/14/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022]
Abstract
Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by challenges, similar to many of those documented in the severe acute respiratory syndrome outbreak of 2003. Despite a high degree of pandemic preparedness, the relative success with flattening the curve during the first wave of the pandemic was not matched in much of Canada during the second wave. This paper critically reviews Canada's response to the COVID-19 pandemic with a focus on the role of the federal government in this public health emergency, considering areas within its jurisdiction (international borders), areas where an increased federal role may be warranted (long-term care), as well as its technical role in terms of generating evidence and supporting public health surveillance, and its convening role to support collaboration across the country. This accounting of the first 12 months of the pandemic highlights opportunities for a strengthened federal role in the short term, and some important lessons to be applied in preparing for future pandemics.
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Affiliation(s)
- Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- North American Observatory on Health Systems and Policies (NAO), University of Toronto, Toronto, ON, Canada
| | - Tiffany Fitzpatrick
- North American Observatory on Health Systems and Policies (NAO), University of Toronto, Toronto, ON, Canada
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Gregory P. Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- North American Observatory on Health Systems and Policies (NAO), University of Toronto, Toronto, ON, Canada
| | - Amélie Quesnel-Vallée
- North American Observatory on Health Systems and Policies (NAO), University of Toronto, Toronto, ON, Canada
- Departments of Epidemiology, Biostatistics and Occupational Health and Sociology, McGill University, Montreal, QC, Canada
- McGill Observatory on Health and Social Services Reforms, Montreal, QC, Canada
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50
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Vijh R, Ng CH, Shirmaleki M, Bharmal A. Factors associated with transmission of COVID-19 in long-term care facility outbreaks. J Hosp Infect 2021; 119:118-125. [PMID: 34808312 PMCID: PMC8603873 DOI: 10.1016/j.jhin.2021.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/13/2021] [Accepted: 11/07/2021] [Indexed: 11/18/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a disproportionate impact on residents in long-term care facilities (LTCFs). Aim To identify risk factors associated with outbreak severity to inform current outbreak management and future pandemic preparedness planning efforts. Methods A retrospective cohort study design was used to evaluate the association between non-modifiable factors (facility building, organization level, and resident population characteristics), modifiable factors (measured through an assessment tool for infection prevention and control (IPC) and pandemic preparedness), and severity of COVID-19 outbreaks (attack rate) in LTCFs. Findings From March 1st, 2020 to January 10th, 2021, a total of 145 exposures to at least one confirmed case of COVID-19 in 82 LTCFs occurred. Risk factors associated with increased outbreak severity were older facility age, a resident (vs staff) index case, and poorer assessment tool performance. Specifically, for every item not met in the assessment tool, a 22% increase in the adjusted rate ratio was observed (1.2; 95% confidence interval: 1.1–1.4) after controlling for other risk factors. Conclusion Scores from an assessment tool, older building age, and the index case being a resident were associated with severity of COVID-19 outbreaks in our jurisdiction. The findings reinforce the importance of regularly assessing IPC measures and outbreak preparedness in preventing large outbreaks. Regular, systematic assessments incorporating IPC and outbreak preparedness measures may help mitigate impacts of future outbreaks and inform future pandemic preparedness planning.
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Affiliation(s)
- R Vijh
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - C H Ng
- Office of the Medical Health Officer, Fraser Health, Surrey, British Columbia, Canada
| | - M Shirmaleki
- Office of the Medical Health Officer, Fraser Health, Surrey, British Columbia, Canada
| | - A Bharmal
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Office of the Medical Health Officer, Fraser Health, Surrey, British Columbia, Canada.
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