IMPORTANCE In April , 2020, Massachusetts nursing homes (NHs) became a hotspot for COVID-19 infections and associated deaths . In response, Governor Charles Baker allocated $130 million in additional funding for 2 months contingent upon compliance with a new set of care criteria, including mandatory testing of all residents and staff, and a 28-point infection control check-list .
OBJECTIVE To describe the Massachusetts effort and associated outcomes .
DESIGN Longitudinal cohort study
PARTICIPANTS : 360 Massachusetts NHs . EXPOSURE The Massachusetts Senior Care Association and Hebrew SeniorLife rapidly organized a Central Command team, targeted 123``special focus"facilities with infection control deficiencies for on-site and virtual consultations, and offered all 360 facilities weekly webinars and answers to questions regarding infection control procedures . The facilities were also informed of resources for the acquisition of PPE, back-up staff, and SARS-COV-2 testing . MAIN MEASURES AND
OUTCOMES We used 2 data sources : 1) Four state audits of all NHs, and 2) weekly NH reports to the Massachusetts Center for Health Information and Analysis . Primary independent process measures were the checklist scores and adherence to each of its six core competencies . Primary outcomes were the average weekly rates of new infections, hospitalizations, and deaths in residents and staff . We used a hurdle mixed effects model adjusted for county COVID-19 prevalence to estimate relationships between infection control process measures and rates of new infections or deaths .
RESULTS Both resident and staff infection rates started higher in special focus facilities, then rapidly declined to the same low level in both groups . Adherence to infection control processes, especially proper wearing of PPE and cohorting, was significantly associated with declines in weekly infection and mortality rates .
CONCLUSIONS This state-wide effort could serve as a national model for other states to prevent the devastating effects of pandemics like COVID-19 in frail NH residents. This article is protected by copyright . All rights reserved.