Evidence map›Paper›PMID 32699006›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2020

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths.

Nathan M Stall, Aaron Jones, Kevin A Brown, Paula A Rochon, Andrew P Costa

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 97 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
97citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

97 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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37 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Nathan M StallDivision of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont. nathan.stall@sinaihealth.ca.
Aaron JonesDivision of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.
Kevin A BrownDivision of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.
Paula A RochonDivision of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.
Andrew P CostaDivision of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLong-term care (LTC) homes have been the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada to date. Previous research shows that for-profit LTC homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than nonprofit homes.

methodsWe conducted a retrospective cohort study of all LTC homes in Ontario, Canada, from Mar. 29 to May 20, 2020, using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between profit status of LTC homes (for-profit, nonprofit or municipal) and COVID-19 outbreaks in LTC homes, the extent of COVID-19 outbreaks (number of residents infected), and deaths of residents from COVID-19.

resultsThe analysis included all 623 Ontario LTC homes, comprising 75 676 residents; 360 LTC homes (57.7%) were for profit, 162 (26.0%) were nonprofit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) outbreaks of COVID-19 in LTC homes, involving 5218 residents and resulting in 1452 deaths, with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak were associated with the incidence of COVID-19 in the public health unit region surrounding an LTC home (adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.19-3.05), the number of residents (adjusted OR 1.38, 95% CI 1.18-1.61), and older design standards of the home (adjusted OR 1.55, 95% CI 1.01-2.38), but not profit status. For-profit status was associated with both the extent of an outbreak in an LTC home (adjusted risk ratio [RR] 1.96, 95% CI 1.26-3.05) and the number of resident deaths (adjusted RR 1.78, 95% CI 1.03-3.07), compared with nonprofit homes. These associations were mediated by a higher prevalence of older design standards in for-profit LTC homes and chain ownership.

interpretationFor-profit status is associated with the extent of an outbreak of COVID-19 in LTC homes and the number of resident deaths, but not the likelihood of outbreaks. Differences between for-profit and nonprofit homes are largely explained by older design standards and chain ownership, which should be a focus of infection control efforts and future policy.

Indexed as

CoronavirusCoronavirus InfectionsLong-Term CarePandemicsPneumonia, ViralBetacoronavirusCOVID-19Disease OutbreaksHumansNursing HomesOntarioOwnershipRetrospective StudiesSARS-CoV-2

Identifiers

PMID32699006
PMCPMC7828970

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.