Table 2. Adjusted Differential Change in Health and Quality of Life Outcome for Long-term Care Residents by COVID-19 Exposure Status, 2020 vs 2018-2019.
| Outcome | Unadjusted 2018-2019 rate, %b | Change in outcome, January-November 2018-2019c | Adjusted difference, 2020 vs 2018-2019a | |
|---|---|---|---|---|
| Active COVID-19 outbreak (95% CI), % | No-known COVID-19 outbreak (95% CI), % | |||
| Health and utilization | ||||
| Monthly mortality | 2.2 | 1.60 (1.58 to 1.62) | −0.15 (−0.16 to −0.13) | |
| Monthly hospitalization | 3.0 | −0.10 (−0.12 to −0.09) | −0.83 (−0.85 to −0.81) | |
| Monthly ED visits | 2.9 | −0.57 (−0.59 to −0.55) | −0.79 (−0.81 to −0.77) | |
| Quality of life (within-resident change from last assessment in prior year to November annually) | ||||
| Change in No. of ADLs requiring assistance by November (higher is worse) | 0.89 | 0.36 (0.34 to 0.38) | −0.06 (−0.12 to 0.01) | |
| Change in weight by November, lb (lower is worse) | −1.9 | −3.1 (−3.2 to −3.0) | −1.8 (−2.1 to −1.49) | |
| % of residents with worse PHQ-9 by November (higher is worse)d | 27.1 | 4.4 (4.1 to 4.7) | 3.2 (2.3 to 4.1) | |
Abbreviations: ADLs, activities of daily living; ED, emergency department; PHQ-9, Patient Health Questionnaire-9.
Conversion factor: To convert pounds to kilograms, multiply by 0.45.
Adjusted differences represent the difference within the active and no-known COVID-19 groups for each outcome in 2020 vs the average in 2018-2019. Each adjusted difference is estimated using separate linear regression models at the resident-month level. Each model controls for SNF fixed effects (which control for all observable and unobservable SNF characteristics that are time invariant) and beneficiary characteristics (age, sex, race and ethnicity, Medicaid eligibility, indicators for 27 chronic conditions). These results come from coefficients on an indicator for the year 2020 (health and utilization outcomes) or an interaction term between an indicator for year 2020 and November (quality of life outcomes, which are cumulative over the year) for each outcome in adjusted models.
The mean unadjusted monthly rate across all months in 2018-2019. For the quality of life outcomes, the 2018-2019 baseline is the average within-individual change for all assessments by November in 2018 and 2019 vs the prior year.
Mean within-individual cumulative change for all assessments from January to November 2018 and 2019.
The range for the PHQ-9 is 0 to 27 points. Higher scores indicate worse symptoms. This outcome measures whether residents had a worsened PHQ-9 score compared with their latest assessment in the prior year.