Ana Montoya

Background: Transfer trauma, defined as the negative consequences of moving from one environment to another, can affect some long‐term nursing home (NH) residents who are relocated between facilities. However, it remains unclear whether such transfers are associated with serious acute health risks, such as hospitalization or death, and whether these outcomes should be considered indicators of transfer trauma. Methods: We conducted a retrospective cohort study to determine whether long‐term NH residents who experience a transfer are at greater risk for hospitalization or death compared to residents who remain in the same facility. We used a 20% national Medicare sample linked to minimum data set (MDS) assessments. Long‐term NH residents who underwent a NH‐to‐NH transfer in 2019 were matched 1:1 with residents from the same facility in the same calendar month who did not transfer. Outcomes were hospitalization and death within 90 days following the transfer. We used conditional logistic regression models, adjusted for demographic variables, dual enrollment status, activities of daily living, cognitive function, and comorbidity scores to assess the association of transfer with outcomes. Results: A total of 1375 matched resident pairs ( n = 2750) were analyzed. The number of hospitalizations did not differ between the transfer and non‐transfer groups (173 vs. 160, respectively; p = 0.45). Ninety‐day mortality also did not differ between the two groups; however, exact death counts are not reported in accordance with CMS small cell suppression rules. In adjusted analysis, transfer status was not associated with higher odds of 90‐day hospitalization (OR = 1.18 [95% CI: 0.91, 1.53]) or death (OR = 1.58 [95% CI: 0.27, 9.40]). Conclusion: Among long‐term NH residents, transfer to another NH was not associated with a higher risk of hospitalization or mortality within 90 days post‐transfer. These findings suggest that NH‐to‐NH transfers, when necessary, may not inherently increase severe acute health risks for this population.

Background: Nursing home (NH) residents are susceptible to healthcare-associated infections (HAIs). Alignment among NHs, hospitals, and health departments is critical for effective implementation of infection prevention efforts. We tested a collaborative model that engaged hospitals and NHs to reduce infections among NH residents. Methods: We recruited 92 NHs and 15 hospitals over four 12-month cohorts (2018–2022). The intervention focused on HAI prevention; practices to reduce infection transmission; and effective communication among hospitals, NHs, and state health departments. NHs submitted data on urinary tract infection, catheter-associated urinary tract infection, Clostridioides difficile infection, methicillin-resistant Staphylococcus aureus infection, catheter use, and urine cultures. Changes in outcomes before and during the coronavirus disease 2019 (COVID-19) pandemic were assessed using multilevel negative binomial regression. Results: A total of 63 NHs (68%) partnered with 18 hospitals and submitted 2 or more months of outcome data. Forty NHs participated before COVID-19 (contributing to 1 364 492 resident-days, 56 258 device-days), and 23 NHs participated during COVID-19 (566 142 resident-days, 29 568 device-days). While reductions in the incidence of urine cultures (incidence rate ratio [IRR], 0.37; P < .001) and total composite infections (IRR, 0.68; P = .03) were observed before COVID-19, these reductions were not sustained during the pandemic. Conclusions: Prior to COVID-19 pandemic, collaboration between NHs and referring regional hospitals with engagement from state health departments led to reductions in NH urine cultures and total infections. Although the pandemic significantly impacted our study, we demonstrate the importance of regional networks in promoting infection prevention in NHs.

Background and Objectives: Nursing home (NH)-to-NH transfers place NH residents at risk for developing transfer trauma. We aimed to develop a composite measure of transfer trauma and apply it among those transferring before and during the pandemic. Research Design and Methods: Cross-sectional cohort analysis of long-stay NH residents with a NH-to-NH transfer. Minimum Data Set data (2018–2020) were used to create the cohorts. A composite measure of transfer trauma was developed (2018 cohort) and applied to the 2019 and 2020 cohorts. We analyzed resident characteristics and conducted logistic regression analyses to compare rates of transfer trauma between periods. Results: In 2018, 794 residents were transferred; 242 (30.5%) met the criteria for transfer trauma. In the 2019 and 2020, 750 residents (2019) and 795 (2020) were transferred. In 2019 cohort, 30.7% met the criteria for transfer trauma, and 21.9% in 2020 cohort. During the pandemic, a higher proportion of transferred residents left the facility before the first quarterly assessment. Among residents who stayed in NH for their quarterly assessment, after adjusting for demographic characteristics, residents in the 2020 cohort were less likely to experience transfer trauma than those in the 2019 cohort (adjusted odds ratio [AOR] = 0.64, 95% confidence interval [CI]: 0.51, 0.81). However, residents in 2020 cohort were two times more likely to die (AOR = 1.94, 95% CI: 1.15, 3.26) and 3 times more likely to discharge within 90 days after transfer (AOR = 2.86, 95% CI: 2.30, 3.56) compared with those in 2019 cohort. Discussion and Implications: These findings highlight how common transfer trauma is after NH-to-NH transfer and the need for further research to mitigate negative outcomes associated with the transfer in this vulnerable population.