PDF(Pubmed)
Abstract：
BACKGROUND: From March 7 to April 7, 2020, the Community of Madrid (CoM), Spain, issued interventions in response to the COVID-19 epidemic, including hospital referral triage protocols for long-term care facility (LTCF) residents (March 18-25). Those with moderate to severe physical disability and cognitive impairment were excluded from hospital referral. This research assesses changes in the association between daily hospital referrals and the deaths of LTCF residents attributable to the triage protocols.
METHODS: Daily hospital referrals and all-cause mortality from January to June 2020 among LTCF residents and the CoM population aged 65 + were obtained. Significant changes in LTCF resident daily hospital referrals time series, and in-LTCF and in-hospital daily deaths, were examined with tests for breaks and regimes in time series. Multivariate time series analyses were conducted to test changes in the associations between LTCF resident hospital referrals with daily deaths in-hospital and in-LTCF, and in the CoM population aged 65 + when the triage protocols were implemented.
RESULTS: Among LTCF residents, hospital referrals declined sharply from March 6 to March 23, 2020. Increases in LTCF residents\' daily deaths occurred from March 7 to April 1, followed by a decrease reaching pre-epidemic levels after April 28. The daily ratio of in-hospital deaths to in-LTCF deaths reached its lowest values from March 9 to April 19, 2020. The four versions of the triage protocol, published from March 18 to March 25 had no impact on further changes in the association of hospital referrals with daily deaths of LTCF residents in-hospital or in-LTCF.
CONCLUSIONS: While LTCF residents\' deaths increased, hospital referrals of LTCF residents decreased with the introduction of the CoM governmental interventions on March 7. They were implemented before the enactment of the triage protocols, protecting hospitals from collapse while overlooking the need for standards of care within LTCFs. The CoM triage protocols sanctioned the existing restrictions on hospital referrals of LTCF residents.
METHODS: Daily hospital referrals and all-cause mortality from January to June 2020 among LTCF residents and the CoM population aged 65 + were obtained. Significant changes in LTCF resident daily hospital referrals time series, and in-LTCF and in-hospital daily deaths, were examined with tests for breaks and regimes in time series. Multivariate time series analyses were conducted to test changes in the associations between LTCF resident hospital referrals with daily deaths in-hospital and in-LTCF, and in the CoM population aged 65 + when the triage protocols were implemented.
RESULTS: Among LTCF residents, hospital referrals declined sharply from March 6 to March 23, 2020. Increases in LTCF residents\' daily deaths occurred from March 7 to April 1, followed by a decrease reaching pre-epidemic levels after April 28. The daily ratio of in-hospital deaths to in-LTCF deaths reached its lowest values from March 9 to April 19, 2020. The four versions of the triage protocol, published from March 18 to March 25 had no impact on further changes in the association of hospital referrals with daily deaths of LTCF residents in-hospital or in-LTCF.
CONCLUSIONS: While LTCF residents\' deaths increased, hospital referrals of LTCF residents decreased with the introduction of the CoM governmental interventions on March 7. They were implemented before the enactment of the triage protocols, protecting hospitals from collapse while overlooking the need for standards of care within LTCFs. The CoM triage protocols sanctioned the existing restrictions on hospital referrals of LTCF residents.
摘要：
背景：从2020年3月7日至4月7日，马德里社区（CoM），西班牙,针对COVID-19疫情发布干预措施，包括长期护理机构（LTCF）居民的医院转诊分诊方案（3月18日至25日）。中度至重度身体残疾和认知障碍的患者被排除在医院转诊之外。这项研究评估了由于分诊方案而导致的每日医院转诊与LTCF居民死亡之间的关联变化。
方法：获得2020年1月至6月LTCF居民和65岁以上CoM人群的每日医院转诊和全因死亡率。LTCF住院医师每日医院转诊时间序列的显著变化，以及LTCF和医院内的每日死亡，通过时间序列中的休息和制度测试进行了检查。进行了多变量时间序列分析，以测试LTCF住院病人医院转诊与住院和LTCF中每日死亡之间的相关性变化。以及实施分诊方案时65岁以上的CoM人群。
结果：在LTCF居民中，2020年3月6日至3月23日，医院转诊率急剧下降。从3月7日至4月1日，LTCF居民的每日死亡人数增加，随后在4月28日之后下降到流行前的水平。从2020年3月9日至4月19日，住院死亡人数与LTCF死亡人数的每日比率达到最低值。分诊协议的四个版本，3月18日至3月25日发表的文章对医院转诊与LTCF居民住院或LTCF中每日死亡的关系的进一步变化没有影响.
结论：虽然LTCF居民的死亡增加，3月7日，随着CoM政府干预措施的实施，LTCF居民的医院转诊减少。它们是在制定分诊协议之前实施的，保护医院免于崩溃，同时忽视了LTCF中对护理标准的需求。CoM分诊协议批准了对LTCF居民医院转诊的现有限制。
方法：获得2020年1月至6月LTCF居民和65岁以上CoM人群的每日医院转诊和全因死亡率。LTCF住院医师每日医院转诊时间序列的显著变化，以及LTCF和医院内的每日死亡，通过时间序列中的休息和制度测试进行了检查。进行了多变量时间序列分析，以测试LTCF住院病人医院转诊与住院和LTCF中每日死亡之间的相关性变化。以及实施分诊方案时65岁以上的CoM人群。
结果：在LTCF居民中，2020年3月6日至3月23日，医院转诊率急剧下降。从3月7日至4月1日，LTCF居民的每日死亡人数增加，随后在4月28日之后下降到流行前的水平。从2020年3月9日至4月19日，住院死亡人数与LTCF死亡人数的每日比率达到最低值。分诊协议的四个版本，3月18日至3月25日发表的文章对医院转诊与LTCF居民住院或LTCF中每日死亡的关系的进一步变化没有影响.
结论：虽然LTCF居民的死亡增加，3月7日，随着CoM政府干预措施的实施，LTCF居民的医院转诊减少。它们是在制定分诊协议之前实施的，保护医院免于崩溃，同时忽视了LTCF中对护理标准的需求。CoM分诊协议批准了对LTCF居民医院转诊的现有限制。
