■目前对患有轻度COVID-19疾病的休假医护人员的指导可能会阻止COVID-19的传播,但可能会加剧养老院人员短缺以及与COVID-19无关的健康结果。
■比较与COVID-19相关的与非COVID-19相关的危害,这些危害与允许患有轻度COVID-19的工作人员在蒙面时工作有关。
■这项建模研究,从2023年11月到2024年6月进行,使用基于代理的模型,代表100张床的疗养院及其居民,工作人员,以及它们之间的相互作用;护理任务;以及居民和工作人员的健康结果,以模拟不同COVID-19休假政策在大流行后一年的影响。
■模拟越来越多的轻病员工在各种疫苗接种覆盖下戴着N95呼吸器工作,SARS-CoV-2的传播性和严重程度,掩盖坚持。
■主要结果是工作人员和居民COVID-19病例,员工休假日,错过的护理任务,疗养院住院医师住院(与COVID-19相关且无关),死亡,和成本。
■在研究的基于100床试剂的模型中没有SARS-CoV-2感染的情况下,养老院人员不足导致每年平均(SD)93.7(0.7)每天错过护理任务(22.1%),38.0(7.6)居民住院(5.2%),4.6(2.2)例死亡(0.6%),非COVID-19相关危害损失39.7(19.8)质量调整生命年,从医疗保险和医疗补助服务中心(CMS)的角度来看,花费$1071950($217200),从社会角度来看,花费$1112800($225450)。在2023年至2024年的SARS-CoV-2Omicron变异条件下,所有SARS-CoV-2检测呈阳性的员工休假与平均(SD)326.5(69.1)年休假天数和649.5(95%CI,593.4-705.6)额外的错过护理任务,导致4.3(95%CI,2.9-5.9)非COVID-19相关居民住院和0.7(95%CI,0.2-1.1)死亡,从CMS的角度来看,额外花费$247090(95%CI,$203160-$291020)和$405250(95%CI,$358550-$451950)。允许75%的轻度疾病工作人员在蒙面工作时与另外5名工作人员和另外5名居民COVID-19病例相关,没有增加与COVID-19相关的住院治疗,但缓解了人员短缺,每年执行475.9项额外护理任务,3.5非COVID-19相关住院治疗减少,非COVID-19相关死亡人数减少0.4人。从CMS的角度来看,允许轻度患病的员工最终节省了每年平均$85470(95%CI,$41210-$129730)和$134450(95%CI,$86370-$182540)。这些结果对增加疫苗接种覆盖率是强有力的,疗养院传播增加,从社区进口COVID-19的增加,在生病工作时无法掩盖。
■在这项对COVID-19员工休假政策的建模研究中,允许疗养院工作人员在患有轻度COVID-19疾病的情况下工作,与人员短缺和错过护理任务对居民的伤害相比,与COVID-19传播增加的伤害相比,最终节省了大量的直接医疗和社会成本。
UNASSIGNED: Current guidance to furlough health care staff with mild COVID-19 illness may prevent the spread of COVID-19 but may worsen nursing home staffing shortages as well as health outcomes that are unrelated to COVID-19.
UNASSIGNED: To compare COVID-19-related with non-COVID-19-related harms associated with allowing staff who are mildly ill with COVID-19 to work while masked.
UNASSIGNED: This modeling study, conducted from November 2023 to June 2024, used an agent-based model representing a 100-bed nursing home and its residents, staff, and their interactions; care tasks; and resident and staff health outcomes to simulate the impact of different COVID-19 furlough policies over 1 postpandemic year.
UNASSIGNED: Simulating increasing proportions of staff who are mildly ill and are allowed to work while wearing N95 respirators under various vaccination coverage, SARS-CoV-2 transmissibility and severity, and masking adherence.
UNASSIGNED: The main outcomes were staff and resident COVID-19 cases, staff furlough days, missed care tasks, nursing home resident hospitalizations (related and unrelated to COVID-19), deaths, and costs.
UNASSIGNED: In the absence of SARS-CoV-2 infection in the study\'s 100-bed agent-based model, nursing home understaffing resulted in an annual mean (SD) 93.7 (0.7) missed care tasks daily (22.1%), 38.0 (7.6) resident hospitalizations (5.2%), 4.6 (2.2) deaths (0.6%), and 39.7 (19.8) quality-adjusted life years lost from non-COVID-19-related harms, costing $1 071 950 ($217 200) from the Centers for Medicare & Medicaid Services (CMS) perspective and $1 112 800 ($225 450) from the societal perspective. Under the SARS-CoV-2 Omicron variant conditions from 2023 to 2024, furloughing all staff who tested positive for SARS-CoV-2 was associated with a mean (SD) 326.5 (69.1) annual furlough days and 649.5 (95% CI, 593.4-705.6) additional missed care tasks, resulting in 4.3 (95% CI, 2.9-5.9) non-COVID-19-related resident hospitalizations and 0.7 (95% CI, 0.2-1.1) deaths, costing an additional $247 090 (95% CI, $203 160-$291 020) from the CMS perspective and $405 250 (95% CI, $358 550-$451 950) from the societal perspective. Allowing 75% of staff who were mildly ill to work while masked was associated with 5 additional staff and 5 additional resident COVID-19 cases without added COVID-19-related hospitalizations but mitigated staffing shortages, with 475.9 additional care tasks being performed annually, 3.5 fewer non-COVID-19-related hospitalizations, and 0.4 fewer non-COVID-19-related deaths. Allowing staff who were mildly ill to work ultimately saved an annual mean $85 470 (95% CI, $41 210-$129 730) from the CMS perspective and $134 450 (95% CI, $86 370-$182 540) from the societal perspective. These results were robust to increased vaccination coverage, increased nursing home transmission, increased importation of COVID-19 from the community, and failure to mask while working ill.
UNASSIGNED: In this modeling study of staff COVID-19 furlough policies, allowing nursing home staff to work with mild COVID-19 illness was associated with fewer resident harms from staffing shortages and missed care tasks than harms from increased COVID-19 transmission, ultimately saving substantial direct medical and societal costs.