ImpAct of COVID-19 on CaRe TransitOns and Health OutcomeS for Vulnerable PopulationS in Nursing Homes and Home HealthCARE Agencies (ACROSS-CARE) - The COVID-19 pandemic has disproportionately impacted elderly vulnerable populations (i.e., racial/ethnic
minorities and rural residents). The high risk for acquiring COVID-19 and the dire outcomes in these vulnerable
populations is partially explained by the high prevalence of comorbidities and other social determinants of
health. Home healthcare agencies (HHAs) and nursing homes (NHs), provide essential post-acute services for
a large number of elderly patients. The pandemic has disrupted care transitions from hospitals to HHAs and
NHs, which may lead to important health outcomes consequences, including the widening of existing health
disparities. In our previous, pre-COVID-19 studies, we have found that when HHAs and NHs provide best
practices in infection prevention and control (IPC) nosocomial infections are reduced. Building upon this novel
previous work and guided by the National Institute on Minority Health and Health Disparities (NIMHD)
framework, the aims of this study are to: 1) Describe how HHA and NH IPC programs have changed in
response to the COVID-19 pandemic across the nation, and examine if these changes vary for facilities serving
a large proportion of vulnerable populations; 2) Characterize how COVID-19 disrupted hospital admissions and
subsequent discharges to HHAs and NHs, and determine if the disruptions disproportionately affected
vulnerable populations; and, 3) Quantify the impact of COVID-19 on inpatient, HHA and NH health outcomes
and the effectiveness of IPC programs in HHAs and NHs in reducing the impact of the pandemic in vulnerable
and non-vulnerable elderly populations. In Aim 1, we will conduct qualitative interviews of and a national survey
of HHAs and NHs. We will sample from the core HHAs and NHs from our pre-COVID-19 surveys and augment
with new facilities as needed. We will link our prior surveys and the new 2022 survey to examine changes in
IPC programs and determine if these changes differed in facilities predominately serving vulnerable
populations. In Aim 2, we will use longitudinal (2013 to 2022) Centers for Medicare and Medicaid (CMS) data
to characterize how select urgent and elective hospital admissions and discharge dispositions to HHAs and
NHs changed with COVID-19; and, whether these changes differed for vulnerable populations. In Aim 3, we
will link our pre-COVID surveys and the 2022 survey with longitudinal CMS data to model the health outcomes
(i.e., COVID-19 cases, infections, rehospitalizations and mortality) of elderly Medicare beneficiaries, controlling
for the local COVID-19 environment. Our prior national surveys of IPC in both NHs and HHAs are ideal and
novel baseline data. Leveraging our prior work, this innovative study will address the impact of COVID-19 on
transitions and health outcomes of elderly, vulnerable patients (i.e., racial and ethnic minorities versus non-
Latinx whites and urban versus rural), identify health disparities and effective practices to mitigate health
disparities. The study findings will also inform NHs, HHAs and policymakers in future planning for infectious
disease emergencies and decrease health disparities.
