ExpiresNovember 13, 2023
CME Provider: JAMA Internal Medicine
Description of CME Course
Nursing home residents have been disproportionately affected by coronavirus disease 2019 (COVID-19). Prevention recommendations emphasize frequent testing of health care personnel and residents, but additional strategies are needed.
To develop a reproducible index of nursing home crowding and determine whether crowding was associated with COVID-19 cases and mortality in the first months of the COVID-19 epidemic.
Design, Setting, and Participants:
This population-based retrospective cohort study included more than 78?000 residents across more than 600 nursing homes in Ontario, Canada, and was conducted from March 29 to May 20, 2020.
The nursing home crowding index equaled the mean number of residents per bedroom and bathroom.
Main Outcomes and Measures:
The cumulative incidence of COVID-19 cases confirmed by a validated nucleic acid amplification assay and mortality per 100 residents; the introduction of COVID-19 into a home (=1 resident case) was a negative tracer.
Of 623 homes in Ontario, we obtained complete information on 618 homes (99%) housing 78?607 residents (women, 54?160 [68.9%]; age =85 years, 42?919 [54.6%]). A total of 5218 residents (6.6%) developed COVID-19 infection, and 1452 (1.8%) died of COVID-19 infection as of May 20, 2020. COVID-19 infection was distributed unevenly across nursing homes; 4496 infections (86%) occurred in 63 homes (10%). The crowding index ranged across homes from 1.3 (mainly single-occupancy rooms) to 4.0 (exclusively quadruple occupancy rooms); 308 homes (50%) had a high crowding index (=2). Incidence in high crowding index homes was 9.7% vs 4.5% in low crowding index homes (P? In this cohort of Canadian nursing homes, crowding was common and crowded homes were more likely to experience larger and deadlier COVID-19 outbreaks.
1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.
ABMS Member Board Approvals by Type
ABMS MOC Part II CME Activity
Allergy and Immunology
Colon and Rectal Surgery
Medical Genetics and Genomics
Physical Medicine and Rehabilitation
Psychiatry and Neurology
NOTE: If a Member Board has not deemed this activity for MOC approval as an accredited CME activity, this activity may count toward an ABMS Member Board’s general CME requirement. Please refer directly to your Member Board’s MOC Part II Lifelong Learning and Self-Assessment Program Requirements.
To identify the key insights or developments described in this article
Infection Control, Infectious Diseases, Public Health, Geriatrics, Coronavirus (COVID19)
CME Credit Type
AMA PRA Category 1 Credit