Clinical features and medical care factors associated with mortality in French nursing homes during the COVID-19 outbreak

Highlights • Among nursing homes with COVID-19 cases, mortality rates are highly variable. • Hospital dependent nursing homes are associated with lower mortality rates. • Increased material, human and medical resources reduce mortality in nursing homes. • Daily clinical examination by a physician reduces mortality in COVID-19 nursing home patients.
Objectives The aim of this study is to identify demographic, clinical and medical care factors associated with mortality in three nursing homes. Methods Two nursing homes were hospital-dependent, had connections with infection prevention and control departments, and had permanent physicians. Third nursing home had no direct connection with general hospital, no infection control practitioner, and no permanent physician. The main outcome was death. Results During first 3 months of the outbreak, 224/375 (59.7%) residents were classified “COVID-19 cases” and 57/375 (15.2%) died. Hospital dependent nursing homes had lower COVID-19 case fatality rates in comparison to non-hospital dependent nursing home (15 [6.6%] vs 38 [25.8%], OR 0.20 [0.11-0.38], p = 0.001). During first 3 weeks of the outbreak, mortality in COVID-19 patients decreased if they had daily clinical examination (aOR: 0.09 [0.03-0.35], p = 0.01), 3 vital signs measurements per day (OR: 0.06 [0.01-0.30], p = 0.001) and prophylactic anticoagulation (OR: 0 [0.00-0.24], p = 0.001). Conclusions This study suggests that high mortality rates in some nursing homes during COVID-19 outbreak might be favoured by a lack of medical care management. Increasing human and material resources, encouraging presence of nursing home physicians and establishing connection with general hospitals should be consider to deal with present and future health disasters in nursing homes.