Hospital Influenza Admissions as a Harbinger for Nursing Home Influenza Cases.

McConeghy KW, Huang SS, Miller LG, McKinnell JA, Shireman TI, Mor V, Gravenstein S. Hospital Influenza Admissions as a Harbinger for Nursing Home Influenza Cases. Journal of The American Medical Directors Association. 2020 Jan 1; 21(1):121-126.

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Abstract:

OBJECTIVES: To determine temporal associations of local measures of influenza morbidity and mortality by the Centers for Disease Control and Prevention (CDC) with influenza hospitalizations in nursing home residents. DESIGN: Retrospective, longitudinal panel study. SETTING AND PARTICIPANTS: Long-stay nursing home residents, aged 65 years or older in 823 nursing homes from 2011 to 2015. MEASURES: CDC-reported rates of influenza and pneumonia mortality and laboratory-confirmed influenza hospitalizations. We compared the CDC measures to nursing home resident hospitalizations due to (1) all-cause, (2) a primary diagnosis of respiratory or circulatory illness, and (3) a primary diagnosis of pneumonia or influenza based on Medicare Part A Claims data. RESULTS: Our final sample included 273,743 unique residents in 819 nursing homes in 108 cities. National laboratory-confirmed influenza-associated hospitalizations for the group aged 65 and older occurred 0 to 1 week prior to nursing home resident influenza-related hospitalizations (Spearman ?  = 0.54). CDC-reported influenza hospitalizations occurred 3 weeks prior to CDC-reported influenza deaths (?  = 0.59). Nursing home resident influenza hospitalizations occurred 2 weeks before local CDC-reported pneumonia and influenza deaths occurred (?  = 0.44). CONCLUSIONS/IMPLICATIONS: Publicly reported CDC measures correlate well with nursing home hospitalizations for pneumonia and influenza. Rates of laboratory-confirmed influenza hospitalizations (as reported by the CDC) may be a useful surrogate for nursing home influenza outbreaks but should be considered along with local indicators of disease outbreaks. Early community signals could be clinically leveraged as a trigger for increased infection control measures in nursing homes.