Hospital and Community Skilled Nursing Partnership for Monoclonal Antibody Treatment During the Novel Coronavirus Pandemic

Abstract

Skilled nursing facilities emerged as the "canary in the coal mine" at the outset of the COVID19 pandemic. This study examines two collaborative pilots, both focused on the administration of monoclonal antibody (MAB) treatment in a skilled nursing facility (SNF), to reduce hospitalizations and deaths. The participating SNF is a 130 bed for-profit nursing home with an individual owner. The referring hospital is Baylor Scott & White Memorial Medical Center, a 635-bed non-profit tertiary hospital. The design is a retrospective case control study in two phases, SNF Outbreak 1 and SNF Outbreak 2. The initial phase took place in December 2020 over the course of a 4-week COVID19 outbreak. The second phase took place in July 2021, during Outbreak 2. Phase 1 cases were those patients who were COVID19(+) and treated with MAB in addition to standard supportive care. Phase 1 controls were those patients who were COVID19(+) but not treated with MAB. Phase 2 cases were those patients who were COVID19(+) and treated with MAB whereas the controls were COVID19(-) patients who were treated with MAB for post-exposure prophylaxis (PEP). Outcome measures included deaths and hospitalizations. During Outbreak 1, the census was 72 and 59 residents tested (+) for COVID19. Of the total (+) COVID19 cases, 37 patients (cases) received MAB, while 22 patients (controls) did not (either because they refused are were outside the treatment window). There were 7 deaths (31.8%) and 7 hospitalizations (31.8%) in the control group. There were 6 deaths (16.2%) and 3 hospitalizations (8.1%) in the treatment group. During Outbreak 2, the census was 65. Sixteen patients tested (+) for COVID19 and were treated with MAB (cases), whereas 46 patients tested (-) for COVID19, but received MAB for PEP (controls). Three patients refused, and 1 patient was hospitalized before he could receive treatment, later passing away. There were 5 hospitalizations among (+) patients, 2 related and 3 unrelated to COVID19. There were no deaths or hospitalizations in the COVID19 (-) group. We demonstrated significant reductions in hospitalizations and deaths (75% and 50%, respectively) for those who received MAB during the phase 1 outbreak. During the phase 2 outbreak, only 12.5% of COVID19 (+) patients were hospitalized and 6.25% died due to COVID19. Importantly, prophylaxis with MAB drastically reduced the rate of conversion the spread and accelerated our ability to extinguish the outbreak. These reductions in hospitalization and mortality would not have been possible without collaboration between the hospital and the community SNF. This creates a unique opportunity to pilot new innovations in collaborative health care modeling with iterative adjustments based on lessons learned during the process. By partnering with the hospital, our nursing home was able to improve outcomes for COVID (+) residents, reduce the spread of COVID19 with PEP, and help preserve hospital capacity by treating residents in place.