{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:04:02Z","timestamp":1791965042413,"version":"4.3.4"},"reference-count":19,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,8,21]],"date-time":"2020-08-21T00:00:00Z","timestamp":1597968000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["T32 HS000011"],"award-info":[{"award-number":["T32 HS000011"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["3P01AG027296\u201011S1"],"award-info":[{"award-number":["3P01AG027296\u201011S1"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To identify county and facility factors associated with severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102) outbreaks in skilled nursing facilities (SNFs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>Cross\u2010sectional study linking county SARS\u2010CoV\u20102 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post\u2010acute and long\u2010term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SETTING AND PARTICIPANTS<\/jats:title>\n                    <jats:p>The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non\u2010Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MEASUREMENTS<\/jats:title>\n                    <jats:p>For Genesis and non\u2010Genesis SNFs: any outbreak (one or more residents testing positive for SARS\u2010CoV\u20102). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, and prevalence after universal testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      One hundred eighteen (34.6%) Genesis SNFs and 640 (21.2%) non\u2010Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% confidence interval (CI) =\u20099.6\u201357.7 percentage point;\n                      <jats:italic>P\u2009=<\/jats:italic>\n                      .008) difference in the probability of an outbreak for Genesis and non\u2010Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI = 4.4\u201320.8 cases;\n                      <jats:italic>P\u2009=<\/jats:italic>\n                      .003) for Genesis SNFs. A 10\u2010bed difference in facility size was associated with a 0.9 percentage point (95% CI = 0.6\u20131.2 percentage point;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five\u2010Star ratings or past infection control deficiency citations and probability or severity of outbreak.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Larger SNFs and SNFs in areas of high SARS\u2010CoV\u20102 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications. J Am Geriatr Soc 68:2167\u20132173, 2020.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.16752","type":"journal-article","created":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T17:19:20Z","timestamp":1594919960000},"page":"2167-2173","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":97,"title":["Variation in\n                    <scp>SARS\u2010CoV<\/scp>\n                    \u20102 Prevalence in\n                    <scp>U.S.<\/scp>\n                    Skilled Nursing Facilities"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4175-8662","authenticated-orcid":false,"given":"Elizabeth M.","family":"White","sequence":"first","affiliation":[{"name":"Department of Health Services, Policy, and Practice Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus M.","family":"Kosar","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Feifer","sequence":"additional","affiliation":[{"name":"Genesis HealthCare  Kennett Square Pennsylvania USA"},{"name":"Genesis Physician Services  Kennett Square Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Blackman","sequence":"additional","affiliation":[{"name":"Genesis HealthCare  Kennett Square Pennsylvania USA"},{"name":"Genesis Physician Services  Kennett Square Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Gravenstein","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice Brown University School of Public Health  Providence Rhode Island USA"},{"name":"Division of Geriatrics and Palliative Medicine Brown University Alpert Medical School  Providence Rhode Island USA"},{"name":"Providence Veterans Administration Medical Center Research Service  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Ouslander","sequence":"additional","affiliation":[{"name":"Florida Atlantic University Schmidt College of Medicine  Boca Raton Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Mor","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice Brown University School of Public Health  Providence Rhode Island USA"},{"name":"Providence Veterans Administration Medical Center Research Service  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,21]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Kaiser Family Foundation. 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Guidance for infection control and prevention of coronavirus disease 2019 (COVID\u201019) in nursing homes (revised). 2020. QSO\u201020\u201014\u2010NH.https:\/\/www.cms.gov\/files\/document\/3-13-2020-nursing-home-guidance-covid-19.pdf. Accessed May 10 2020."},{"key":"e_1_2_7_9_1","unstructured":"Brown University School of Public Health. LTCfocus: long\u2010term care: facts on care in the US. 2018.http:\/\/ltcfocus.org\/. Accessed May 23 2020."},{"key":"e_1_2_7_10_1","unstructured":"Johns Hopkins University. Coronavirus resource center. 2020.https:\/\/coronavirus.jhu.edu\/us-map. Accessed May 23 2020."},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1001\/jama.2020.6637","article-title":"Symptom screening at illness onset of health care personnel with SARS\u2010CoV\u20102 infection in King County, Washington","volume":"323","author":"Chow EJ","year":"2020","journal-title":"JAMA"},{"key":"e_1_2_7_12_1","unstructured":"BerklanJM. 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