{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T12:35:47Z","timestamp":1782304547981,"version":"3.54.5"},"reference-count":30,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100022244","name":"National Institute for Health Research Applied Research Collaboration West","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022244","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Bath and North East Somerset Council"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Health Serv Res Policy"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Identify and explore risk factors associated with COVID-19 infection and mortality rates in care homes in the West of England and gain an understanding of challenges faced during the pandemic, how they were addressed and how care homes can be better equipped for future pandemics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed-methods study combined observational analysis of numbers of infections and deaths with potential risk factors supported by semi-structured interviews. Thirty-three care homes within a single local authority (LA) in the West of England were included in the quantitative analysis and, in the qualitative study, five care homes were included, including those located outside the participating LA. The quantitative analysis assessed two outcomes: number of weekly COVID-19 cases and deaths between 31\/08\/2020 and 21\/02\/2021. Associations with potential care risk factors were analysed using Poisson regression. 14 interviews were conducted with care home staff in various roles between November 2022 and September 2023. Data were analysed thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Care home size was associated with higher COVID-19 infection (large compared with small care homes: incidence rate ratio (IRR) = 12.60, 95% confidence interval (CI) 2.54 to 62.51) and mortality rates (large compared with small care homes: IRR = 16.48, 95% CI 0.81 to 335.88). Qualitative data revealed that care home managers recognized these risks and were focussed on the challenges of implementing infection control within the limitations of their buildings. The primary challenge identified was staff shortages, requiring care home staff to assume expanded responsibilities. There was no evidence of association between hospital discharges and COVID-19 cases (IRR = 0.45, 95% CI 0.11 to 1.83) or deaths (IRR = 0.61, 0.11 to 3.22). The qualitative data highlighted care home staff had feelings of separation and felt under-valued in relation to the wider health care sector. There was also concern that COVID-19 prevention measures prioritised infection control over the psycho-social welfare of residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Research on the risk factors for infection spread and associated mortality should be prioritised to better protect care homes in future pandemics. This requires making routine data in social care more readily available for research purposes. Proactive planning for future pandemics, by care homes and local authorities, should recognise the individual nature of buildings and the needs of residents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13558196251344174","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T04:36:28Z","timestamp":1748925388000},"page":"247-257","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring risk factors for COVID-19 mortality and infection in care homes in the west of England: A mixed-methods study"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4709-7260","authenticated-orcid":false,"given":"Rebecca","family":"Wilson","sequence":"first","affiliation":[{"name":"The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) &amp; Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9514-9761","authenticated-orcid":false,"given":"Selin","family":"Sivi\u015f","sequence":"additional","affiliation":[{"name":"The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) &amp; Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Scott","sequence":"additional","affiliation":[{"name":"Bath and North East Somerset Council &amp; College of Health, Science and Society, University of West England, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0656-5646","authenticated-orcid":false,"given":"Jeremy","family":"Dixon","sequence":"additional","affiliation":[{"name":"School of Social Sciences, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Green","sequence":"additional","affiliation":[{"name":"Bath and North East Somerset Council, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Westcott","sequence":"additional","affiliation":[{"name":"NHS Dorset, Dorset, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Marriott","sequence":"additional","affiliation":[{"name":"Wiltshire Council, Wiltshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3889-6098","authenticated-orcid":false,"given":"Jonathan","family":"Banks","sequence":"additional","affiliation":[{"name":"The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) &amp; Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Theresa","family":"Redaniel","sequence":"additional","affiliation":[{"name":"The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) &amp; Population Health Sciences, University of Bristol, Bristol, UK"},{"name":"National Cancer Registry Ireland, Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afab060"},{"key":"e_1_3_6_3_2","unstructured":"Public Health England. A data linkage approach to assessing the contribution of hospital-associated SARS-CoV-2 infection to care home outbreaks in England 30 January to 12 October 2020. 2021. https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/1005583\/Nosocomial_Seeding_OF_care_home_outbreaks_report_Official_Sensitive-3.pdf (accessed 15 April 2024)."},{"key":"e_1_3_6_4_2","article-title":"Consensus statement on the association between the discharge of patients from hospitals and COVID in care homes","author":"Guthrie B","year":"2022","unstructured":"Guthrie B, Comas-Herrera A, Chudasama D, et al. Consensus statement on the association between the discharge of patients from hospitals and COVID in care homes. Report, Scientific Advisory Group for Emergencies, UK, 2022. https:\/\/www.gov.uk\/government\/publications\/the-association-between-the-discharge-of-patients-from-hospitals-and-covid-in-care-homes\/consensus-statement-on-the-association-between-the-discharge-of-patients-from-hospitals-and-covid-in-care-homes (accessed 15 April 2024).","journal-title":"Report, Scientific Advisory Group for Emergencies, UK"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.31389\/jltc.109"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/spol.12645"},{"key":"e_1_3_6_7_2","first-page":"58","article-title":"The COVID-19 pandemic in UK care homes \u2013 revealing the cracks in the system","volume":"6","author":"Devi R","year":"2020","unstructured":"Devi R, Hinsliff-Smith K, Goodman C, et al. The COVID-19 pandemic in UK care homes \u2013 revealing the cracks in the system. J Nurs Home Res Sci 2020; 6: 58\u201360.","journal-title":"J Nurs Home Res Sci"},{"key":"e_1_3_6_8_2","unstructured":"Office for National Statistics. Death registrations and occurrences by local authority and place of death. 2022. https:\/\/www.ons.gov.uk\/datasets\/weekly-deaths-local-authority (accessed 24 February 2025)."},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2022.06.028"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2023.10.027"},{"key":"e_1_3_6_11_2","unstructured":"Office for National Statistics. Death registrations and occurrences by local authority and place of death. 2020. https:\/\/www.ons.gov.uk\/datasets\/weekly-deaths-local-authority\/editions\/2020\/versions\/21 (accessed 24 February 2025)."},{"key":"e_1_3_6_12_2","article-title":"Beyond Covid-19 wave two: what now for care homes?","author":"Curry N","year":"2021","unstructured":"Curry N. Beyond Covid-19 wave two: what now for care homes? Nuffield Trust Comment 2021. https:\/\/www.nuffieldtrust.org.uk\/news-item\/beyond-covid-19-wave-two-what-now-for-care-homes (accessed 24 February 2025).","journal-title":"Nuffield Trust Comment"},{"key":"e_1_3_6_13_2","unstructured":"Office for National Statistics. Coronavirus (COVID-19) latest insights. 2023. https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/articles\/coronaviruscovid19latestinsights\/deaths (accessed 24 February 2025)."},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780100410"},{"key":"e_1_3_6_15_2","unstructured":"NIHR. ENRICH: enabling research in care homes. 2024. https:\/\/enrich.nihr.ac.uk\/ (accessed 20 June 2024)."},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1628806"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-7568(20)30012-X"},{"key":"e_1_3_6_18_2","unstructured":"Office for National Statistics. Impact of coronavirus in care homes in England. https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/articles\/impactofcoronavirusincarehomesinenglandvivaldi\/26mayto19june2020 (accessed 24 February 2025)."},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-021-02053-9"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2020.11.022"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2020.06.010"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1080\/08959420.2020.1773192"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afac072"},{"key":"e_1_3_6_24_2","volume-title":"Public health profiles: palliative and End of Life Care Profiles. Percentage of deaths that occur in care homes (All ages)","author":"Office for Health Improvement and Disparities","year":"2024","unstructured":"Office for Health Improvement and Disparities. Public health profiles: palliative and End of Life Care Profiles. Percentage of deaths that occur in care homes (All ages), 2024a. https:\/\/fingertips.phe.org.uk\/profile\/end-of-life\/data#page\/4\/gid\/1938132883\/pat\/6\/par\/E12000009\/ati\/402\/iid\/93475\/age\/1\/sex\/4\/cat\/-1\/ctp\/-1\/yrr\/1\/cid\/4\/tbm\/1 (accessed 24 February 2025)."},{"key":"e_1_3_6_25_2","volume-title":"Public health profiles: palliative and end of life care profiles. Percentage of deaths that occur in hospital (all ages)","author":"Office for Health Improvement and Disparities","year":"2024","unstructured":"Office for Health Improvement and Disparities. Public health profiles: palliative and end of life care profiles. Percentage of deaths that occur in hospital (all ages), 2024b. https:\/\/fingertips.phe.org.uk\/profile\/end-of-life\/data#page\/4\/gid\/1938132883\/pat\/6\/par\/E12000009\/ati\/402\/are\/E06000022\/iid\/93474\/age\/1\/sex\/4\/cat\/-1\/ctp\/-1\/yrr\/1\/cid\/4\/tbm\/1 (accessed 24 February 2025)."},{"key":"e_1_3_6_26_2","unstructured":"Bath & North East Somerset. Briefing update - work to understand COVID-19 death rates in care homes during the second wave of the pandemic in Bath & North East. 2023. https:\/\/www.bathnes.gov.uk\/sites\/default\/files\/jsna\/Briefing_update_-_Work_to_understand_COVID-19_death_rates_in_care_homes_during_the_second_wave_of_the_pandemic.pdf (accessed 24 February 2025)."},{"key":"e_1_3_6_27_2","unstructured":"Office for Health Improvement and Disparities. Palliative and End of Life Care profiles: nursing home beds per 100 people 75+ 2011-2021. https:\/\/fingertips.phe.org.uk\/profile\/end-of-life\/data#page\/4\/gid\/1938133060\/pat\/6\/par\/E12000009\/ati\/402\/iid\/92490\/age\/162\/sex\/4\/cat\/-1\/ctp\/-1\/yrr\/1\/cid\/4\/tbm\/1 (accessed 24 February 2025)"},{"key":"e_1_3_6_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100295"},{"key":"e_1_3_6_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2021.110856"},{"key":"e_1_3_6_30_2","unstructured":"NHS England NHS federated data Platform 2024. https:\/\/www.england.nhs.uk\/digitaltechnology\/nhs-federated-data-platform\/ (accessed 6 February 2025)."},{"key":"e_1_3_6_31_2","doi-asserted-by":"publisher","DOI":"10.5334\/ijic.6968"}],"container-title":["Journal of Health Services Research &amp; Policy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13558196251344174","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13558196251344174","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13558196251344174","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:45:21Z","timestamp":1777452321000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13558196251344174"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/13558196251344174"],"URL":"https:\/\/doi.org\/10.1177\/13558196251344174","relation":{},"ISSN":["1355-8196","1758-1060"],"issn-type":[{"value":"1355-8196","type":"print"},{"value":"1758-1060","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,3]]}}}