{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:00:23Z","timestamp":1782846023866,"version":"3.54.5"},"reference-count":79,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Hum Factors"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The 5-Star Quality Rating System for nursing homes plays a central role in evaluating quality of care, although it has both strengths and limitations. This system relies heavily on the Minimum Data Set and derives several quality measures (QMs) from it. In this study, we validated the effectiveness of the 5-Star Quality Rating System for nursing homes and its underlying QMs in estimating quality of care. We constructed a panel dataset of US nursing homes (n=15,416) active from May 2020 to June 2023, retrieving data from three major sources: (1) COVID-19 nursing home data, (2) Payroll-Based Journal data, and (3) nursing home QM snapshots. The outcome variables included (1) resident infection, (2) staff infection, or (3) resident and staff deaths. The predictor variables were the 5-Star Quality Rating System for nursing homes and its underlying QMs classified as structure, process, or outcome (SPO) QMs.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to evaluate the effectiveness of nursing home QMs by regressing nursing home COVID-19 outcomes on nursing home QMs, classified using the Donabedian SPO framework. We hypothesized that nursing homes with better structural quality (eg, greater staff availability, better skill mix, and so on), better process quality (eg, lower restraint use and higher vaccination rates), and better outcome quality (eg, lower number of residents with pressure ulcers and a lower number of resident falls) experienced better COVID-19 performance in terms of resident and staff infections and deaths.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n To examine the association between the COVID-19 outcomes and SPO QMs, we imputed missing values in the dataset using random forest. Subsequently, we modeled the imputed dataset using hurdled zero-inflated negative binomial mixed effects models. The zero inflation model included factors influencing initial susceptibility to COVID-19 or factors influencing the possibility of death after COVID-19 had been contracted. The model estimates were conditioned on zero inflation and random effects.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Staffing measures (\n P<\/jats:italic>\n <.001 for all variables in all models), health deficiency scores (\n P<\/jats:italic>\n <.001 for all variables in at least 1 model), COVID-19 hospitalization rates (\n P<\/jats:italic>\n <.001 for all variables in at least 2 models), and vaccinations (\n P<\/jats:italic>\n <.001 for all variables in at least 2 models) exhibited meaningful relationships with the COVID-19 outcomes, while the 5-star components, Medicaid dependency, and ownership showed no clear relationships.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Although widely used, the 5-Star Quality Rating System for nursing homes is an unreliable performance measure. Concerted efforts from lawmakers, policy makers, and lobbyists are needed to refine and enhance the measure, thereby ensuring its reliability and effectiveness.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/72770","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T21:53:42Z","timestamp":1769723622000},"page":"e72770-e72770","source":"Crossref","is-referenced-by-count":0,"title":["Demystifying Quality Metrics and Unveiling the True Measure of Quality of Care in Nursing Homes: Mixed Effects Analysis"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4912-4838","authenticated-orcid":false,"given":"Suhas","family":"Bharadwaj","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3303-8200","authenticated-orcid":false,"given":"Haneen","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"R1","unstructured":"Nursing home care. National Center for Health Statistics. 2020. URL: https:\/\/www.cdc.gov\/nchs\/fastats\/nursing-home-care.htm [Accessed 11-09-2025]"},{"issue":"15-16","key":"R2","doi-asserted-by":"publisher","first-page":"2758","DOI":"10.1111\/jocn.15297","article-title":"Nursing homes and COVID-19: we can and should do better","volume":"29","author":"Davidson","journal-title":"J Clin Nurs"},{"issue":"12","key":"R3","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1056\/NEJMoa2210063","article-title":"COVID-19 surveillance testing and resident outcomes in nursing homes","volume":"388","author":"McGarry","journal-title":"N Engl J Med"},{"issue":"2","key":"R4","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1111\/jgs.18260","article-title":"Paying for nursing home quality: an elusive but important goal","volume":"71","author":"Grabowski","journal-title":"J American Geriatrics Society"},{"issue":"12","key":"R5","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1016\/j.jamda.2015.09.006","article-title":"Predicting adverse health outcomes in nursing homes: a 9-year longitudinal study and development of the FRAIL-Minimum Data Set (MDS) quick screening tool","volume":"16","author":"Luo","journal-title":"J Am Med Dir Assoc"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1007\/s12603-014-0001-y","article-title":"Patterns of chronic co-morbid medical conditions in older residents of U.S. nursing homes: differences between the sexes and across the agespan","volume":"18","author":"Moore","journal-title":"J Nutr Health Aging"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1093\/ageing\/afz136","article-title":"Morbidity and mortality among older people admitted to nursing home","volume":"49","author":"Reilev","journal-title":"Age Ageing"},{"key":"R8","unstructured":"Vespa J Armstrong DM Medina L . Demographic turning points for the United States: population projections for 2020 to 2060. United States Census Bureau; 2018. URL: https:\/\/www.census.gov\/content\/dam\/Census\/library\/publications\/2020\/demo\/p25-1144.pdf [Accessed 06-01-2026]"},{"key":"R9","unstructured":"Consumer Financial Protection Bureau Office for Older Americans. Issue spotlight: nursing home debt collection. Consumer Financial Protection Bureau; 2022. URL: https:\/\/www.consumerfinance.gov\/data-research\/research-reports\/issue-spotlight-nursing-home-debt-collection\/full-report\/ [Accessed 06-01-2026]"},{"key":"R10","unstructured":"Medina L Sabo S Vespa J . Living longer: historical and projected life expectancy in the United States, 1960 to 2060. United States Census Bureau; 2020. URL: https:\/\/www.census.gov\/content\/dam\/Census\/library\/publications\/2020\/demo\/p25-1145.pdf [Accessed 06-01-2026]"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1177\/154193120905301118","article-title":"Older adults\u2019 needs for home health care and the potential for human factors interventions","volume":"53","author":"Mitzner","journal-title":"Proc Hum Factors Ergon Soc Annu Meet"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2022.107174","article-title":"Excess deaths in the United States during the first year of COVID-19","volume":"162","author":"Ruhm","journal-title":"Prev Med"},{"issue":"8","key":"R13","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.3201\/eid2608.200679","article-title":"Population-based estimates of chronic conditions affecting risk for complications from coronavirus disease, United States","volume":"26","author":"Adams","journal-title":"Emerg Infect Dis"},{"issue":"8","key":"R14","doi-asserted-by":"publisher","first-page":"2070","DOI":"10.1111\/jgs.17309","article-title":"The association of nursing home quality ratings and spread of COVID-19","volume":"69","author":"Williams","journal-title":"J Am Geriatr Soc"},{"key":"R15","unstructured":"COVID-19: who\u2019s at higher risk of serious symptoms. Mayo Clinic. 2024. URL: https:\/\/www.mayoclinic.org\/diseases-conditions\/coronavirus\/in-depth\/coronavirus-who-is-at-risk\/art-20483301 [Accessed 11-09-2025]"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1017\/S0714980823000399","article-title":"\u201cYou needed to accept the situation\u201d: resilience of nursing home residents in times of COVID-19","volume":"43","author":"De Witte","journal-title":"Can J Aging"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1016\/j.gerinurse.2021.10.023","article-title":"Infection prevention and control in nursing homes during COVID-19: an environmental scan","volume":"43","author":"Rubano","journal-title":"Geriatr Nurs"},{"issue":"2","key":"R18","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.jhin.2020.02.007","article-title":"Support of nursing homes in infection management varies by US State Departments of Health","volume":"105","author":"Dorritie","journal-title":"J Hosp Infect"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1177\/00469580211044287","article-title":"Social distancing vs social interaction for older adults at long-term care facilities in the midst of the COVID-19 pandemic: a rapid review and synthesis of action plans","volume":"58","author":"Ferdous","journal-title":"Inquiry"},{"key":"R20","unstructured":"How to protect yourself and others. Centers for Disease Control and Prevention. 2025. URL: https:\/\/www.cdc.gov\/covid\/prevention\/index.html [Accessed 11-09-2025]"},{"key":"R21","unstructured":"Infection control deficiencies were widespread and persistent in nursing homes prior to COVID-19 pandemic. United States Government Accountability Office. 2020. URL: https:\/\/www.gao.gov\/products\/gao-20-576r [Accessed 11-09-2025]"},{"key":"R22","unstructured":"Nursing home quality initiative. Centers for Medicare & Medicaid Services; 2003. URL: https:\/\/www.cms.gov\/Medicare\/Quality-Initiatives-Patient-Assessment-Instruments\/NursingHomeQualityInits\/Downloads\/NHQIOverView20030731.pdf [Accessed 11-09-2025]"},{"key":"R23","unstructured":"CMS\u2019 five star quality rating system for nursing homes. Centers for Medicare & Medicaid Services. 2014. URL: https:\/\/www.cms.gov\/newsroom\/fact-sheets\/cms-five-star-quality-rating-system-nursing-homes [Accessed 11-09-2025]"},{"issue":"4","key":"R24","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1093\/geront\/gnq052","article-title":"What is nursing home quality and how is it measured?","volume":"50","author":"Castle","journal-title":"Gerontologist"},{"issue":"6","key":"R25","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1097\/01.mlr.0000163661.67170.b9","article-title":"Staff turnover and quality of care in nursing homes","volume":"43","author":"Castle","journal-title":"Med Care"},{"issue":"2","key":"R26","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1001\/jama.289.2.223","article-title":"Pressure ulcer prevention and management","volume":"289","author":"Lyder","journal-title":"JAMA"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2021.104036","article-title":"The relationship between quality and staffing in long-term care: a systematic review of the literature 2008-2020","volume":"122","author":"Clemens","journal-title":"Int J Nurs Stud"},{"issue":"3","key":"R28","doi-asserted-by":"publisher","first-page":"157","DOI":"10.3928\/19404921-20080701-02","article-title":"Staffing characteristics, turnover rates, and quality of resident care in nursing facilities","volume":"1","author":"Collier","journal-title":"Res Gerontol Nurs"},{"issue":"6","key":"R29","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1016\/j.ijnurstu.2011.02.014","article-title":"The relationship between nurse staffing and quality of care in nursing homes: a systematic review","volume":"48","author":"Spilsbury","journal-title":"Int J Nurs Stud"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1177\/1077558704273769","article-title":"Nursing home profit status and quality of care: is there any evidence of an association?","volume":"62","author":"Hillmer","journal-title":"Med Care Res Rev"},{"key":"R31","unstructured":"R Foundation for Statistical Computing. 2025. URL: https:\/\/www.R-project.org\/ [Accessed 06-01-2026]"},{"issue":"8","key":"R32","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1037\/\/0003-066X.55.8.963","article-title":"Increasing statistical power without increasing sample size","volume":"55","author":"McClelland","journal-title":"Am Psychol"},{"issue":"12","key":"R33","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1001\/jama.1988.03410120089033","article-title":"The quality of care: how can it be assessed?","volume":"260","author":"Donabedian","journal-title":"JAMA"},{"issue":"10","key":"R34","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.26702","article-title":"Comparative performance of private equity-owned US nursing homes during the COVID-19 pandemic","volume":"3","author":"Braun","journal-title":"JAMA Netw Open"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1177\/1094428114548590","article-title":"Missing data","volume":"17","author":"Newman","journal-title":"Organ Res Methods"},{"key":"R36","unstructured":"Mayer M . MissRanger: fast imputation of missing values R package version 2.6.0. Comprehensive R Archive Network (CRAN). 2024. URL: https:\/\/CRAN.R-project.org\/package=missRanger [Accessed 06-01-2026]"},{"issue":"19-20","key":"R37","doi-asserted-by":"publisher","first-page":"2722","DOI":"10.1111\/j.1365-2702.2011.03854.x","article-title":"Approaches for dealing with missing data in health care studies","volume":"21","author":"Penny","journal-title":"J Clin Nurs"},{"issue":"1","key":"R38","doi-asserted-by":"publisher","DOI":"10.1186\/s40488-021-00121-4","article-title":"A comparison of zero-inflated and hurdle models for modeling zero-inflated count data","volume":"8","author":"Feng","journal-title":"J Stat Distrib Appl"},{"issue":"6","key":"R39","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1007\/s41999-021-00531-2","article-title":"Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses","volume":"12","author":"Giri","journal-title":"Eur Geriatr Med"},{"key":"R40","unstructured":"Interim guidelines for COVID-19 antibody testing. Centers for Disease Control and Prevention. URL: https:\/\/archive.cdc.gov\/#\/details?q=https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/testing\/antibody-tests-guidelines.html&start=0&rows=10&url=https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/testing\/antibody-tests-guidelines.html [Accessed 11-09-2025]"},{"issue":"2","key":"R41","doi-asserted-by":"publisher","first-page":"378","DOI":"10.32614\/RJ-2017-066","article-title":"glmmTMB balances speed and flexibility among packages for zero-inflated generalized linear mixed modeling","volume":"9","author":"Brooks","journal-title":"R J"},{"key":"R42","unstructured":"Hartig F . DHARMa: residual diagnostics for hierarchical (multi-level\/mixed) regression models (version 046) [R package]. Comprehensive R Archive Network (CRAN). URL: https:\/\/CRAN.R-project.org\/package=DHARMa [Accessed 11-09-2025]"},{"issue":"12","key":"R43","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10121493","article-title":"Presumed urinary tract infection in patients admitted with COVID-19: are we treating too much?","volume":"10","author":"Van Laethem","journal-title":"Antibiotics (Basel)"},{"issue":"5","key":"R44","doi-asserted-by":"publisher","first-page":"327","DOI":"10.5694\/mja12.10085","article-title":"Surveillance of infection burden in residential aged care facilities","volume":"196","author":"Lim","journal-title":"Med J Aust"},{"issue":"6","key":"R45","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1046\/j.1525-1497.2001.016006376.x","article-title":"Antibiotic use in Ontario facilities that provide chronic care","volume":"16","author":"Loeb","journal-title":"J Gen Intern Med"},{"issue":"3","key":"R46","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1300\/J089v09n03_05","article-title":"Antimicrobial use in nursing homes in Manitoba","volume":"9","author":"Montgomery","journal-title":"J Geriatr Drug Ther"},{"issue":"2","key":"R47","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/jgs.12099","article-title":"Another setting for stewardship: high rate of unnecessary antimicrobial use in a veterans affairs long-term care facility","volume":"61","author":"Peron","journal-title":"J Am Geriatr Soc"},{"issue":"10","key":"R48","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1111\/j.1445-5994.2012.02796.x","article-title":"Antibiotic use and misuse in residential aged care facilities","volume":"42","author":"Stuart","journal-title":"Intern Med J"},{"issue":"10","key":"R49","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1111\/j.1532-5415.1986.tb04301.x","article-title":"Systemic antibiotic use in nursing homes. A quality assessment","volume":"34","author":"Zimmer","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"R50","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-85081-0","article-title":"Comparison of clinical characteristics and disease outcome of COVID-19 and seasonal influenza","volume":"11","author":"Brehm","journal-title":"Sci Rep"},{"issue":"6","key":"R51","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/S2213-2600(20)30105-3","article-title":"Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"8","author":"Soriano","journal-title":"Lancet Respir Med"},{"issue":"2","key":"R52","doi-asserted-by":"publisher","DOI":"10.3390\/geriatrics9020034","article-title":"Pulmonary diseases in older patients: understanding and addressing the challenges","volume":"9","author":"Joshi","journal-title":"Geriatrics (Basel)"},{"issue":"3","key":"R53","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1164\/rccm.201210-1843CI","article-title":"Chronic bronchitis and chronic obstructive pulmonary disease","volume":"187","author":"Kim","journal-title":"Am J Respir Crit Care Med"},{"issue":"7","key":"R54","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1513\/AnnalsATS.201601-063OC","article-title":"Classifying chronic lower respiratory disease events in epidemiologic cohort studies","volume":"13","author":"Oelsner","journal-title":"Ann Am Thorac Soc"},{"issue":"1","key":"R55","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00093-2015","article-title":"Mortality rates for chronic lower respiratory diseases in Italy from 1979 to 2010: an age-period-cohort analysis","volume":"2","author":"Pesce","journal-title":"ERJ Open Res"},{"key":"R56","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2023.104555","article-title":"Prevalence of indwelling urinary catheters in nursing home residents: systematic review","volume":"145","author":"Czwikla","journal-title":"Int J Nurs Stud"},{"issue":"1","key":"R57","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-024-01512-w","article-title":"Use of indwelling urinary catheters in nursing home residents: results from a cross-sectional study in 21 German nursing homes","volume":"24","author":"Czwikla","journal-title":"BMC Urol"},{"key":"R58","unstructured":"Nosocomial infections (healthcare-associated infections). Cleveland Clinic. URL: https:\/\/my.clevelandclinic.org\/health\/diseases\/16397-avoiding-healthcare-associated-infections-hais [Accessed 11-09-2025]"},{"issue":"3","key":"R59","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1177\/1527154420938707","article-title":"Nurse staffing and coronavirus infections in California nursing homes","volume":"21","author":"Harrington","journal-title":"Policy Polit Nurs Pract"},{"issue":"8","key":"R60","doi-asserted-by":"publisher","first-page":"1653","DOI":"10.1111\/jgs.16661","article-title":"Characteristics of U.S. nursing homes with COVID-19 cases","volume":"68","author":"Abrams","journal-title":"J Am Geriatr Soc"},{"issue":"7","key":"R61","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.16930","article-title":"Characteristics and quality of US nursing homes reporting cases of coronavirus disease 2019 (COVID-19)","volume":"3","author":"Chatterjee","journal-title":"JAMA Netw Open"},{"issue":"11","key":"R62","doi-asserted-by":"publisher","first-page":"2462","DOI":"10.1111\/jgs.16787","article-title":"Staffing levels and COVID-19 cases and outbreaks in U.S. nursing homes","volume":"68","author":"Gorges","journal-title":"J Am Geriatr Soc"},{"issue":"11","key":"R63","doi-asserted-by":"publisher","first-page":"1533","DOI":"10.1016\/j.jamda.2020.08.030","article-title":"Predicting coronavirus disease 2019 infection risk and related risk drivers in nursing homes: a machine learning approach","volume":"21","author":"Sun","journal-title":"J Am Med Dir Assoc"},{"issue":"10","key":"R64","doi-asserted-by":"publisher","first-page":"2167","DOI":"10.1111\/jgs.16752","article-title":"Variation in SARS-CoV-2 prevalence in U.S. skilled nursing facilities","volume":"68","author":"White","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"R65","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.jamda.2021.12.026","article-title":"Nursing home design and COVID-19: implications for guidelines and regulation","volume":"23","author":"Zhu","journal-title":"J Am Med Dir Assoc"},{"key":"R66","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.12.004","article-title":"Clinical features and medical care factors associated with mortality in French nursing homes during the COVID-19 outbreak","volume":"104","author":"Tarteret","journal-title":"Int J Infect Dis"},{"issue":"2","key":"R67","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.37431","article-title":"Factors associated with racial differences in deaths among nursing home residents with COVID-19 infection in the US","volume":"4","author":"Gorges","journal-title":"JAMA Netw Open"},{"issue":"1","key":"R68","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-042804","article-title":"Compress the curve: a cross-sectional study of variations in COVID-19 infections across California nursing homes","volume":"11","author":"Gopal","journal-title":"BMJ Open"},{"issue":"9","key":"R69","doi-asserted-by":"publisher","first-page":"1899","DOI":"10.1111\/jgs.16689","article-title":"COVID-19 infections and deaths among Connecticut nursing home residents: facility correlates","volume":"68","author":"Li","journal-title":"J Am Geriatr Soc"},{"key":"R70","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2020.141946","article-title":"Mapping community-level determinants of COVID-19 transmission in nursing homes: a multi-scale approach","volume":"752","author":"Sugg","journal-title":"Sci Total Environ"},{"issue":"37","key":"R71","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.15585\/mmwr.mm6937a5","article-title":"Association between CMS quality ratings and COVID-19 outbreaks in nursing homes - West Virginia, March 17-June 11, 2020","volume":"69","author":"Bui","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"7","key":"R72","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1016\/j.jamda.2021.05.002","article-title":"COVID-19 cases and death in nursing homes: the role of racial and ethnic composition of facilities and their communities","volume":"22","author":"Cai","journal-title":"J Am Med Dir Assoc"},{"key":"R73","unstructured":"Konetzka RT . Testimony of R. Tamara Konetzka, PhD. in United States Senate Special Committee on Aging. United States Senate Special Committee on Aging; 2020. URL: https:\/\/www.aging.senate.gov\/imo\/media\/doc\/SCA_Konetzka_05_21_20.pdf [Accessed 11-09-2025]"},{"issue":"1","key":"R74","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2015455118","article-title":"Nursing home staff networks and COVID-19","volume":"118","author":"Chen","journal-title":"Proc Natl Acad Sci U S A"},{"key":"R75","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2022.102592","article-title":"Nursing home quality, COVID-19 deaths, and excess mortality","volume":"82","author":"Cronin","journal-title":"J Health Econ"},{"issue":"11","key":"R76","doi-asserted-by":"publisher","first-page":"1993","DOI":"10.1377\/hlthaff.2020.01011","article-title":"Mortality rates from COVID-19 are lower in unionized nursing homes","volume":"39","author":"Dean","journal-title":"Health Aff (Millwood)"},{"issue":"11","key":"R77","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1001\/jama.2020.14709","article-title":"Association of nursing home ratings on health inspections, quality of care, and nurse staffing with COVID-19 cases","volume":"324","author":"Figueroa","journal-title":"JAMA"},{"issue":"10","key":"R78","doi-asserted-by":"publisher","first-page":"2766","DOI":"10.1111\/jgs.17434","article-title":"A systematic review of long-term care facility characteristics associated with COVID-19 outcomes","volume":"69","author":"Konetzka","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"R79","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0267377","article-title":"Relationship between nursing home COVID-19 outbreaks and staff neighborhood characteristics","volume":"17","author":"Shen","journal-title":"PLOS ONE"}],"container-title":["JMIR Human Factors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/humanfactors.jmir.org\/2026\/1\/e72770","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:03:11Z","timestamp":1782842591000},"score":1,"resource":{"primary":{"URL":"https:\/\/humanfactors.jmir.org\/2026\/1\/e72770"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":79,"URL":"https:\/\/doi.org\/10.2196\/72770","relation":{},"ISSN":["2292-9495"],"issn-type":[{"value":"2292-9495","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"article-number":"v13i15-16e72770"}}