Background and Significance: The COVID-19 pandemic, which started in China, spread rapidly worldwide. As of June 2022, there are 532,887,351confirmed cases of COVID-19 in the world (WHO, 2022). In the United States, there are 85,402,874 COVID-19 infections (CDC, 2022). More specifically, there are 101,440 cases of infections in congregate settings, such as long-term care facilities and homeless shelters in Illinois (IDPH, 2022). Due to challenges in social distancing measures in these settings, testing is essential to mitigate and control the spread of COVID-19 (CDC, 2020). In April 2020, an academic institution in the Midwest, through its Department of Community Health Equity and College of Nursing Faculty Practice, partnered with a city's Department of Public Health to start the program, "COVID-19 Testing Services in Congregate Settings." However, since its inception, the program has not been evaluated for its outcomes, value, and effectiveness.
Purpose: The purpose of this project was to conduct a comprehensive evaluation of the "COVID-19 Testing Services in Congregate Settings" program. Specifically, the program's structural components, fidelity, operational cost, sustainability, effectiveness, utilization, and nurse satisfaction, were analyzed.
Objectives: The outcome objectives of this project were to: 1) identify the structural components of the COVID-19 testing program, 2) evaluate the processes by which the different structural components of the program worked together to deliver the desired outcomes, 3) analyze the value and effectiveness of the program, and 4) provide a comprehensive list of recommendations based on evaluation findings.
Methods: The COVID-19 testing program was evaluated using the Donabedian and the Glasgow frameworks. The program's structure and processes were assessed by reviewing the program contract and operational protocol, conducting stakeholder interviews, and direct observation of clinical testing sites. Program outcomes were evaluated by analyzing financial reports, participant electronic records, and staff surveys.
Results: From June 2020 through July 2021, a core team of six registered nurses operated the program, with community health workers and volunteers providing additional support. Program fidelity was 87.97%. 17,831 tests were conducted among 13,287 individuals in 65 LTC facilities, yielding 152 positive results (0.85 positivity rate). 6,477 tests were conducted among 3,405 individuals in 47 homeless shelters and six encampments, yielding 343 positive results (5.3 positivity rate). Staff satisfaction was high (4.5 on a 1-5 satisfaction scale). Generated income sustained the program's operational costs.
Implications and Recommendations: The nurse-led COVID-19 Testing Services in Congregate Setting program was effective, sustainable, and adaptable to address the community's needs during the pandemic; and can serve as a model for similar events in the future. Recommendations include: 1) Maintaining a centralized location for participant record-keeping for more accessible data collection and analysis, 2) Actively engaging community partners to improve processes and meet their needs, 3) Providing staff training on emergency preparedness, stress management, and other topics that staff identifies as priorities.