Antipsychotic reduction in nursing home residents with Alzheimer's disease: Impact on state, facility, and resident psychopharmacological medication use and outcomes

患有阿尔茨海默病的疗养院居民抗精神病药物减少：对州、设施和居民精神药理学药物使用和结果的影响

• 批准号: 10318254
• 负责人: LINDA J SIMONI-WASTILA
• 金额: $ 9.72万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-01 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10318254
• 关键词: Affect; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Anti-Anxiety Agents; Anticonvulsants; Antidepressive Agents; Antipsychotic Agents; Behavioral Symptoms; Caring; Certification; Characteristics; Clinical; Data; Data Set; Dementia; Discipline of Nursing; Elderly; Emergency department visit; Evaluation; Foundations; Fracture; Future; Geography; Geriatric Nursing; Geriatric Psychiatry; Goals; Health; Health Policy; Heterogeneity; Hospital Departments; Individual; Interdisciplinary Study; Link; Long-Term Care Nursing; Mediating; Medicare; Medicare claim; Methodology; National Institute of Mental Health; Neurologic; Nursing Homes; Nursing Staff; Opioid; Outcome; Outcome Measure; Pain; Patients; Pattern; Pharmaceutical Preparations; Physical Function; Physical Restraint; Policies; Policy Maker; Population; Prevalence; Provider; Public Health; Quality of life; Race; Reporting; Research; Research Design; Risk; Sampling; Series; Surveys; Testing; Time trend; United States Centers for Medicare and Medicaid Services; beneficiary; chronic pain; comorbidity; dementia care; experience; falls; functional status; health care service utilization; hypnotic; improved; mortality; patient oriented; person centered; primary outcome; programs; psychopharmacologic; racial minority; sedative; severe mental illness; sex; sociodemographics

In 2012, the National Partnership to Improve Dementia Care launched an initiative to reduce antipsychotic use among nursing home residents with Alzheimer’s Disease and Related Dementias (ADRD). Within 5 years, antipsychotic use decreased by 34.1% in all nursing home residents to a national prevalence of 15.7%. There remain important unanswered questions surrounding outcomes of the antipsychotic reduction program (ARP), including: which residents experienced reduced antipsychotic use; were residents who experienced antipsychotic reductions switched to other psychopharmacological medications (PPM); and did medication changes influence their health outcomes? The primary goal of this project is to conduct a series of analyses using national administrative claims data linked to resident and nursing home survey data to assess the impact of the ARP on state-, nursing home-, and individual- level antipsychotic and PPM (sedative-hypnotics, opioids, antidepressants, anxiolytics, and anticonvulsants) utilization and health outcomes in the nursing home population with ADRD. Our central hypothesis is that antipsychotic reductions resulted in unintended consequences that exposed vulnerable nursing home residents to potentially harmful PPMs, leading to downstream adverse health consequences. The proposed study utilizes a nationally-representative, 100% sample of Medicare beneficiaries residing in long-stay nursing facilities from 2010–2016 that links prescription and healthcare utilization claims data to nursing home- and nursing resident- level survey data. We will accomplish the following specific aims: 1) To predict the impact of the ARP on antipsychotic and PPM use patterns in nursing home residents, by state- and population- level characteristics; 2) To identify the impact of the ARP on antipsychotic and PPM use patterns in nursing home residents, by facility-level characteristics; and 3) To test the prediction that ARP implementation affected critical individual-level public health outcomes (e.g., mortality, transitions in care settings, and falls/fractures) and patient-centered health outcomes (e.g., physical restraint use, behavioral symptom emergence, functional status, pain) in nursing home residents with ADRD. Using advanced methodological approaches, our multidisciplinary research team will assess state-, facility-, and individual- level characteristics that may have mediated the impact of a sweeping policy that affected over 1.4 million nursing home residents. Our findings have the potential to guide health policy and program refinement, and will add to our understanding of psychopharmacological medication use and their contribution to health consequences in older adults with ADRD. Results will inform future studies that allow granular examination of medication policies on other vulnerable nursing home subpopulations, such as racial minorities and those with serious mental illness, chronic pain, and/or neurologic conditions. Findings will provide a foundation to achieve our ultimate goal: to provide guidance to providers and policy-makers on how to optimize prescribing decisions and policies that support nursing-home patients’ health and quality of life.

2012年，改善痴呆症护理的国家伙伴关系发起了一项减少抗精神病药物使用的倡议。 老年痴呆症和相关痴呆症（ADRD）的疗养院居民。五年内， 抗精神病药物的使用在所有疗养院居民中下降了34.1%，全国患病率为15.7%。那里 仍然是围绕抗精神病药物减量计划（阿普）结果的重要未回答的问题， 包括：哪些居民减少了抗精神病药物的使用; 抗精神病药物减量转换为其他精神药理学药物（PPM）; 变化会影响他们的健康结果吗？该项目的主要目标是进行一系列分析 使用与居民和疗养院调查数据相关联的国家行政索赔数据来评估影响 在国家，疗养院和个人层面的抗精神病药和PPM（镇静催眠药，阿片类药物， 抗抑郁药、抗焦虑药和抗惊厥药）的使用和疗养院的健康结果 ADRD人群。我们的中心假设是，抗精神病药物的减少导致了非预期的 结果，暴露脆弱的养老院居民潜在有害的PPM，导致 对下游的健康造成不利影响。这项研究利用了具有全国代表性的，100% 2010-2016年居住在长期护理机构的医疗保险受益人样本， 和医疗保健利用索赔数据，以疗养院和护理住院医师水平的调查数据。我们将 完成以下具体目标：1）预测阿普对抗精神病药和PPM使用的影响 模式在养老院居民，由国家和人口水平的特点; 2），以确定的影响， 按设施水平特征列出的养老院居民抗精神病药物的阿普和PPM使用模式; 3)为了检验阿普实施影响关键个人水平公共卫生结果的预测（例如， 死亡率、护理环境的转变和福尔斯/骨折）和以患者为中心的健康结果（例如，物理 约束的使用，行为症状的出现，功能状态，疼痛）与ADRD的疗养院居民。 使用先进的方法，我们的多学科研究团队将评估国家，设施， 以及个人层面的特征，这些特征可能介导了一项全面政策的影响， 1.4百万养老院居民我们的发现有可能指导卫生政策和计划 完善，并将增加我们对精神药理学药物的使用及其贡献的理解 老年ADRD患者的健康后果。结果将为未来的研究提供信息， 检查对其他弱势养老院亚群（如少数民族）的药物政策 以及患有严重精神疾病、慢性疼痛和/或神经系统疾病的患者。调查结果将提供一个 为实现我们的最终目标奠定基础：为供应商和政策制定者提供指导， 制定支持疗养院患者健康和生活质量的决策和政策。