In-hospital Antipsychotic Use among Elderly Patients Discharged to Nursing Homes

PA-11-261（NIH探索/发展研究资助计划）：四分之一到三分之一 在美国，所有老年疗养院的居民都接受抗精神病药物， 数据表明临床获益有限，严重不良反应包括成人死亡。 尽管联邦进行了十多年的干预，但高使用率仍然存在。了解哪里 首先开处方的抗精神病药物对改善这一公共卫生问题至关重要。最近， 我们记录到，在疗养院里，近一半的服用抗精神病药物的居民 疗养院入院前的治疗。超过三分之一的护理人员直接来自 从医院转移和住院的风险，在6个月内的疗养院 居民占25%。因此，相当数量的住院老年人被转移到 由于护理人员不知道的原因，已经开始使用抗精神病药物的疗养院 在家工作人员。我们对文献的回顾显示，没有研究表明 医院环境和抗精神病药物在疗养院的使用。我们将使用大量的当代数据 来源（Cerner HealthFacts）关于老年人的住院护理和药物处方 从地理上分散在各地的约230家医院出院到疗养院的患者 美国（2011-2012年，n=约1，200，000例老年患者出院至疗养院）。具体 目的：1）估计老年人使用抗精神病药的患病率和发生率 患者在综合医院设置，并评估在何种程度上，患者水平的因素 与在疗养院环境中确定的抗精神病药物使用相关的是 2）检查抗精神病药物使用在医院环境中的医院水平变化 3）建立并检验一个多水平模型，解释住院期间 抗精神病药物的使用是患者水平、组织水平和社区水平因素的函数。 我们假设NH居民在入院接受急性护理时没有服用抗精神病药物 住院患者经常出院回到NH服用抗精神病药物， 在医院开始的急性和可逆的适应症，如谵妄，往往不是 当适应症可能已消退时，在出院时停药，并且 抗精神病药物处方模式的医院水平差异将存在， 使用（患者，组织和社区），如在疗养院的情况下观察到的，将是 在医院观察。尽管约220万老年住院患者出院， 每年从医院到NHS，没有研究（据我们所知）检查过 抗精神病药物在医院老年患者中的应用。这项研究将提供一个新的领域， 探索未来的干预措施，以最终减少老年人抗精神病药物的使用。

PA-11-261 (NIH Exploratory/Developmental Research Grant Program): One-quarter to one-third of all elderly nursing home residents in the US receive antipsychotic drugs despite extensive data demonstrating marginal clinical benefits and serious adverse effects including death adults. High use persists despite over a decade of federal intervention. Understanding where antipsychotics are first prescribed is critical for ameliorating this public health problem. Recently, we documented that nearly half of residents on antipsychotics in the nursing home initiate therapy before the nursing home admission. Over 1/3 of all nursing admissions come directly from hospital transfers and the risk of being hospitalized in a 6 month period for nursing home residents is ~25%. As a result, a nontrivial number of hospitalized older adults are transferred to nursing homes already initiated on antipsychotics for reasons that are unknown to the nursing home staff. Our review of the literature revealed no studies on the relationship between the hospital setting and antipsychotic use in nursing homes. We will use a large contemporary data source (Cerner HealthFacts) on the inpatient care and medications prescribing of elderly patients discharged to nursing home from~230 hospitals geographically dispersed throughout the US (n=~1,200,000 elderly patients discharged to nursing homes in 2011-2012). The specific aims are: 1) To estimate the prevalence and incidence of antipsychotic use among elderly patients in a general hospital setting and evaluate the extent to which patient level factors associated with antipsychotic use identified in the nursing home setting are correlates of use in the hospital; 2) To examine hospital level variation in antipsychotic use in-hospital settings among older adults; 3) To develop and test a multilevel model explaining variation in in-hospital antipsychotic use as a function of patient level, organizational level and community level factors. We hypothesize that NH residents not on antipsychotics when admitted for an acute care hospitalization are frequently discharged back to the NH on antipsychotics, that Antipsychotics initiated in the hospital for acute and reversible indications such as delirium are often not discontinued upon discharge from the hospital when the indication may have resolved, and that hospital level variation in antipsychotic prescribing patterns will exist and similar correlates of use (patient, organizational, and community) as observed in the nursing home context will be observed in hospitals. Despite the ~2.2 million elderly hospital patients discharged from hospital to NHs each year, no studies (to our knowledge) have examined the initiation of antipsychotics among elderly patients in hospitals. This study will provide a novel area of exploration for future interventions to ultimately reduce antipsychotic use in older adults.