Consequences of Reduced Antipsychotic Prescribing in Nursing Homes

描述（由申请人提供）：在140万美国养老院居民中，有五分之一的人接受抗精神病药物治疗痴呆症，尽管大量证据表明其边际效益和包括死亡在内的严重不良反应。医疗保险和医疗补助服务中心最近发起了一项全国性的运动，以减少老年人不必要的抗精神病药物处方，但人们担心这项倡议弊大于利。本研究的目的是描述当前抗精神病药物在养老院使用的情况，并估计抗精神病药物减少运动如何影响处方。这项研究的一个独特方面是检查治疗替代药物的程度，这些药物在治疗痴呆症方面无效。我们还将检查重要健康结果的变化，如行为症状和住院治疗。为了完成这些目标，本研究项目将分析与医疗保险计划数据（包括D部分药物索赔）相关的养老院居民护理计划的现有数据集。这个项目应该处于一个独特的位置，告知医疗保险计划和政策制定者关于养老院居民与抗精神病药物相关的经验，以及如何改善养老院的痴呆症护理。

DESCRIPTION (provided by applicant): One in 5 of the 1.4 million US nursing home residents receive antipsychotic drugs to manage dementia despite extensive evidence of marginal benefits and serious adverse effects including death. The Centers for Medicare and Medicaid Services recently launched a national campaign to reduce unnecessary prescribing of antipsychotics in the elderly but concerns have been raised that the initiative did more harm than good. The objectives of this study are to describe the current landscape of antipsychotic use in the nursing home setting and estimate how the antipsychotic reduction campaign influenced prescribing. A unique aspect of this study is to examine the extent of therapeutic substitution with medications that are not effective at managing dementia. We will also examine changes in important health outcomes such as behavioral symptoms and hospitalization. To complete these objectives, this research project will analyze an existing dataset of nursing home resident care plans linked to Medicare program data including Part D drug claims. This project should be in a unique position to inform the Medicare program and policymakers about the experience of nursing home residents related to antipsychotics and how to improve dementia care in nursing homes.