POOR QUALITY IN PSYCHOACTIVE DRUG USE

描述(由申请人提供)：有证据表明，精神药物在许多疗养院中被不当使用(Beers等人，1988；Ray FederSpeil，&Schaffner，1980)，使用率往往过高，且在临床上不合理(Burns&Kamerow，1988；Gurwitz，Soumerai，&Avorn，1990)。适当使用这些药物是衡量疗养院质量的关键指标(Castle，1997)，因此也是审查这些设施质量的调查员检查的护理领域之一。在拟议的研究中，我们将使用这些调查员和其他来源的数据来检查质量持续较差的养老院，因为它与精神药物的使用有关。 州和联邦调查员每9到15个月对养老院进行一次检查。当设施不符合标准(或规范)时，测量员会发出缺陷传票。12种不同的引文被用于药物使用。我们将使用描述这些引用的数据以及报告的精神药物水平作为质量较差的衡量标准。根据美国总会计师办公室(GAO)最近的一份报告，我们对持续劣质产品的定义是对连续两次检查的引用。在我们的初步分析中，我们将使用1999年和2000年进行的检查，然后我们将在连续三次检查(1999、2000和2001)中检查有缺陷的设施，因为我们相信这一额外的分析将使我们更彻底地了解持续质量较差的养老院。我们还将研究疗养院在1999至2001年间使用精神药物的增加和减少，以确定随着时间的推移，调查过程和以前的引用对这一质量衡量标准的影响。

DESCRIPTION (provided by applicant): Evidence suggests that psychotropic medications have been used inappropriately in many nursing homes (Beers et al., 1988; Ray Federspeil, & Schaffner, 1980), with often excessive and clinically unjustified rates of use (Burns & Kamerow, 1988; Gurwitz, Soumerai, & Avorn, 1990). Appropriate use of these drugs is a key measure of nursing home quality, (Castle, 1997), and as such is among the areas of care examined by surveyors who review the quality of these facilities. In the proposed study we will use data from these surveyors and other sources to examine nursing homes with persistent poor quality as it relates to the use of psychotropic medications. State and federal surveyors conduct inspections of nursing homes every 9 to 15 months. When a facility does not meet a standard (or code), the surveyors issue a deficiency citation. Twelve different citations are used for medication use. We will use data describing these citations along with reported levels of psychotropic medications, as our measures of poor quality. Based on a recent General Accounting Office (GAO) report, our definition of persistence in poor quality is a citation on two consecutive inspections. In our initial analysis will use inspections conducted in 1999 and 2000, and we will then examine facilities with deficiencies in three consecutive inspections (1999, 2000, and 2001) because we believe this additional analysis will give us a more thorough understanding of nursing homes with persistent poor quality. We will also examine increases and decreases in nursing homes' use of psychotropic medications between 1999 and 2001 in order to determine the impact over time of the survey process and previous citations on this measure of quality.