未报告的抗精神病药物在养老院中的使用不断增加：质量措施排除对接受抗精神病药物质量措施的长期居住居民比例的影响。
Unreported Antipsychotic Use Increasing in Nursing Homes: The Impact of Quality-Measure Exclusions on the Percentage of Long-Stay Residents Who Got an Antipsychotic Medication Quality-Measure.
机构信息
VCU-Shenandoah Family Practice Residency (JDW, JWK, KMW), Front Royal, VA; Department Biostatistics, Department of Family Medicine and Population Health (JDW, JWK, AR, RTS), Virginia Commonwealth University, Richmond, VA.
VCU-Shenandoah Family Practice Residency (JDW, JWK, KMW), Front Royal, VA; Department Biostatistics, Department of Family Medicine and Population Health (JDW, JWK, AR, RTS), Virginia Commonwealth University, Richmond, VA.
出版信息
Am J Geriatr Psychiatry. 2021 Jul;29(7):704-708. doi: 10.1016/j.jagp.2020.11.008. Epub 2020 Dec 1.
OBJECTIVE
Excluded from reporting to CMS's Percentage of long-stay residents who got an antipsychotic medication quality-measure are antipsychotics prescribed to nursing home patients with schizophrenia, Tourette's, or Huntington's. Over the 4 years following its 2012 debut, the quality-measure calculated a 27% reduction in inappropriate antipsychotic use but also an 18.3% increase in exclusion claims. This study evaluated the impact of these exclusions on the measure's findings.
METHODS
Claims data for the years 2011-2016 retrospectively identified the prevalence of schizophrenia, Tourette's, and Huntington's in quarterly cohorts of Virginia long-stay residents prescribed antipsychotics. Annualized diagnoses in 2011 were compared with subsequent years using simple logistic regression.
RESULTS
In 2016, 29% of the antipsychotics prescribed in Virginia nursing homes were to residents with diagnoses of schizophrenia, Tourette's, and Huntington's, a significant 32% increase from 2011.
CONCLUSION
Almost 30% of the antipsychotics employed in Virginia nursing homes are excluded from CMS's long-stay antipsychotic quality-measure.
目的
被排除在向 CMS（医疗保险和医疗补助服务中心）报告的“长期居住居民接受抗精神病药物治疗的比例”质量指标之外的是，为患有精神分裂症、妥瑞氏症或亨廷顿氏病的疗养院患者开具的抗精神病药物。自 2012 年首次推出该质量指标的四年以来，该质量指标计算出不适当使用抗精神病药物的比例降低了 27%，但排除的索赔也增加了 18.3%。本研究评估了这些排除对该措施结果的影响。
方法
使用回顾性索赔数据，确定了 2011 年至 2016 年弗吉尼亚州长期居住居民接受抗精神病药物治疗的季度队列中精神分裂症、妥瑞氏症和亨廷顿氏病的患病率。使用简单逻辑回归比较 2011 年和随后各年的年度诊断结果。
结果
2016 年，弗吉尼亚州疗养院开具的抗精神病药物中，有 29%是为患有精神分裂症、妥瑞氏症和亨廷顿氏病的居民开具的，与 2011 年相比，这一比例显著增加了 32%。
结论
弗吉尼亚州疗养院使用的近 30%的抗精神病药物被 CMS（医疗保险和医疗补助服务中心）的长期抗精神病药物质量指标所排除。
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