Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
J Am Geriatr Soc. 2021 Aug;69(8):2152-2162. doi: 10.1111/jgs.17172. Epub 2021 Apr 9.
The Centers for Medicare & Medicaid Services' (CMS) National Partnership to Improve Dementia Care in Nursing Homes ("CMS National Partnership") focuses on reducing antipsychotic prescribing to long-term care residents. Hospice enrollment is not an exclusionary condition for the antipsychotic quality measure reported by CMS. It is unclear how prescribing in hospice may have been impacted by the initiative.
Estimate the association of the CMS National Partnership with trends in antipsychotic prescribing among long-term care residents in hospice.
Interrupted time-series analysis of a 100% Minimum Data Set sample with linked hospice claims from 2011 to 2017.
Long-term care nursing facilities.
Older adults ≥65 residing in long-term care (n = 3,741,379) and limited to those enrolled in hospice (n = 821,610).
Quarterly prevalence of antipsychotic and other psychotropic (antianxiety, hypnotic, antidepressant) use among long-term care residents; overall and among residents with dementia, stratified by hospice enrollment.
From 2011 to 2017, parallel declines in antipsychotic prescribing were observed among long-term care residents enrolled and not enrolled in hospice (hospice: decline from 26.8% to 18.7%; non-hospice: decline from 23.0% to 14.4%). Following the 2012 CMS National Partnership, quarterly rates of antipsychotic prescribing declined significantly for both residents enrolled and not enrolled in hospice care. Declines in antipsychotic prescribing were greater for residents with dementia, with similar rates among residents enrolled and not enrolled in hospice. Among residents with dementia enrolled in hospice, use of other psychotropic medication classes including antianxiety, antidepressant, and hypnotic use remained relatively stable over time.
Declines in antipsychotic prescribing during the CMS National Partnership occurred among long-term care residents in hospice, where use may be deemed clinically appropriate. Nursing homes are an important location for the provision of dementia end-of-life care and the drivers of potentially unintended reductions in antipsychotic use merits further investigation.
医疗保险和医疗补助服务中心（CMS）的国家改善疗养院痴呆症护理伙伴关系（“CMS 国家伙伴关系”）专注于减少长期护理居民的抗精神病药物处方。临终关怀的入组并不是 CMS 报告的抗精神病药物质量指标的排除条件。目前尚不清楚该倡议如何影响临终关怀中的处方。
估计 CMS 国家伙伴关系与长期护理居民临终关怀中抗精神病药物处方趋势的关联。
对 2011 年至 2017 年 100%最小数据集样本与链接的临终关怀索赔进行中断时间序列分析。
长期护理护理设施。
年龄在 65 岁及以上的老年人，居住在长期护理中（n=3741379），仅限于参加临终关怀的老年人（n=821610）。
长期护理居民中抗精神病药和其他精神药物（抗焦虑药、催眠药、抗抑郁药）的季度流行率；总体以及根据临终关怀的入组情况，分为痴呆症患者和非痴呆症患者。
从 2011 年到 2017 年，在参加和未参加临终关怀的长期护理居民中，抗精神病药物的使用都呈平行下降趋势（临终关怀：从 26.8%下降到 18.7%；非临终关怀：从 23.0%下降到 14.4%）。在 2012 年 CMS 国家伙伴关系之后，参加和未参加临终关怀护理的居民的抗精神病药物处方的季度率都显著下降。对于痴呆症患者，抗精神病药物的使用下降幅度更大，参加和未参加临终关怀的患者之间的比例相似。在参加临终关怀的痴呆症患者中，其他精神药物类别的使用（包括抗焦虑药、抗抑郁药和催眠药）随着时间的推移相对稳定。
在 CMS 国家伙伴关系期间，参加临终关怀的长期护理居民的抗精神病药物处方减少，在这种情况下，使用抗精神病药物可能被认为是临床适当的。疗养院是提供痴呆症临终关怀的重要场所，潜在减少抗精神病药物使用的驱动因素值得进一步调查。
