Winter Jonathan D, Petterson Stephen, Qato Danya M, Kerns J William, Sabo Roy T, Winter Katherine M, Brandt Nicole, Wastila Linda, Chung YoonKyung, Funk Adam, Ewasiuk Craig, Etz Rebecca, Krist Alex H
Department of Family Medicine & Population Health, Virginia Commonwealth University School of Medicine, Richmond, USA.
Shenandoah Valley Family Practice Residency, Front Royal, VA, USA.
Gerontol Geriatr Med. 2024 Jun 18;10:23337214241262914. doi: 10.1177/23337214241262914. eCollection 2024 Jan-Dec.
The Centers for Medicare & Medicaid Services (CMS) grades nursing home performance in antipsychotic prescribing quarterly, publishing findings as a quality measure. While scores have improved since 2011, marked performance variation between facilities persists. To assess quality gap changes between best- and worst-performing deciles, we compared quarterly prescribing changes between these groups pre-pandemic (April 2011 to March 2020) and during the pandemic (April 2020 to March 2022). Antipsychotic quality measure scores, improving pre-pandemic, deteriorated during the pandemic. The pre-pandemic quality gap between the best- and worst-performing deciles narrowed as the worst-performing decile improved faster than the best-performing decile. During the pandemic, the quality gap widened as the worst-performing decile relapsed more than the best-performing decile ( < .0001). The pandemic disrupted quality performance gains and compounded disparities between facilities. A better understanding of the factors allowing high performers to weather pandemic stressors better than poor performers may reveal opportunities to improve nursing home quality and equity for all residents.
医疗保险和医疗补助服务中心（CMS）每季度对疗养院使用抗精神病药物的情况进行评分，并将结果作为一项质量指标公布。自2011年以来，评分虽有所提高，但各机构之间显著的绩效差异依然存在。为了评估表现最佳和最差的十分位数组之间的质量差距变化，我们比较了疫情前（2011年4月至2020年3月）和疫情期间（2020年4月至2022年3月）这两组的季度处方变化情况。抗精神病药物质量指标评分在疫情前有所改善，但在疫情期间恶化。疫情前，表现最佳和最差的十分位数组之间的质量差距缩小，因为表现最差的十分位数组比表现最佳的十分位数组改善得更快。在疫情期间，质量差距扩大，因为表现最差的十分位数组比表现最佳的十分位数组复发得更多（<0.0001）。疫情扰乱了质量绩效的提升，并加剧了各机构之间的差距。更好地了解使表现出色的机构比表现不佳的机构更能经受住疫情压力的因素，可能会揭示改善疗养院质量和所有居民公平性的机会。
