Nursing Home Characteristics Associated with Antipsychotic Prescribing After Implementation of the National Antipsychotic Reduction Initiative (ARI)

ABSTRACT

Objectives

To describe nursing home (NH) characteristics associated with antipsychotic use and test whether associations changed after implementation of the National Partnership to Improve Dementia Care’s antipsychotic reduction initiative (ARI).

Methods

Longitudinal quasi-experimental design using data from multiple sources and piecewise linear mixed models were used for statistical analyses.

Results

There was a significant decrease in monthly antipsychotic use across the study period (pre-ARI b = −0.0003, p <.001; post-ARI b = −0.0012, p <.001), which held after adjusting for NH characteristics. Registered nurse hours (b = −0.0026, p <.001), licensed practical nurse hours (b = −0.0019, p <.001), facility chain membership (b = −0.0013, p <.01), and health inspection ratings (b = −0.0003, p >.01) were associated with decreased antipsychotic use. Post-ARI changes in associations between NH characteristics and antipsychotic use were small and not statistically significant.

Conclusions

Decreases in antipsychotic use were associated with most NH characteristics, and associations persisted post-ARI. Further research is warranted to examine the interactions between ARI policy and NH characteristics on antipsychotic prescribing, as well as other NH factors, such as facility prescribing cultures and clinical specialty of staff.

Clinical Implications

Decreases in monthly antipsychotic use were observed following the ARI. The decreases in monthly antipsychotic use were associated with most NH characteristics, and these associations persisted during the post-ARI period.

KEYWORDS:

• Antipsychotics
• long-term care
• nursing homes

Clinical Implications

• Following the ARI there was a significant decrease in monthly antipsychotic utilization among NH residents.

• Decreases in monthly antipsychotic use were associated with most NH characteristics, and these associations showed similar patterns during the post-ARI period and thus did not substantially change following implementation of the ARI.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The CMS claims data and the MDS data used in this study are not available publicly due to data privacy laws and were made available to the investigators as part of a data use agreement with CMS. Any inquiries regarding access to CMS data can be directed to ResDAC via email at: [email protected].

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/07317115.2024.2346906.

Additional information

Funding

This work was supported by the National Institute on Aging [R01AG060939-01].