Treatment patterns and clinical outcomes among Medicare beneficiaries using antipsychotic medications for FDA-approved indications before and after transitioning from the community to a nursing home

Abstract

Objectives

This study examines the relationships between changes in antipsychotic medication (AP) use and acute clinical events (identified with administrative claims data) for patients with FDA-approved indications for APs following transition from the community (e.g. home) to a nursing home (NH) in a Medicare population.

Methods

A retrospective analysis was conducted using 100% Medicare fee-for-service (FFS) research identifiable files (RIF) claims data (2016–2018). Medicare beneficiaries with a condition for which APs are approved by the FDA were examined using logistic regression models to determine whether changes in AP use following transition from community to NHs were correlated with the likelihood of experiencing acute clinical events.

Results

We identified 38,448 Medicare FFS beneficiaries meeting our study criteria. A change in AP use after transition to a NH did not have a statistically significant association with acute skeletal events, coronary artery events, or cerebrovascular events (p = .55, p = .69, and p = .59, respectively).

Conclusions

Between 2016 and 2018, Medicare FFS patients with approved-use indications for APs had lower average AP use following transition to a NH. Changes in the use of other medications of interest largely followed a similar pattern, indicating that these medications did not tend to be used as substitutions for APs. No clear relationship exists between increases or decreases in AP use and adverse events among NH residents who used APs and had FDA-approved conditions in the community setting.

Keywords:

• transition to nursing home
• antipsychotic medications
• CMS star metric

Transparency

Declaration of financial/other relationships

Heidi Waters is employed by Otsuka Pharmaceutical, Kyle Pérez, Michele Berrios, and Bruce Pyenson are employed by Milliman, Inc., and received consulting fees from Otsuka Pharmaceutical. The authors also note that findings of this study reflect the research conducted by Milliman and that, by reporting these findings, Milliman does not intend to endorse any product or organization. The authors report no other conflicts of interest in this work.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The authors would like to thank their Milliman colleague Jared Hirsch for his assistance in the data analysis, and Susan Worley for editorial assistance.

Data availability statement

Data available on request from authors. Summary data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethics statement

Use of the data for this study was obtained through an application approved by the Western Institutional Review Board (IRB Report ID 1887351), which is an independent review board. The patient data accessed from the Medicare 100% Research Identifiable Files complied with a Data Use Agreement (DUA) with CMS and the DUA was reviewed by CMS’s Privacy Board to ensure that the beneficiary’s privacy was protected and only the minimum data necessary was requested and justified. All data and summaries used for this report were reviewed by the CMS Chronic Condition Warehouse Analytical Review Team for compliance with CMS requirements to protect the privacy of Medicare beneficiaries’ data.

Additional information

Funding

This study was funded by Otsuka Pharmaceutical Co., Ltd.