Optimizing Antipsychotic Use across Nursing Homes: Implications for Dementia Care
type: CreativeWork
description: Objectives: The study objectives were to (1) examine individual and contextual factors associated with initiation of antipsychotics among short-stay nursing home residents with dementia; (2) evaluate the relationship of nursing home level initiation of antipsychotics with all-cause hospitalization and mortality; and (3) examine individual and contextual factors associated with discontinuation of antipsychotics among short-stay nursing home residents with dementia. Methods: This study involved retrospective cohort study design using Medicare claims, Minimum Data Set (MDS), and the Certification and Survey Provider Enhanced Reporting (CASPER) data from 2007-2009. The participants included individuals aged 65 years or older with Medicare continuous eligibility six months prior to the nursing home admission. The study sample consisted of short-stay (a nursing home stay of ≤ 100 days) elderly nursing home residents with dementia. The study excluded patients with any antipsychotic use in six months prior to the nursing home admission (objectives 1 and 2) or patients with no antipsychotic use in six months prior to the nursing home admission (objective 3) based on Part D. The outcome measures of interest were measured after nursing home admission and included patient-level antipsychotic initiation (objective 1) and discontinuation (objective 3) and 30-days all-cause hospitalization and mortality (objective 2). The primary independent variable for objective was contextual level predisposing factor, nursing home level antipsychotic initiation rate (objectives 1 and 2) and nursing home level antipsychotic discontinuation (objective 3). The nursing home level antipsychotic imitation rate was categorized into 0% (no use) and tertiles (low, medium, or high) based on antipsychotic use rate groups. The nursing home level antipsychotic discontinuation rate was categorized into less than equal to or greater than the median value. Multilevel Andersen Behavioral model was used to sele…
abstract: Objectives: The study objectives were to (1) examine individual and contextual factors associated with initiation of antipsychotics among short-stay nursing home residents with dementia; (2) evaluate the relationship of nursing home level initiation of antipsychotics with all-cause hospitalization and mortality; and (3) examine individual and contextual factors associated with discontinuation of antipsychotics among short-stay nursing home residents with dementia. Methods: This study involved retrospective cohort study design using Medicare claims, Minimum Data Set (MDS), and the Certification and Survey Provider Enhanced Reporting (CASPER) data from 2007-2009. The participants included individuals aged 65 years or older with Medicare continuous eligibility six months prior to the nursing home admission. The study sample consisted of short-stay (a nursing home stay of ≤ 100 days) elderly nursing home residents with dementia. The study excluded patients with any antipsychotic use in six months prior to the nursing home admission (objectives 1 and 2) or patients with no antipsychotic use in six months prior to the nursing home admission (objective 3) based on Part D. The outcome measures of interest were measured after nursing home admission and included patient-level antipsychotic initiation (objective 1) and discontinuation (objective 3) and 30-days all-cause hospitalization and mortality (objective 2). The primary independent variable for objective was contextual level predisposing factor, nursing home level antipsychotic initiation rate (objectives 1 and 2) and nursing home level antipsychotic discontinuation (objective 3). The nursing home level antipsychotic imitation rate was categorized into 0% (no use) and tertiles (low, medium, or high) based on antipsychotic use rate groups. The nursing home level antipsychotic discontinuation rate was categorized into less than equal to or greater than the median value. Multilevel Andersen Behavioral model was used to sele…
author: Sura, Sneha
language: eng
keywords: Dementia, Nursing Homes, Antipsychotics, Multilevel Andersen Behavioral Model
date published: 2017-12
date modified: 2026-07-24T02:31:42Z
provider: University of Houston
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Houston

PropertyValue
property ID: Handle
value: http://hdl.handle.net/10657/2960