The Effects of Public Reporting on Physical Restraints and Antipsychotic Use in Nursing Home Residents with Severe Cognitive Impairment

Konetzka, R. Tamara; Brauner, Daniel J.; Shega, Joseph W.; Werner, Rachel M.

doi:10.1111/jgs.12711

Cited by 52 publications

(47 citation statements)

References 33 publications

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“…Studies have also shown that providers, 12 nursing homes in particular, 2951,52 improve in response to publicly published performance measures. Furthermore, improvement is stronger in more competitive markets.…”

Section: Discussionmentioning

confidence: 99%

Does Mandating Nursing Home Participation in Quality Reporting Make a Difference? Evidence From Massachusetts

Mukamel

Glance

et al. 2015

Medical Care

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Background Quality report cards have been shown to be effective in influencing patients' referrals and promoting quality improvement in some instances and not others. In this study we investigate one of the mechanisms that may detract from their effectiveness: voluntary versus mandatory participation of nursing homes in public quality reporting. Objectives To answer two questions: 1) Were the nursing homes choosing not to participate low quality performers relative to those who chose to participate? 2) Once participation became mandatory, did those that did not voluntarily participate initially, improve more than those that participated voluntarily? Research Design Massachusetts published the Massachusetts Satisfaction Survey report card for nursing homes for the years 2005, 2007, and 2009. Nursing homes' participation was voluntary in 2005 and mandatory in 2007 and 2009. We performed a retrospective statistical analysis of the relationship between nursing homes' decision to participate in quality reporting and 12 quality outcomes: deficiency citations, staffing, and 8 survey domains. Subjects 424 Massachusetts nursing homes. Results 67% of nursing homes participated in reporting voluntarily. Volunteer nursing homes had better quality for all measures (significant at the 0.05 level or trending towards significance at the 0.10 level for all but 2). Once reporting became mandatory, non-volunteers improved more than volunteers in all but 2 staffing measures (trending towards significance at the 0.10 level in 5). Conclusions Report cards are more effective if nursing homes' participation is mandated. Non-mandatory reporting systems, as those implemented by some states and professional associations, lead to missed opportunities for quality improvements.

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Section: Discussionmentioning

confidence: 99%

Does Mandating Nursing Home Participation in Quality Reporting Make a Difference? Evidence From Massachusetts

Mukamel

Glance

et al. 2015

Medical Care

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“…The percentage of residents physically restrained is a quality indicator that may be inversely related to an NH's use of antipsychotics and other chemical restraints . Medicare is another federal insurance program specifically for older adults and individuals with disabilities, but Medicare reimburses at a higher rate than Medicaid.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Inappropriate Antipsychotic Use: The Impact of Nursing Home Socioeconomic and Racial Composition

Fashaw

Chisholm

Mor

et al. 2020

J American Geriatrics Society

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OBJECTIVES Previous research suggests black nursing home (NH) residents are more likely to receive inappropriate antipsychotics. Our aim was to examine how NH characteristics, particularly the racial and socioeconomic composition of residents, are associated with the inappropriate use of antipsychotics. DESIGN This study used a longitudinal approach to examine national data from Long‐Term Care: Facts on Care in the US (http://ltcfocus.org) between 2000 and 2015. We used a multivariate linear regression model with year and state fixed effects to estimate the prevalence of inappropriate antipsychotic use at the NH level. SETTING Free‐standing NHs in the United States. PARTICIPANTS The sample consisted of 12 964 NHs. MEASUREMENTS The outcome variable was inappropriate antipsychotic use at the facility level. The primary indicator variables were whether a facility had high proportions of black residents and the percentage of residents with Medicaid as their primary payer. RESULTS NHs with high and low proportions of blacks had similar rates of antipsychotic use in the unadjusted analyses. NHs with high proportions of black residents had significantly lower rates of inappropriate antipsychotic use (β = −2; P < .001) in the adjusted analyses. Facilities with high proportions of Medicaid‐reliant residents had higher proportions of inappropriate use (β = .04; P < .001). CONCLUSION Findings from this study indicate a decline in the use of antipsychotics. Although findings from this study indicated facilities with higher proportions of blacks had lower inappropriate antipsychotic use, facility‐level socioeconomic disparities continued to persist among NHs. Policy interventions that focus on reimbursement need to be considered to promote reductions in antipsychotic use, specifically among Medicaid‐reliant NHs. J Am Geriatr Soc 68:630–636, 2020

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“…Th e HRRP is federal policy targeted specifi cally to the Medicare population, and we believe that the choice of states captures the heterogeneity of benefi ciaries. 31 Th e rate of unplanned readmissions decreased 0.3% from 2009 to 2011, leading us to believe that there has been no major trend change in COPD readmissions more recently. Additionally, the study population aft er exclusion of patients who died during the index hospitalization may not refl ect the entire COPD Medicare population.…”

Section: Similar To Work In Other Conditions By Jencks Et Al 12 Andmentioning

confidence: 99%

Understanding Why Patients With COPD Get Readmitted

Shah

Churpek

Perraillon

et al. 2015

Chest

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184

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The Effects of Public Reporting on Physical Restraints and Antipsychotic Use in Nursing Home Residents with Severe Cognitive Impairment

Abstract: This analysis suggests that public reporting of physical restraint use had the unintended consequence of increasing use of antipsychotics in NH residents with severe cognitive impairment.

Cited by 52 publications

References 33 publications

Does Mandating Nursing Home Participation in Quality Reporting Make a Difference? Evidence From Massachusetts

Does Mandating Nursing Home Participation in Quality Reporting Make a Difference? Evidence From Massachusetts

Inappropriate Antipsychotic Use: The Impact of Nursing Home Socioeconomic and Racial Composition

Understanding Why Patients With COPD Get Readmitted

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