Abstract

Objectives

This study examines the association between antipsychotic (AP) medication use and care transitions in the nursing home (NH) population.

Methods

This cross-sectional study used data from a 5% random sample of Medicare beneficiaries between 2011 and 2015. Propensity score adjusted negative binomial regression was performed and conditional probabilities of having a first transition from the NH to specific locations were calculated.

Results

Among 150,284 eligible beneficiaries, the majority were female (67%), white (84%), and >75 years old (63%). Controlling for resident characteristics, the odds of having any transition was 5% lower among those with AP use [IRR (95% confidence interval (CI))=0.95(0.94–0.96)] relative to those with no AP use. Residents with AP use had higher proportions of transitions to hospital (22.7% vs. 19.5%, p < 0.01), emergency department (19.6% vs. 10.7%, p < 0.01), and different NH (1.5% vs. 0.4%, p < 0.01), and lower proportions of transition to non-healthcare locations compared to those without AP use.

Conclusions

Findings demonstrate that residents with AP use had higher probabilities of transitions to more costly care settings such as the emergency department and hospital compared to those without AP use. Future longitudinal studies will help to inform clinical interventions aimed at improving the quality of care for this population.

中文翻译：

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检查使用和不使用抗精神病药物的疗养院居民的护理转变

 抽象的

 目标

本研究探讨了疗养院 (NH) 人群中抗精神病药物 (AP) 药物使用与护理转变之间的关联。

 方法

这项横断面研究使用了 2011 年至 2015 年间 Medicare 受益人 5% 随机样本的数据。进行了倾向评分调整负二项式回归，并计算了首次从 NH 转移到特定地点的条件概率。

 结果

在 150,284 名符合资格的受益人中，大多数是女性 (67%)、白人 (84%) 和 >75 岁 (63%)。控制居民特征后，使用 AP 的人发生任何转变的几率比不使用 AP 的人低 5% [IRR（95% 置信区间 (CI)）=0.95(0.94–0.96)]。使用 AP 的居民转入医院（22.7% vs. 19.5%， p < 0.01）、急诊科（19.6% vs. 10.7%， p < 0.01）和不同 NH（1.5% vs. 0.4）的比例较高%, p < 0.01)，与不使用 AP 的人相比，转移到非医疗保健地点的比例较低。

 结论

研究结果表明，与不使用 AP 的居民相比，使用 AP 的居民更有可能转向更昂贵的护理机构，例如急诊室和医院。未来的纵向研究将有助于为旨在提高该人群护理质量的临床干预措施提供信息。