Antipsychotic medication use in nursing homes: a proposed measure of quality.

Objective: The potential misuse of antipsychotic medications (APMs) is an ongoing quality concern in nursing homes (NHs), especially given recent black box warnings and other evidence regarding the risk of APMs when used in NH populations. One mechanism regulators could use is public reporting of APM use by NHs; however, there is currently no agreed-upon measure of guideline-inconsistent APM use. In this paper, we describe a proposed measure of quality of APM use that is based on Centers for Medicare and Medicaid Services (CMS) Interpretive Guidelines, Food and Drug Administration (FDA) indications for APMs, and severity of behavioral symptoms.

Race, education, and the treatment of depression in nursing homes.

Objectives: We investigate, among older adult nursing home residents diagnosed with depression, whether depression treatment differs by race and schooling, and whether differences by schooling differ by race. We examine whether Blacks and less educated residents are placed in facilities providing less treatment, and whether differences reflect disparities in care.

Method: Data from the 2006 Nursing Home Minimum Data Set for 8 states (n = 124,431), are merged with facility information from the Online Survey Certification and Reporting system.

Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005.

Objective: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer-generation antidepressants.

No longer undertreated? Depression diagnosis and antidepressant therapy in elderly long-stay nursing home residents, 1999 to 2007.

Objectives: To examine the evolution of depression identification and use of antidepressants in elderly long-stay nursing home residents from 1999 through 2007 and the associated sociodemographic and facility characteristics.

Design: Annual cross-sectional analysis of merged resident assessment data from the Minimum Data Set (MDS) and facility characteristics from the Online Survey Certification and Reporting data.

Setting: Nursing homes in eight states (5,445 facilities).

Hospitalization for psychiatric illness among community-dwelling elderly persons in 1992 and 2002.

Objective: The authors evaluated the evolution of inpatient care for psychiatric illness in 1992 and 2002 for senior community-dwelling Medicare beneficiaries.

Methods: National Medicare Provider Analysis and Review files for 1992 and 2002 were analyzed.

Results: From 1992 to 2002, rates of inpatient hospital use for treatment of psychiatric illness declined 28%, from 429 to 311 stays per 100,000 eligible beneficiaries, mostly because of reduced hospitalization for depression, and next, for substance use disorder.

Psychiatric rehospitalization among elderly persons in the United States.

Objective: This study examined predictors of psychiatric rehospitalization among elderly persons.

Methods: Readmission within six months of an index hospitalization was modeled by using Medicare data on all hospitalizations with a primary psychiatric diagnosis in the first half of 2002 (N=41,839). Data were linked with state and community-level information from the U.

Medicare inpatient treatment for elderly non-dementia psychiatric illnesses 1992--2002; length of stay and expenditures by facility type.

We summarize Medicare utilization and payment for inpatient treatment of non-dementia psychiatric illnesses (NDPI) among the elderly during 1992 and 2002. From 1992 to 2002, overall mean Medicare expenditures per elderly NDPI inpatient stay declined by $2,254 (in 2002 dollars) and covered days by 2.8.