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Data show National Partnership to Improve Dementia Care exceeds goals to reduce unnecessary antipsychotic medications in nursing homes

Date
2014-09-19
Title
Data show National Partnership to Improve Dementia Care exceeds goals to reduce unnecessary antipsychotic medications in nursing homes
For Immediate Release
Friday, September 19, 2014
Contact
press@cms.hhs.gov

Data show National Partnership to Improve Dementia Care exceeds goals to reduce unnecessary antipsychotic medications in nursing homes

The Centers for Medicare & Medicaid Services (CMS) established the National Partnership to Improve Dementia Care. The partnership catalyzed a broad range of activities by provider organizations and others, and ultimately led to the formation of state-based coalitions to improve dementia care in every state. The goal of the Partnership is to continue to reduce the use of unnecessary antipsychotic medications, as well as other potentially harmful medications in nursing homes and eventually other care settings as well.  The Partnership includes consumers, advocacy organizations, nursing home staff, and professional associations, such as American Health Care Association (AHCA) and LeadingAge.

Today, the National Partnership to Improve Dementia Care announced that it met its initial goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 15.1 percent. It also announced a new goal of a 25 percent reduction by the end of 2015, and a 30 percent reduction by the close of 2016 using the prior baseline rate (fourth quarter of 2011). The data below show current trends related to the prevalence of antipsychotic use, CMS noncompliance/deficiency citations, as well as the utilization of psychopharmacological medications. In 2011, Medicare Part D spending on antipsychotic drugs totaled $7.6 billion, which was the second highest class of drugs, accounting for 8.4 percent of Part D spending.

Current data trends

  • Over 21 months, the national prevalence of antipsychotic use by long-stay nursing home residents was reduced by 17.1 percent (from 23.8 percent to 19.8 percent). All 50 states and every CMS region showed at least some improvement. Some states showed much more improvement than others. The states that have reduced their rate by the most include Hawaii (31.4 percent), North Carolina (29.9 percent), Vermont (28.2 percent), and Georgia (28.1percent). (Data on all states is below in figure 3). Short-stay incidence rates improved as well.
  • Trends for unnecessary drug use (tracked by CMS deficiency tag F329) from 2009 through 2013 are represented in tables 1 and 2. CMS tracks citation patterns by state and region for unnecessary drug use, including scope and severity. (Please note: Not all citations for unnecessary drug use (F329) relate to antipsychotic medications specifically; this deficiency tag includes deficiencies related to any unnecessary drug).
  • CMS is also looking at how other psychopharmacological medications are prescribed. For example, there has been seen a small decline in the use of sedative-hypnotics.

Moving forward
CMS is actively seeking input from measurement experts and others on additional measures of person-centered care and dementia care practices in an effort to consider balancing measures, beyond current metrics that quantify antipsychotic medication use.  

CMS and all our partners will continue to look at a variety of efforts and interventions to help meet our goals, such as:  

  • Focused dementia health and safety care surveys;
  • Review of surveyor feedback on guidance and trends in enforcement;
  • Additional opportunities to measure and publicly report on improved dementia care;
  • Continuation of our national education sessions on non-pharmacological, person-centered care;
  • Ongoing work of grassroots state coalitions in all 50 states; and
  • Provision of technical assistance through Quality Improvement Organizations (QIOs) or other quality improvement partners.  

CMS will also continue to monitor potential consequences, such as prescribing shifts from antipsychotic medications to anxiolytics or sedative/hypnotics, as well as changes in functional or cognitive status of nursing home residents that may result from a shift to approaches that don’t rely on medication to treat dementia.

Finally, CMS and its partners will continue to promote research on improving systems of care in nursing homes, use of individualized, person-centered approaches to care of people with dementia, innovative programs such as telepsychiatry for rural nursing homes, and the effectiveness of this and other national initiatives to reduce unnecessary antipsychotic medication use in nursing homes.

Figure 1: Quarterly Prevalence of Antipsychotic Use for Long-Stay Nursing Home Residents, 2011-Q2 to 2014-Q1     
Figure 1 –This chart displays a national downward trend in the utilization of antipsychotic medications between 2011-Q2 and 2014-Q1, using data from 2011-Q4, 23.9 percent, as a baseline measurement for the National Partnership to Improve Dementia Care in Nursing Homes.  The current prevalence of antipsychotic medication use for long-stay nursing home residents is 19.8 percent.
Figure 2
: Quarterly Prevalence of Antipsychotic Use for Long-Stay Residents, CMS Regions* 2011-Q2 to 2014-Q1
 

Figure 2 – This chart displays a regional downward trend in the utilization of antipsychotic medications between 2011-Q2 and 2014-Q1, using data from 2011-Q4 as a baseline measurement for the National Partnership to Improve Dementia Care in Nursing Homes.  All CMS Regions have shown a decrease in the use of antipsychotic medications, although variability is present.  CMS Region-1 has had the greatest decrease, 6.48 percentage points, in the use of antipsychotic medications for long-stay nursing home residents.  While CMS Region-6 continues to have the highest rate of antipsychotic medication use with a prevalence rate of 24.4 percent.
*Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont; Region 2: New Jersey, New York, Puerto Rico, Virgin Islands; Region 3: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia; Region 4: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee; Region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin; Region 6: Kansas, Louisiana, New Mexico, Oklahoma, Texas; Region 7: Iowa, Kansas, Missouri, Nebraska; Region 8: Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming; Region 9: Arizona, California, Hawaii, Nevada, Pacific Territories; Region 10: Alaska, Idaho, Oregon Washington

Figure 3: Quarterly Prevalence of Antipsychotic Use for Long-Stay Residents, States 2011Q2 to 2014Q1

State 2011Q2 2011Q3 2011Q4 2012Q1 2012Q2 2012Q3 2012Q4 2013Q1 2013Q2 2013Q4 2014Q1 Rank in
2014Q1 
Percentage
point difference
(2011Q4-2014Q1)
%
Change
AK 15.60% 15.10% 13.70% 13.40% 13.00% 13.60% 12.40% 12.50% 11.80% 12.80% 12.70% 2 -0.99 -7.20%
AL 27.00% 27.40% 27.30% 27.50% 26.50% 26.00% 24.00% 22.90% 22.20% 22.20% 22.10% 44 -5.19 -19.00%
AR 25.70% 27.00% 26.10% 26.10% 25.30% 25.80% 25.50% 25.10% 24.40% 22.80% 21.70% 42 -4.42 -16.90%
AZ 22.40% 22.50% 22.70% 22.70% 21.70% 21.60% 20.90% 20.40% 20.20% 20.70% 18.50% 26 -4.20 -18.40%
CA 21.70% 21.60% 21.60% 21.30% 20.40% 20.10% 19.20% 19.00% 18.40% 17.10% 16.30% 13 -5.22 -24.20%
CO 19.80% 19.70% 19.90% 19.90% 20.30% 19.60% 19.40% 18.50% 17.50% 16.40% 16.40% 14 -3.48 -17.50%
CT 25.80% 26.10% 26.00% 25.80% 25.00% 24.30% 23.20% 22.40% 21.60% 21.00% 20.40% 34 -5.63 -21.60%
DC 21.40% 20.00% 20.00% 19.40% 18.80% 19.40% 18.20% 17.40% 17.60% 14.50% 14.80% 5 -5.14 -25.70%
DE 21.10% 21.00% 21.30% 21.80% 22.60% 21.90% 20.90% 18.00% 16.80% 15.50% 15.50% 9 -5.83 -27.40%
FL 24.20% 24.30% 24.50% 24.60% 23.80% 23.50% 23.30% 22.70% 22.10% 21.20% 21.20% 38 -3.30 -13.50%
GA 28.40% 28.40% 28.70% 28.70% 28.00% 27.10% 24.20% 22.70% 21.80% 21.10% 20.60% 36 -8.06 -28.10%
HI 11.40% 12.20% 12.50% 13.50% 15.30% 13.20% 11.70% 11.00% 11.40% 11.60% 8.50% 1 -3.91 -31.40%
IA 22.20% 22.30% 22.30% 22.00% 21.70% 21.10% 20.60% 20.20% 20.20% 20.00% 19.70% 32 -2.62 -11.70%
ID 26.40% 25.70% 25.30% 26.40% 25.10% 24.50% 23.90% 23.10% 21.90% 19.30% 19.30% 30 -6.01 -23.70%
IL 26.00% 25.80% 25.70% 25.60% 25.30% 25.70% 25.50% 25.00% 25.20% 24.00% 24.10% 49 -1.56 -6.10%
IN 23.00% 23.60% 24.00% 24.10% 22.90% 23.10% 22.20% 21.70% 20.90% 20.20% 19.90% 33 -4.18 -17.40%
KS 26.10% 26.50% 26.10% 26.10% 25.20% 25.30% 25.10% 24.20% 23.90% 23.00% 23.10% 47 -2.98 -11.40%
KY 25.50% 25.20% 26.00% 26.00% 25.20% 24.40% 23.10% 21.90% 22.00% 21.60% 21.20% 37 -4.82 -18.50%
LA 29.70% 29.90% 29.70% 29.70% 29.10% 28.90% 28.60% 27.80% 27.00% 26.50% 25.50% 50 -4.20 -14.10%
MA 26.60% 26.70% 26.70% 26.60% 25.40% 25.10% 24.50% 22.90% 22.20% 21.20% 20.60% 35 -6.14 -23.00%
MD 19.50% 19.80% 19.80% 19.60% 18.50% 17.80% 17.70% 17.30% 16.70% 15.90% 15.90% 10 -3.84 -19.40%
ME 26.40% 26.70% 27.20% 26.90% 25.90% 25.10% 24.20% 22.60% 21.70% 20.10% 18.50% 25 -8.69 -31.90%
MI 16.20% 16.00% 16.40% 16.40% 15.80% 16.00% 15.50% 14.90% 14.40% 13.90% 13.70% 3 -2.73 -16.70%
MN 18.90% 19.00% 19.00% 18.80% 18.10% 18.00% 18.00% 17.90% 17.30% 16.60% 16.00% 11 -2.99 -15.70%
MO 25.50% 26.00% 26.10% 26.00% 25.30% 25.20% 24.90% 24.60% 24.40% 23.10% 22.20% 45 -3.96 -15.20%
MS 26.60% 26.80% 26.60% 26.30% 26.60% 26.10% 25.30% 24.70% 24.40% 24.30% 23.80% 48 -2.78 -10.50%
MT 21.60% 22.00% 21.50% 21.50% 19.50% 19.70% 19.50% 19.70% 19.20% 17.20% 16.90% 17 -4.56 -21.20%
NC 21.10% 20.80% 21.40% 21.30% 20.70% 19.90% 18.00% 16.50% 16.00% 15.60% 15.00% 6 -6.41 -29.90%
ND 20.80% 21.40% 21.30% 21.20% 20.60% 20.40% 19.80% 19.10% 18.50% 18.70% 18.00% 19 -3.34 -15.70%
NE 22.70% 22.40% 22.30% 22.90% 22.60% 22.60% 22.90% 22.50% 22.20% 22.70% 22.00% 43 -0.35 -1.60%
NH 25.70% 25.40% 25.50% 25.10% 24.00% 23.80% 23.70% 22.70% 21.10% 20.10% 18.80% 27 -6.77 -26.50%
NJ 17.00% 18.20% 17.90% 17.80% 17.50% 17.40% 17.10% 16.60% 15.90% 15.10% 14.50% 4 -3.36 -18.80%
NM 22.40% 22.30% 21.70% 22.00% 20.00% 20.40% 22.20% 20.30% 20.70% 18.10% 19.50% 31 -2.12 -9.80%
NV 22.20% 20.70% 20.30% 20.50% 21.10% 19.70% 20.20% 20.10% 20.40% 19.70% 19.10% 29 -1.22 -6.00%
NY 22.00% 21.60% 21.30% 21.40% 20.80% 20.60% 19.70% 19.50% 18.90% 18.20% 18.00% 21 -3.28 -15.40%
OH 24.90% 25.00% 25.40% 25.40% 25.00% 24.80% 24.50% 24.10% 23.30% 22.00% 21.60% 40 -3.87 -15.20%
OK 26.70% 26.80% 27.30% 27.50% 27.30% 26.60% 25.50% 23.00% 22.70% 21.70% 21.50% 39 -5.86 -21.40%
OR 20.60% 21.00% 21.50% 21.30% 20.00% 19.90% 19.20% 19.10% 18.60% 18.30% 18.40% 24 -3.07 -14.30%
PA 21.60% 22.10% 22.30% 22.20% 21.70% 21.70% 21.10% 20.50% 19.40% 18.80% 18.30% 23 -4.00 -17.90%
RI 23.00% 23.80% 24.00% 23.90% 23.10% 21.70% 20.20% 20.30% 19.30% 17.50% 16.90% 16 -7.12 -29.70%
SC 20.60% 20.50% 20.70% 20.60% 20.70% 20.20% 18.30% 17.20% 16.90% 15.50% 15.30% 7 -5.38 -26.00%
SD 21.80% 21.80% 21.50% 21.50% 21.30% 21.40% 20.50% 20.00% 18.80% 18.60% 18.00% 20 -3.53 -16.40%
TN 29.30% 29.50% 30.00% 29.30% 29.00% 27.70% 27.20% 25.00% 23.90% 23.40% 23.10% 46 -6.87 -22.90%
TX 28.40% 28.50% 28.80% 28.90% 28.20% 28.30% 28.00% 27.90% 27.30% 26.50% 25.70% 51 -3.13 -10.90%
UT 26.90% 24.70% 27.10% 26.90% 27.10% 26.30% 26.40% 25.00% 24.50% 21.70% 21.70% 41 -5.43 -20.00%
VA 22.40% 22.80% 23.00% 22.90% 21.80% 21.90% 22.10% 22.10% 21.00% 19.70% 19.00% 28 -4.01 -17.40%
VT 25.50% 26.10% 25.40% 25.70% 26.20% 24.90% 23.40% 20.30% 20.20% 18.80% 18.20% 22 -7.17 -28.20%
WA 22.80% 23.00% 22.30% 21.80% 21.70% 21.60% 20.60% 20.20% 19.70% 18.60% 17.80% 18 -4.49 -20.10%
WI 18.70% 18.70% 19.00% 18.90% 18.90% 19.00% 18.00% 17.70% 17.40% 16.30% 15.40% 8 -3.64 -19.10%
WV 20.10% 20.30% 20.50% 21.50% 20.40% 20.70% 20.40% 19.80% 19.00% 16.50% 16.10% 12 -4.41 -21.50%
WY 17.80% 18.40% 16.80% 16.90% 19.40% 16.80% 17.50% 17.00% 16.50% 17.90% 16.50% 15 -0.31 -1.80%

 

Table 1: Number of F329 and Total Citations on Annual Surveys, 2009-2013  

Table 1 – This chart displays a regional, as well as national, comparison between the number of F329 citations and the number of total citations that occurred during annual nursing home surveys from 2009 to 2013.  In 2013, although the number of total citations decreased, the number of F329 citations was on the rise.  Prior to that, the number of F329 citations and the number of total citations appear fairly consistent.  It should be noted that not all citations at F329 relate to antipsychotic medications specifically.

Table 2: F329 Citations as a Percentage of All Citations on Annual Surveys, 2009-2013  

Table 2 – This chart displays a regional, as well as national, comparison between the percentage of F329 citations and the percentage of total citations that occurred during annual nursing home surveys from 2009 to 2013.  This comparison shows an upward trend in the percentage of F329 citations during this time period.  It should be noted that not all citations at F329 relate to antipsychotic medications specifically.

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