National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (1)
- Behavioral Health (1)
- Caregiving (1)
- COVID-19 (1)
- Decision Making (2)
- (-) Dementia (21)
- Elderly (18)
- Falls (1)
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- Patient and Family Engagement (2)
- Patient Safety (2)
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- Quality Measures (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (2)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 21 of 21 Research Studies DisplayedHua Y, Temkin-Greener H, Cai S
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
The purpose of this study was to explore primary care telemedicine use among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) who resided in Assisted Living Facilities (Als) during the early stage of the COVID-19 pandemic, with a focus on possible racial and socioeconomic differences. The study found that at the start of the pandemic in quarter 2 of 2020, Black residents were less likely to have telemedicine visits than their White counterparts. In the following two quarters, Black residents were more likely to receive primary care via telemedicine than White residents; a similar difference was observed between Hispanic and White residents, but with smaller effect sizes. Compared with nondual residents, dual residents were more likely to receive primary care via telemedicine in Q3. In addition, residents in AL communities with a higher proportion of dual residents, compared with those in low-dual ALs, were less likely to receive primary care via telemedicine throughout the study period. However, the difference in telemedicine use between higher vs lower dual ALs narrowed over time.
AHRQ-funded; HS026893.
Citation: Hua Y, Temkin-Greener H, Cai S .
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
J Am Med Dir Assoc 2023 Aug; 24(8):1157-58.e3. doi: 10.1016/j.jamda.2023.05.005..
Keywords: COVID-19, Primary Care, Telehealth, Health Information Technology (HIT), Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Racial and Ethnic Minorities, Elderly
Rosenthal M, Poling J, Wec A
"Medication is just one piece of the whole puzzle": how nursing homes change their use of antipsychotic medications.
This article investigated health professionals’ experiences with decision-making during changes under the National Partnership to Improve Dementia Care in Nursing Homes and its companion coalitions. These programs were introduced in 2012 for the purpose of encouraging reductions in antipsychotic use and increasing use of nonpharmacological treatments for dementia. Interviews were conducted with 40 nursing home physicians and staff in seven states. The authors found that reducing antipsychotics is more time and resource-intensive than relying on medication. However, respondents supported reductions in antipsychotic use. They indicated that with supported staffing, effective communications, and training, they could create or implement individualized treatments.
AHRQ-funded; HS023464.
Citation: Rosenthal M, Poling J, Wec A .
"Medication is just one piece of the whole puzzle": how nursing homes change their use of antipsychotic medications.
J Appl Gerontol 2022 Jan;41(1):62-72. doi: 10.1177/0733464820958919..
Keywords: Elderly, Medication, Nursing Homes, Dementia, Neurological Disorders, Long-Term Care, Decision Making
Fashaw-Walters SA, McCreedy E, Bynum JPW
Disproportionate increases in schizophrenia diagnoses among Black nursing home residents with ADRD.
Investigators examined how race and Alzheimer's and related dementia (ADRD) status influenced the rate of schizophrenia diagnoses among nursing home (NH) residents following the CMS National Partnership to Improve Dementia Care. Using 2011-2015 Minimum Data Set 3.0 assessments, they found that, following the partnership, black NH residents with ADRD were more likely to have a schizophrenia diagnosis documented on their minimum data set assessments, and schizophrenia rates increased for black NH residents with ADRD only.
AHRQ-funded; HS000011.
Citation: Fashaw-Walters SA, McCreedy E, Bynum JPW .
Disproportionate increases in schizophrenia diagnoses among Black nursing home residents with ADRD.
J Am Geriatr Soc 2021 Dec;69(12):3623-30. doi: 10.1111/jgs.17464..
Keywords: Elderly, Dementia, Nursing Homes, Racial and Ethnic Minorities, Long-Term Care
Orth J, Li Y, Simning A
Nursing home residents with dementia: association between place of death and patient safety culture.
This study examined the association of place of death and patient safety culture among nursing home (NH) residents with dementia. The authors examined the estimated effects of patient safety culture (PSC) among 11,957 long-stay NH residents with dementia, aged 65+ who died in NHs or hospitals shortly following discharge from one of 800 US NHs in 2017. Residents with dementia in NHs with higher PSC scores in communication openness had lower odds of in-hospital death, with the strongest effect in NHs located in states with higher minimum NH nurse staffing requirements.
AHRQ-funded; HS024923.
Citation: Orth J, Li Y, Simning A .
Nursing home residents with dementia: association between place of death and patient safety culture.
Gerontologist 2021 Nov 15;61(8):1296-306. doi: 10.1093/geront/gnaa188..
Keywords: Elderly, Dementia, Nursing Homes, Mortality, Patient Safety
Abrahamson K, Davila H, Kirk L
Can a nursing home psychotropic reduction project be successfully implemented in assisted living?
This study’s objective was to compare implementation of a psychotropic medication reduction project across nursing homes (NH) and assisted living (AL) facilities. Fifteen NHs and 14 AL facilities within a single corporate chain participated. In-person and telephone interviews with 62 staff members from participating NH and AL facilities were conducted to investigate project implementation experience. Implementation at nursing homes made more dramatic changes in residents’ lives and medication use than at assisted living facilities. AL staff identified numerous barriers to implementation.
AHRQ-funded; HS018464.
Citation: Abrahamson K, Davila H, Kirk L .
Can a nursing home psychotropic reduction project be successfully implemented in assisted living?
J Appl Gerontol 2021 Sep;40(9):1071-79. doi: 10.1177/0733464820948328..
Keywords: Elderly, Nursing Homes, Long-Term Care, Medication, Dementia
Shepard V, Chou LN, Kuo YF, et al.
Characteristics associated with feeding tube placement: retrospective cohort study of Texas nursing home residents with advanced dementia.
The purpose of this retrospective cohort study was to investigate resident-level, provider-type, nursing home (NH), and regional factors associated with feeding tube (FT) placement in advanced dementia. The investigators concluded that regional, race, and ethnic variations in prevalence of FT use among NH residents suggested opportunities for clinicians and policy makers to improve the quality of end-of-life care by especially considering other palliative care measures for minorities living in border towns.
AHRQ-funded; HS020642.
Citation: Shepard V, Chou LN, Kuo YF, et al..
Characteristics associated with feeding tube placement: retrospective cohort study of Texas nursing home residents with advanced dementia.
J Am Med Dir Assoc 2021 Jul;22(7):1471-76.e4. doi: 10.1016/j.jamda.2020.10.033..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders
Orth J, Li Y, Simning A
End-of-life care among nursing home residents with dementia varies by nursing home and market characteristics.
This study’s objectives were to examine variations in end-of-life (EOL) care/outcomes among decedents with Alzheimer's disease/related dementias (ADRD) and to identify associations with nursing home (NH)/market characteristics. Findings showed that decedents with ADRD in NHs that were nonprofit, had Alzheimer's units, higher licensed nurse staffing, and in more competitive markets, had better EOL care/outcomes. Recommendations included modifications to state Medicaid NH payments to promote better EOL care/outcomes and future research to understand NH care practices associated with presence of Alzheimer's units in order to identify mechanisms possibly promoting higher-quality EOL care.
AHRQ-funded; HS024923.
Citation: Orth J, Li Y, Simning A .
End-of-life care among nursing home residents with dementia varies by nursing home and market characteristics.
J Am Med Dir Assoc 2021 Feb;22(2):320-28.e4. doi: 10.1016/j.jamda.2020.06.021..
Keywords: Elderly, Palliative Care, Dementia, Nursing Homes, Long-Term Care
Crystal S, Jarrín OF, Rosenthal M
National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.
This study examines the success of the national partnership campaign to reduce prescription of antipsychotic medications to elderly nursing home residents with dementia. Antipsychotic medications have been shown to increase mortality. Use of these medications had increased 23.9% in dementia patients by 2011. The campaign reduced use by 40.1% to 14.3% by the second quarter of 2019. The campaign measured progress with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. Sedative-hypnotic medication use also decreased in tandem with antipsychotic reduction suggesting that the campaign increased attention to the use of other risky psychotropic medications.
AHRQ-funded; HS023464; HS022406; HS023258; HS021112.
Citation: Crystal S, Jarrín OF, Rosenthal M .
National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.
Innov Aging 2020 Jun 2;4(3):igaa018. doi: 10.1093/geroni/igaa018..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Quality Improvement, Quality of Care, Medication, Mortality
McCreedy E, Ogarek JA, Thomas KS
The minimum data set agitated and reactive behavior scale: measuring behaviors in nursing home residents with dementia.
Researchers in this study test the internal consistency and construct validity of the Agitated and Reactive Behavior Scale (ARBS), a measure created to measure agitated and aggressive behaviors in dementia residents at nursing homes (NHs). This cross-sectional study used data from the 2016 national sample of 15,326 Centers for Medicare and Medicaid Services-certified NHs. The sample included 489,854 new admissions and 765,367 long-stay residents (defined as 90 days or more) all diagnosed with dementia. The ARBS is a composite measure of physical and verbal agitation or aggressiveness towards other people; other behavioral symptoms not directed at other people; and rejection of care. The study found that 1) the ARBS score has borderline-adequate internal consistency in the national population of NH residents with dementia; 2) only 18% of new admissions, and 21% of long-stay residents with dementia displayed any aggressive or agitated behaviors in the previous week; and 3) the ARBS demonstrated good construct validity. Conclusions were that nationally available MDS data may significantly underestimate the prevalence of agitated and aggressive behaviors among NH dementia patients.
AHRQ-funded; HS000011.
Citation: McCreedy E, Ogarek JA, Thomas KS .
The minimum data set agitated and reactive behavior scale: measuring behaviors in nursing home residents with dementia.
J Am Med Dir Assoc 2019 Dec;20(12):1548-52. doi: 10.1016/j.jamda.2019.08.030..
Keywords: Elderly, Dementia, Neurological Disorders, Nursing Homes, Long-Term Care, Behavioral Health
Joyce NR, McGuire TG, Bartels SJ
The impact of dementia special care units on quality of care: an instrumental variables analysis.
The purpose of this study was to compare the quality of care following admission to a nursing home (NH) with and without a dementia special care unit (SCU) for residents with dementia. The investigators found that facilities with an SCU provided better quality of care as measured by several validated quality indicators. The authors suggested that given the aging population, policies to promote the expansion and use of dementia SCUs may be warranted.
AHRQ-funded; HS022998.
Citation: Joyce NR, McGuire TG, Bartels SJ .
The impact of dementia special care units on quality of care: an instrumental variables analysis.
Health Serv Res 2018 Oct;53(5):3657-79. doi: 10.1111/1475-6773.12867..
Keywords: Dementia, Elderly, Quality of Care, Long-Term Care, Nursing Homes
McCreedy E, Loomer L, Palmer JA
Representation in the care planning process for nursing home residents with dementia.
This study examined the participation of residents, family members, or representatives in nursing home (NH) long-term care planning for residents with cognitive impairment. A large for-profit NH system was used to recruit study participants. A sample of 18,552 long-stay NH residents in 2016 were surveyed. Of residents with no cognitive impairment, 8% had family or representative participation in care planning, compared with 26% of residents with severe impairments. Family participation was greater in NHs with more social workers.
AHRQ-funded; HS000011.
Citation: McCreedy E, Loomer L, Palmer JA .
Representation in the care planning process for nursing home residents with dementia.
J Am Med Dir Assoc 2018 May;19(5):415-21. doi: 10.1016/j.jamda.2018.01.004..
Keywords: Dementia, Nursing Homes, Long-Term Care, Patient and Family Engagement, Neurological Disorders
Blackburn J, Zheng Q, Grabowski DC
Nursing home chain affiliation and its impact on specialty service designation for Alzheimer disease.
Specialty care units (SCUs) in nursing homes (NHs) grew in popularity during the 1990s to attract residents while national policies and treatment paradigms changed. Alzheimer disease has consistently been the dominant form of SCU. This study explored the extent to which chain affiliation, which is common among NHs, affected SCU bed designation.
AHRQ-funded; HS023009.
Citation: Blackburn J, Zheng Q, Grabowski DC .
Nursing home chain affiliation and its impact on specialty service designation for Alzheimer disease.
Inquiry 2018 Jan-Dec;55:46958018787992. doi: 10.1177/0046958018787992..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders
Jutkowitz E, Kuntz KM, Dowd B
Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia.
This study used cross-sectional data (Aging, Demographics, and Memory Study) to estimate probabilities of experiencing outcomes by clinical features. It found that no clinical feature predicted the probability of having out-of-pocket medical expenditures. For those with medical expenditures, higher cognition and poorer function were associated with more spending.
AHRQ-funded; HS024165.
Citation: Jutkowitz E, Kuntz KM, Dowd B .
Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia.
Alzheimers Dement 2017 Jul;13(7):801-09. doi: 10.1016/j.jalz.2016.12.011.
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Keywords: Caregiving, Dementia, Elderly, Healthcare Costs, Long-Term Care, Neurological Disorders, Nursing Homes
Tjia J, Lemay CA, Bonner A
Informed family member involvement to improve the quality of dementia care in nursing homes.
Researchers described the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40 percent of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process.
AHRQ-funded; HS019351.
Citation: Tjia J, Lemay CA, Bonner A .
Informed family member involvement to improve the quality of dementia care in nursing homes.
J Am Geriatr Soc 2017 Jan;65(1):59-65. doi: 10.1111/jgs.14299.
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Keywords: Decision Making, Dementia, Medication, Nursing Homes, Patient and Family Engagement
Chatterjee S, Bali V, Carnahan RM
Anticholinergic medication use and risk of dementia among elderly nursing home residents with depression.
The purpose of this study was to examine the risk of dementia with anticholinergic use among elderly nursing home residents with depression. The study concluded that use of clinically significant anticholinergic medications was associated with a 26% increase in risk of dementia among elderly nursing home residents with depression. With increasing safety concerns, there is a significant need to optimize anticholinergic use, especially for those who are at risk for dementia.
AHRQ-funded; HS021264.
Citation: Chatterjee S, Bali V, Carnahan RM .
Anticholinergic medication use and risk of dementia among elderly nursing home residents with depression.
Am J Geriatr Psychiatry 2016 Jun;24(6):485-95. doi: 10.1016/j.jagp.2015.12.011..
Keywords: Adverse Drug Events (ADE), Dementia, Elderly, Medication, Nursing Homes
Bali V, Chatterjee S, Carnahan RM
Risk of dementia among elderly nursing home patients using paroxetine and other selective serotonin reuptake inhibitors.
This study evaluated the comparative risk of dementia associated with use of paroxetine and other selective serotonin reuptake inhibitors (SSRIs) among elderly nursing home patients. It found that compared with use of other SSRIs, use of paroxetine was not associated with higher risk of dementia among elderly nursing home patients with depression.
AHRQ-funded; HS021264.
Citation: Bali V, Chatterjee S, Carnahan RM .
Risk of dementia among elderly nursing home patients using paroxetine and other selective serotonin reuptake inhibitors.
Psychiatr Serv 2015 Dec;66(12):1333-40. doi: 10.1176/appi.ps.201500011.
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Keywords: Adverse Drug Events (ADE), Dementia, Elderly, Nursing Homes, Medication
Konetzka RT, Brauner DJ, Coca Perraillon M
The role of severe dementia in nursing home report cards.
This article examined the intended and unintended effects of quality reporting for nursing home residents with severe dementia relative to other residents, using a difference-in-differences design to examine selected reported and unreported quality measures. The results indicate that prior to public reporting, nursing home residents with severe dementia were at significantly higher risk of poor outcomes on most reported quality measures.
AHRQ-funded; HS018718.
Citation: Konetzka RT, Brauner DJ, Coca Perraillon M .
The role of severe dementia in nursing home report cards.
Med Care Res Rev 2015 Oct;72(5):562-79. doi: 10.1177/1077558715588436.
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Keywords: Dementia, Nursing Homes, Long-Term Care, Quality Measures
Daly JM, Bay CP, Levy BT
Caring for people with dementia and challenging behaviors in nursing homes: a needs assessment geriatric nursing.
The authors conducted a needs assessment of directors of nursing (DON) in Iowa nursing homes in relation to caring for patients with Behavioral and Psychological Symptoms of Dementia. They found that facilities with a larger proportion of patients with challenging behaviors being treated with non-drug approaches instead of antipsychotics had DONs who were more likely to be confident in non-drug management strategies and have knowledge about the FDA antipsychotic medications risks.
AHRQ-funded; HS019355.
Citation: Daly JM, Bay CP, Levy BT .
Caring for people with dementia and challenging behaviors in nursing homes: a needs assessment geriatric nursing.
Geriatr Nurs 2015 May-Jun;36(3):182-91. doi: 10.1016/j.gerinurse.2015.01.001.
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Keywords: Elderly, Dementia, Nursing Homes, Long-Term Care, Nursing
Park Y, Franklin JM, Schneeweiss S
Antipsychotics and mortality: adjusting for mortality risk scores to address confounding by terminal illness.
The researchers sought to determine whether adjustment for prognostic indices specifically developed for nursing home populations affect the magnitude of previously observed associations between mortality and conventional and atypical antipsychotics. They concluded that although causality cannot be proven based on nonrandomized studies, this study adds to the body of evidence rejecting explanations other than causality for the greater mortality risk associated with conventional antipsychotics than with atypical antipsychotics.
AHRQ-funded; HS017918; HS02112.
Citation: Park Y, Franklin JM, Schneeweiss S .
Antipsychotics and mortality: adjusting for mortality risk scores to address confounding by terminal illness.
J Am Geriatr Soc 2015 Mar;63(3):516-23. doi: 10.1111/jgs.13326..
Keywords: Nursing Homes, Mortality, Medication, Elderly, Dementia
Aspinall SL, Zhao X, Semia TP
Epidemiology of drug-disease interactions in older veteran nursing home residents.
The objective of this study was to assess the prevalence of and factors associated with potentially inappropriate drug– disease combinations according to the AGS 2012 Beers criteria that are clinically important in elderly adults residing in Veterans Affairs Community Living Centers. It found that drug-disease interactions were common in older residents with dementia or cognitive impairment or a history of falls or hip fracture.
AHRQ-funded; HS018721.
Citation: Aspinall SL, Zhao X, Semia TP .
Epidemiology of drug-disease interactions in older veteran nursing home residents.
J Am Geriatr Soc 2015 Jan;63(1):77-84. doi: 10.1111/jgs.13197..
Keywords: Adverse Drug Events (ADE), Adverse Events, Dementia, Elderly, Falls, Injuries and Wounds, Medication, Medication: Safety, Neurological Disorders, Nursing Homes, Patient Safety
Konetzka RT, Brauner DJ, Shega J
The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment.
The purpose of this paper was to assess whether reductions in physical restraint use associated with quality reporting may have had the unintended consequence of increasing antipsychotic use in nursing home (NH) residents with severe cognitive impairment. Physical restraint use declined significantly from 1999 to 2008 in NH residents with severe cognitive impairment. Correspondingly, antipsychotic use in the same residents increased more in NHs that were subject to public reporting. 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.
AHRQ-funded; HS018718.
Citation: Konetzka RT, Brauner DJ, Shega J .
The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment.
J Am Geriatr Soc 2014 Mar;62(3):454-61. doi: 10.1111/jgs.12711.
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Keywords: Dementia, Elderly, Medication, Nursing Homes, Public Reporting