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 2: Quarterly Prevalence of Antipsychotic Use for Long-Stay Residents, CMS Regions* 2011-Q2 to 2014-Q1
*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 2: F329 Citations as a Percentage of All Citations on Annual Surveys, 2009-2013
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