Table 5.
Summary of associations of nursing home exposure to the IA-ADAPT intervention and CMS Partnership with antipsychotic and anticholinergic use outcomes in eligible residents
| Outcome group included in analysis | Odds ratio and P value per month after IA-ADAPT exposure∗ |
Odds ratio and P value per month after CMS Partnership start∗ |
||
|---|---|---|---|---|
| Odds ratio (95% CI) | P value | Odds ratio (95% CI) | P value | |
| Antipsychotic use | ||||
| All eligible residents† | 0.92 (0.89, 0.95) | <.001 | 0.96 (0.94, 0.98) | <.001 |
| Dementia‡ | 0.89 (0.86, 0.93) | <.001 | 0.97 (0.95, 0.99) | .011 |
| No dementia§ | 1.42 (1.24, 1.62) | <.001 | 0.86 (0.79, 0.93) | <.001 |
| Appropriate indication† | 0.91 (0.87, 0.95) | <.001 | 0.98 (0.96, 1.01) | .243 |
| No appropriate indication¶ | 0.95 (0.9, 1.01) | .083 | 0.93 (0.89, 0.96) | <.001 |
| Anticholinergic use | ||||
| All eligible residents# | 0.95 (0.92, 0.98) | <.001 | 1.01 (1.00, 1.03) | .149 |
| Dementia∗∗ | 0.96 (0.93, 0.99) | .017 | 1.00 (0.99, 1.02) | .644 |
| No dementia†† | 0.90 (0.85, 0.95) | <.001 | 1.00 (0.98, 1.04) | .394 |
| Excessive antipsychotic dose | ||||
| All eligible residents† | 0.80 (0.75, 0.86) | <.001 | 1.01 (0.97, 1.05) | .530 |
| Appropriate indication | ||||
| Antipsychotic users‡‡ | 1.04 (1.00, 1.09) | .048 | 0.98 (0.96, 1.01) | .152 |
| Any physical or verbal aggression, hallucinations, delusions, or delirium | ||||
| All eligible residents¶¶ | 0.99 (0.97, 1.01) | .230 | 0.98 (0.97, 0.99) | <.001 |
| Any physical aggression | ||||
| All eligible residents¶¶ | 1.02 (0.99, 1.05) | .282 | 0.99 (0.97, 1.01) | .113 |
| Any verbal aggression | ||||
| All eligible residents¶¶ | 0.96 (0.94, 0.99) | .007 | 1.00 (0.99, 1.02) | .572 |
| Hallucinations | ||||
| All eligible residents¶¶ | 1.00 (0.95, 1.05) | .969 | 1.01 (0.98, 1.04) | .394 |
| Delusions | ||||
| All eligible residents¶¶ | 0.99 (0.96, 1.02) | .512 | 1.01 (0.99, 1.03) | .318 |
| Delirium | ||||
| All eligible residents¶¶ | 1.02 (0.99, 1.05) | .115 | 0.98 (0.96, 0.99) | .008 |
Abbreviations: CI, confidence interval; CMS Partnership, Centers for Medicare and Medicaid Services Partnership to Improve Dementia Care; IA-ADAPT, Improving Antipsychotic Appropriateness in Dementia Patients program.
Odds ratios are for each month after exposure to the intervention. Significant P values are shown in bold. Both intervention variables were included in all models.
Adjusted for number of months since resident entry into the database until current month, age, sex, dementia, Parkinson's disease, Lewy body dementia, diabetes, physical aggression, verbal aggression, hallucinations, delusions, and delirium.
Adjusted for all variables in footnote † except dementia.
Adjusted for all variables in footnote † except dementia and Lewy body dementia.
Adjusted for all variables in footnote † except appropriate indications.
Adjusted for number of months since resident entry into the database until current month, age, sex, dementia, Parkinson's disease, and Lewy body dementia.
Adjusted for all variables in footnote # except dementia.
Adjusted for all variables in footnote # except dementia and Lewy body dementia.
Adjusted for number of months resident in database up to current month.
Adjusted for all variables in footnote † except appropriate indications and diabetes.