The American Medical Directors Association (AMDA) proposes to develop an online, interactive educational program on its website to disseminate evidence-based guidelines on caring for nursing home residents with dementia, focusing on the appropriate use of atypical antipsychotic medications. In 2005, the Food and Drug Administration issued an advisory and subsequent "black box" warning regarding the increased risk of death in elderly patients with dementia using atypical antipsychotics. In 2009, the AMDA developed clinical practice guidelines for the management of nursing home residents with dementia using both evidence- and consensus- based approaches, The overall project goal is to decrease inappropriate use of antipsychotics for nursing home residents, particularly those with dementia, by providing an innovative, technology-based, and low-cost means of disseminating AMDA's evidence-based clinical practice guidelines for recognition, assessment, treatment/management and monitoring of residents with dementia. AMDA will revamp its dissemination methods, implementing and evaluating an online, interactive, CME course founded on adult learning theory that utilizes a personalized learning approach, problem-based learning, and testing with immediate feedback. Interactive technology features will be integrated into the curriculum and providers will be able to access the course remotely using smart phones and tablet computers. The project's objectives are: (1) At least 700 Nursing Home Medical Directors and clinicians will complete the CME course;(2) At least 90% of clinical prescribers that complete the AMDA course will achieve a score of 80% or higher when tested on their knowledge of the clinical practice guidelines;(3) At least 75% of survey responders will report that they have integrated the dementia practice guidelines into their clinical practice;(4) At leat 75% of survey responders will integrate reduction of inappropriate antipsychotic medication use in patients with dementia into their organizations'quality improvement projects;and (5) Of the organizations that have integrated this program into their quality improvement projects, at least 75% will report the reduction of inappropriate antipsychotic medication use in patients with dementia. At the completion of each course module, providers will complete a series of brief online test questions to assess their knowledge of the clinical practice guidelines. Course completers will be surveyed at 3 and 6 months post-test to evaluate their integration of acquired knowledge into clinical practice. Information on these outcomes will be collected as a part of the online, follow-up survey. For rate of inappropriate antipsychotic use, integration of guidelines, and inclusion in QI, pre-CME course practices will be assessed retrospectively;pre-CME course levels will be compared to post-CME levels using linear regression. For knowledge retention, covariates will be evaluated as potential confounders using bivariate analysis and included in a linear regression model. At the end of the project, a manuscript of the project results will be prepared for submission to the AMDA's peer-reviewed publication, JAMDA.
The development of an interactive, web-based educational program based on the American Medical Directors Association's evidence-based guidelines for management of nursing home residents with dementia will decrease the inappropriate use of atypical antipsychotic medications for nursing home residents with dementia, improving compliance with the Food and Drug Administration's black box warning issued in September 2006. This initiative is especially relevant at this time since the Centers for Medicare and Medicaid have recently launched the Initiative to Improve Behavioral Health and Reduce the Use of Antipsychotic Medications in Nursing Home Residents, with a goal of reducing the use of antipsychotic drugs in nursing home residents by 15% by the end of 2012;and will be posting individual nursing home data on antipsychotic drug use on the CMS Nursing Home Compare web site.