The proposed project will attempt to relate patterns of psychotropic drug use in nursing home patients to outcomes of care over a six-month period. Outcomes to be studied will include changes in cognitive, physical, and social function, mood and behavior; changes in resource utilization; and occurrence of adverse events such as falls and injuries. Data will be obtained from a HCFA-funded demon-stration of case mix-based nursing home reimbursement (HCFA contract number 500-89-046: Long-Term Care Case Mix and Quality Technical Design Project). The HCFA data will comprise functional assessments performed by facility nurses using the federally-mandated uniform minimum data set (MDS) for resident assessment. Data on psychotropic drug use will be obtained directly from facilities on all subjects at two timepoints; continuous drug utilization data for the entire six months will be derived from Medicaid claim data on at least half of the subjects. Data on nursing staff time inputs will be obtained at two time points using logs kept by staff. Resource utilization groups (RUGs) will be derived under the above-mentioned contract from MDS data and staff time measurements; these will be available for analysis as they are developed. All of the above data will be assembled into a composite analytic file. Following file construction, both propensity matching techniques and standard multivariate methods will be used to address the specific aims of the study. Objectives will include: 1) Characterization of nursing facility residents who receive psychotropic medications with and without diagnosed mental dis-orders; 2) Assessment of the contribution of mental and behavioral symptoms to resource needs; 3) A test of the hypothesis that antidepressant drug treatment increases the likelihood of functional improvement in more-impaired patients; 4) A test of the hypothesis that the use of tranquilizers is associated with a decreased likelihood of functional improvement in less-impaired patients; 5) Assessment of relationships between specific patterns of psychotropic drug use and changes in cognitive function, activity pursuit, and social behavior; 6) Identification of general features of drug choice and drug dosage differen-tially associated with positive or negative outcomes.
