Evidence suggests that psychotropic medications have been used inappropriately in many nursing homes (Beers et al., 1988; Ray Federspeil, & Schaffner, 1980), with often excessive and clinically unjustified rates of use (Burns & Kamerow, 1988; Gurwitz, Soumerai, & Avorn, 1990). Appropriate use of these drugs is a key measure of nursing home quality, (Castle, 1997), and as such is among the areas of care examined by surveyors who review the quality of these facilities. In the proposed study we will use data from these surveyors and other sources to examine nursing homes with persistent poor quality as it relates to the use of psychotropic medications. State and federal surveyors conduct inspections of nursing homes every 9 to 15 months. When a facility does not meet a standard (or code), the surveyors issue a deficiency citation. Twelve different citations are used for medication use. We will use data describing these citations along with reported levels of psychotropic medications, as our measures of poor quality. Based on a recent General Accounting Office (GAO) report, our definition of persistence in poor quality is a citation on two consecutive inspections. In our initial analysis will use inspections conducted in 1999 and 2000, and we will then examine facilities with deficiencies in three consecutive inspections (1999, 2000, and 2001) because we believe this additional analysis will give us a more thorough understanding of nursing homes with persistent poor quality. We will also examine increases and decreases in nursing homes' use of psychotropic medications between 1999 and 2001 in order to determine the impact over time of the survey process and previous citations on this measure of quality.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Small Research Grants (R03)
Project #
1R03MH067045-01A1
Application #
6678108
Study Section
Special Emphasis Panel (ZMH1-SRV-H (01))
Program Officer
Oliver, Karen Anderson
Project Start
2003-06-12
Project End
2005-03-31
Budget Start
2003-06-12
Budget End
2004-03-31
Support Year
1
Fiscal Year
2003
Total Cost
$89,672
Indirect Cost
Name
Rand Corporation
Department
Type
DUNS #
006914071
City
Santa Monica
State
CA
Country
United States
Zip Code
90401