目的:调查辅助生活和住宿护理(AL/RC)和记忆护理(MC)背景与抗精神病药物使用(APU)的90天患病率相关,被认为是长期护理质量的衡量标准。
方法:俄勒冈州所有许可的AL/RC设置都收到了一份年度邮寄问卷,以提供居民人口统计信息,健康敏锐度,卫生服务使用,付款类型,和组织政策。组织措施是从国家网站收集的。
方法:估计了随机截获回归模型,以评估3次研究波(2017-2019年)中与90天APU患病率相关的组织和居民人口特征。
方法:我们检查了2017年至2019年在463个AL/RC设置中的932个观测值(137个设置参与了所有3波,2波中的195,和1波中的131)。
结果:在464个俄勒冈州AL/RC设置中,平均90天APU患病率为30.7%,尽管费率因MC认可而异(AL/RC为23.9%,MC为42.7%)。非营利设置与AL/RC中APU的较低比率相关[β=-4.4(百分点),95%CI-8.4,-0.4]和MC(β=-12.4,95%CI-21.2,-3.6)。与低医疗补助设置相比,医疗补助居民比例非常高的设置与较高的APU患病率相关,AL/RC+8.9(95%CI1.7,16.1)和MC+11.0个百分点(95%CI2.3,19.8)。
结论:在MC设置和高医疗补助人群中,APU的患病率明显高于非MC和低医疗补助设置。联邦政策指导APU在疗养院,但不是AL/RC。没有AL/RC的国家数据库;因此,基于国家的研究可以为国家政策和实践发展的讨论提供信息。需要进行其他研究,以了解AL/RC人口水平实践和特征与APU患病率之间的关系,以告知与该措施相关的政策和实践发展,作为质量指标。
OBJECTIVE: Investigate how assisted living and residential care (AL/RC) and memory care (MC) contexts are associated with the 90-day prevalence of antipsychotic medication use (APU), considered a quality measure in long-term care.
METHODS: All licensed AL/RC settings in Oregon received an annual mailed questionnaire to provide aggregate resident demographics, health acuity, health service use, payment type, and organizational policies. Organizational measures were collected from state websites.
METHODS: Random intercepts regression models were estimated to assess organizational and resident population characteristics associated with 90-day APU prevalence over 3 study waves (2017-2019).
METHODS: We examine 932 observations in 463 AL/RC settings from 2017 to 2019 (137 settings participated in all 3 waves, 195 in 2 waves, and 131 in 1 wave).
RESULTS: The average 90-day APU prevalence in 464 Oregon AL/RC settings is 30.7%, although rates differ by MC endorsement (23.9% in AL/RC and 42.7% in MC). Nonprofit settings were associated with lower rates of APU in both AL/RC [β = -4.4 (percentage points), 95% CI -8.4, -0.4] and MC (β = -12.4, 95% CI -21.2, -3.6). Compared with low-Medicaid settings, settings with very high proportions of Medicaid residents were associated with higher APU prevalence, +8.9 in AL/RC (95% CI 1.7, 16.1) and +11.0 percentage points in MC (95% CI 2.3, 19.8).
CONCLUSIONS: APU prevalence in MC settings and with high-Medicaid populations is considerably higher than non-MC and lower-Medicaid settings. Federal policies guide APU in nursing homes but not AL/RC. No national database of AL/RC exists; thus, state-based studies can inform the discussion of state policy and practice development. Additional study is needed to contextualize the relationships between AL/RC population-level practices and characteristics and the APU prevalence to inform policy and practice development related to this measure as a quality indicator.