{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:42:59Z","timestamp":1792078979674,"version":"4.4.0"},"reference-count":51,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2014,3,20]],"date-time":"2014-03-20T00:00:00Z","timestamp":1395273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["U18 S017918"],"award-info":[{"award-number":["U18 S017918"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001311","name":"The Research Retirement Foundation","doi-asserted-by":"crossref","award":["RRF# 2007-152"],"award-info":[{"award-number":["RRF# 2007-152"]}],"id":[{"id":"10.13039\/100001311","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int J Geriat Psychiatry"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The potential misuse of antipsychotic medications (APMs) is an ongoing quality concern in nursing homes (NHs), especially given recent black box warnings and other evidence regarding the risk of APMs when used in NH populations. One mechanism regulators could use is public reporting of APM use by NHs; however, there is currently no agreed\u2010upon measure of guideline\u2010inconsistent APM use. In this paper, we describe a proposed measure of quality of APM use that is based on Centers for Medicare and Medicaid Services (CMS) Interpretive Guidelines, Food and Drug Administration (FDA) indications for APMs, and severity of behavioral symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The proposed measure identifies NH residents who receive an APM but do not have an approved indication for APM use. We demonstrate the feasibility of this measure using data from Medicaid\u2010eligible long\u2010stay residents aged 65\u2009years and older in seven states. Using multivariable logistic regressions, we compare it to the current CMS Nursing Home Compare quality measure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We find that nearly 52% of residents receiving an APM lack indications approved by CMS\/FDA guidelines compared with 85% for the current CMS quality measure. APM guideline\u2010inconsistent use rates vary significantly across resident and facility characteristics, and states. Only our measure correlates with another quality indicator in that facilities with higher deficiencies have significantly higher odds of APM use. Predictors of inappropriate use are found to be consistent with other measures of NH quality, supporting the validity of our proposed measure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The proposed measure provides an important foundation to improve APM prescribing practices without penalizing NHs when there are limited alternative treatments available. Copyright \u00a9 2014 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/gps.4098","type":"journal-article","created":{"date-parts":[[2014,3,20]],"date-time":"2014-03-20T05:20:47Z","timestamp":1395292847000},"page":"1049-1061","source":"Crossref","is-referenced-by-count":53,"title":["Antipsychotic medication use in nursing homes: a proposed measure of quality"],"prefix":"10.1002","volume":"29","author":[{"given":"Judith A.","family":"Lucas","sequence":"first","affiliation":[{"name":"Seton Hall University and Institute for Health, Health Care Policy, and Aging Research Rutgers, The State University of New Jersey  New Brunswick NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujoy","family":"Chakravarty","sequence":"additional","affiliation":[{"name":"Center for State Health Policy, Institute for Health, Health Care Policy, and Aging Research Rutgers, The State University of New Jersey  New Brunswick NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Bowblis","sequence":"additional","affiliation":[{"name":"Department of Economics and Scripps Gerontology Center Miami University  Oxford OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Gerhard","sequence":"additional","affiliation":[{"name":"Earnest Mario School of Pharmacy and Institute for Health, Health Care Policy, and Aging Research Rutgers, The State University of New Jersey  New Brunswick NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ece","family":"Kalay","sequence":"additional","affiliation":[{"name":"Institute for Health, Health Care Policy, and Aging Research Rutgers, The State University of New Jersey  New Brunswick NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Kwang","family":"Paek","sequence":"additional","affiliation":[{"name":"Institute for Health, Health Care Policy, and Aging Research Rutgers, The State University of New Jersey  New Brunswick NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Crystal","sequence":"additional","affiliation":[{"name":"Institute for Health, Health Care Policy, and Aging Research Rutgers, The State University of New Jersey  New Brunswick NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,3,20]]},"reference":[{"issue":"2","key":"e_1_2_11_2_1","first-page":"100","article-title":"Expert consensus guidelines for using antipsychotic agents in older patients","volume":"65","author":"Alexopoulos GS","year":"2004","journal-title":"J Clin Psychiatry"},{"key":"e_1_2_11_3_1","unstructured":"American Geriatrics Society.2011.Guide to the management of psychotic disorders and neuropsychiatric symptoms of dementia in older adults. 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