{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T11:55:50Z","timestamp":1773921350495,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,2,25]],"date-time":"2023-02-25T00:00:00Z","timestamp":1677283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100019822","name":"Institute for Clinical and Translational Research, University of Maryland, Baltimore","doi-asserted-by":"publisher","award":["1UL1TR003098\u201001"],"award-info":[{"award-number":["1UL1TR003098\u201001"]}],"id":[{"id":"10.13039\/100019822","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["AG0026"],"award-info":[{"award-number":["AG0026"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG060939"],"award-info":[{"award-number":["R01AG060939"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R21AG057979"],"award-info":[{"award-number":["R21AG057979"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R33AG57979"],"award-info":[{"award-number":["R33AG57979"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In July 2012, the Centers for Medicare &amp; Medicaid services launched an antipsychotic reduction initiative (ARI) to improve care for nursing facility residents with Alzheimer's disease and related dementias (ADRD). We examined the impact of this policy on antipsychotic and psychotropic medication (PM) utilization and diagnosis patterns in long\u2010stay nursing facility residents with ADRD and other conditions in which antipsychotics are indicated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using an 80% sample of fee\u2010for\u2010service Medicare beneficiaries with Part D, we conducted a retrospective cohort study of nursing facility residents with ADRD, bipolar disorder, psychosis, Parkinson's disease, and residents exempt from the policy due to diagnoses of schizophrenia, Tourette syndrome, and\/or Huntington's disease. We used interrupted time\u2010series analyses to compare changes in diagnoses, antipsychotic use, and PM utilization before (January 1, 2011\u2013June 30, 2012) and after (July 1, 2012\u2013September 30, 2015) ARI implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 874,487 long\u2010stay nursing facility residents with a diagnosis of ADRD (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0358,518), exempt (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a092,859), bipolar (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0128,298), psychosis (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a093,402), and Parkinson's disease (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a080,211). In all cohorts, antipsychotic use declined prior to the ARI; upon policy implementation, antipsychotic use reductions were sustained throughout the study period, including statistically significant ARI\u2010associated accelerated declines in all cohorts. PM changes varied by cohort, with ARI\u2010associated increases in non\u2010benzodiazepine sedatives and\/or muscle relaxants noted in ADRD, psychosis, and Parkinson's cohorts. Although anticonvulsant use increased throughout the study period in all groups, with the exception of the bipolar cohort, these increases were not associated with ARI implementation. Findings are minimally explained by increased post\u2010ARI membership in the psychosis and Parkinson's cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study documents antipsychotic use significantly declined in non\u2010ADRD clinical and exempt cohorts, where such reductions may not be clinically warranted. Furthermore, ARI\u2010associated compensatory increases in PMs do not offset these reductions. Changes in PM utilization and diagnostic make\u2010up of residents using PMs require further investigation to assess the potential for adverse clinical and economic outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.18276","type":"journal-article","created":{"date-parts":[[2023,2,25]],"date-time":"2023-02-25T05:59:21Z","timestamp":1677304761000},"page":"1714-1723","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Unintended impacts of a national antipsychotic reduction initiative among nursing facility residents with and without Alzheimer's disease"],"prefix":"10.1111","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5363-1816","authenticated-orcid":false,"given":"Linda","family":"Wastila","sequence":"first","affiliation":[{"name":"Department of Practice, Sciences, and Health Outcomes Research University of Maryland School of Pharmacy  Baltimore Maryland USA"},{"name":"Peter Lamy Center on Drug Therapy and Aging University of Maryland School of Pharmacy  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6355-1526","authenticated-orcid":false,"given":"Danya M.","family":"Qato","sequence":"additional","affiliation":[{"name":"Department of Practice, Sciences, and Health Outcomes Research University of Maryland School of Pharmacy  Baltimore Maryland USA"},{"name":"Peter Lamy Center on Drug Therapy and Aging University of Maryland School of Pharmacy  Baltimore Maryland USA"},{"name":"Department of Epidemiology and Public Health University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"Fleming","sequence":"additional","affiliation":[{"name":"Department of Practice, Sciences, and Health Outcomes Research University of Maryland School of Pharmacy  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abree","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Practice, Sciences, and Health Outcomes Research University of Maryland School of Pharmacy  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Becky","family":"Briesacher","sequence":"additional","affiliation":[{"name":"Department of Pharmacy and Health Systems Sciences Northeastern University  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick F.","family":"McArdle","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Holmes","sequence":"additional","affiliation":[{"name":"Peter Lamy Center on Drug Therapy and Aging University of Maryland School of Pharmacy  Baltimore Maryland USA"},{"name":"Department of Organizational Systems and Adult Health University of Maryland School of Nursing  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith A.","family":"Lucas","sequence":"additional","affiliation":[{"name":"Seton Hall University College of Nursing  Nutley New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhilash","family":"Desai","sequence":"additional","affiliation":[{"name":"Idaho Memory &amp; Aging Center  Boise Idaho USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Brandt","sequence":"additional","affiliation":[{"name":"Department of Practice, Sciences, and Health Outcomes Research University of Maryland School of Pharmacy  Baltimore Maryland USA"},{"name":"Peter Lamy Center on Drug Therapy and Aging University of Maryland School of Pharmacy  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3979-1706","authenticated-orcid":false,"given":"Barbara","family":"Zarowitz","sequence":"additional","affiliation":[{"name":"Department of Practice, Sciences, and Health Outcomes Research University of Maryland School of Pharmacy  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,25]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Centers for Medicare and Medicaid Services.National Partnership to Improve Dementia Care in Nursing Homes: Antipsychotic Medication Use Data Report (October 2021);2021. 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