{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:51:14Z","timestamp":1791910274444,"version":"4.3.4"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG074358"],"award-info":[{"award-number":["R01AG074358"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Appl Gerontol"],"abstract":"<jats:p>To assess whether national reductions in antipsychotic prescribing in U.S. nursing homes were shared equitably or masked widening gaps between top and bottom performers, we examined distributional trends across facilities from 2013 to 2023 using national facility-level data (CMS Provider Data Catalog; LTCFocus). We modeled long-stay antipsychotic measure performance using linear quantile mixed regression, assessed mobility across performance quartiles with transition matrices, and evaluated facility characteristics associated with trajectories. From 2013 to 2019, prescribing fell across all quantiles, with the steepest reductions among the worst performers, narrowing gaps with the best. After 2020, progress diverged: lower-performing facilities experienced sharp setbacks while top performers maintained gains. Mobility analyses showed entrenched disadvantage, with bottom-quartile facilities disproportionately likely to remain there. Higher Medicaid share predicted decline, whereas higher star ratings predicted improvement. The pandemic reversed earlier equity gains, amplifying structural disparities and exposing unequal capacity to sustain improvement.<\/jats:p>","DOI":"10.1177\/07334648261496578","type":"journal-article","created":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T14:18:55Z","timestamp":1791728335000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Structural Vulnerability and the Pandemic: Widening Gaps in Nursing Home Antipsychotic Prescribing"],"prefix":"10.1177","author":[{"given":"Adam J.","family":"Funk","sequence":"first","affiliation":[{"name":"Virginia Commonwealth University School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy T.","family":"Sabo","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Petterson","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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Neiman Health Policy Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Hua","family":"Fu","sequence":"additional","affiliation":[{"name":"University of Maryland School of Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Etz","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University School of Medicine"},{"name":"Larry A. Green Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4060-9155","authenticated-orcid":false,"given":"Alex H.","family":"Krist","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8650-5066","authenticated-orcid":false,"given":"Jonathan D.","family":"Winter","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University School of Medicine"},{"name":"Shenandoah Valley Family Practice Residency"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,11]]},"reference":[{"key":"e_1_3_6_2_1","unstructured":"CMS's National Partnership to Improve Dementia Care. (2024). https:\/\/www.cms.gov\/medicare\/health-safety-standards\/quality-safety-oversight-general-information\/national-partnership-improve-dementia-care-nursing-homes"},{"key":"e_1_3_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780080504"},{"key":"e_1_3_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16316"},{"key":"e_1_3_6_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280220903763"},{"key":"e_1_3_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.56816"},{"key":"e_1_3_6_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.8524"},{"key":"e_1_3_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-19425-7"},{"key":"e_1_3_6_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/23337214241277052"},{"key":"e_1_3_6_10_1","unstructured":"LTCfocus: Data Download. (2025). https:\/\/ltcfocus.org\/data"},{"key":"e_1_3_6_11_1","unstructured":"Medicare Program; Prospective Payment System. (2025). Medicare program; prospective payment system and consolidated billing for skilled nursing facilities; updates to the quality reporting program for federal fiscal year 2026 90 fed. Reg. https:\/\/www.federalregister.gov\/documents\/2025\/08\/04\/2025-14679\/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities"},{"key":"e_1_3_6_12_1","unstructured":"National Healthcare Quality and Disparities Report. (2022). https:\/\/www.ahrq.gov\/sites\/default\/files\/wysiwyg\/research\/findings\/nhqrdr\/2022qdr-measurespecs.pdf"},{"key":"e_1_3_6_13_1","unstructured":"Nursing homes including rehab services. 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