The Effects of Public Reporting on Physical Restraints and Antipsychotic Use in Nursing Home Residents with Severe Cognitive Impairment. Issue 3 (11th March 2014)

• Record Type: Journal Article
• Authors: Konetzka, R. Tamara; Brauner, Daniel J.; Shega, Joseph; Werner, Rachel M.
• Is Part Of: Journal of the American Geriatrics Society. Volume 62:Issue 3(2014:Mar.)
• Page Start: 454
• Page End: 461
• Publication Date: 2014-03-11
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12711
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs12711-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12711-sec-0001" sec-type="section"> <title>Objectives</title> <p>To assess whether reductions in physical restraint use associated with quality reporting may have had the unintended consequence of increasing antipsychotic use in nursing home (NH) residents with severe cognitive impairment.</p> </sec> <sec id="jgs12711-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective analysis of NH clinical assessment data from 1999 to 2008 comparing NHs subject to public reporting of physical restraints with nonreporting NHs.</p> </sec> <sec id="jgs12711-sec-0003" sec-type="section"> <title>Setting</title> <p>Medicare‐ and Medicaid‐certified NHs in the United States.</p> </sec> <sec id="jgs12711-sec-0004" sec-type="section"> <title>Participants</title> <p>Observations (N = 3.9 million) on 809, 645 residents with severe cognitive impairment in 4, 258 NHs in six states.</p> </sec> <sec id="jgs12711-sec-0005" sec-type="section"> <title>Intervention</title> <p>Public reporting of physical restraint use rates.</p> </sec> <sec id="jgs12711-sec-0006" sec-type="section"> <title>Measurements</title> <p>Use of physical restraints and antipsychotic medications.</p> </sec> <sec id="jgs12711-sec-0007" sec-type="section"> <title>Results</title> <p>Physical restraint use declined significantly from 1999 to 2008 in NH residents with severe cognitive impairment. The decline was larger in NHs that were subject to reporting of restraints than in those that were not (–8.3 vs –3.3 percentage points, <italic>P </italic>< .001). Correspondingly, antipsychotic use in the same residents increased more in NHs that were subject to public reporting (4.5 vs 2.9 percentage points, <italic>P </italic>< .001). Approximately 36% of the increase in antipsychotic use may be attributable to public reporting of physical restraints.</p> </sec> <sec id="jgs12711-sec-0008" sec-type="section"> <title>Conclusion</title> <p>This analysis suggests that public reporting of physical restraint use had the unintended consequence of increasing use of antipsychotics in NH residents with severe cognitive impairment.</p> </sec> </abstract>