title: Does incorporating medications in the surveyors' interpretive guidelines reduce the use of potentially inappropriate medications in nursing homes?
abstract: OBJECTIVE
  To quantify the association between including specific medications deemed potentially inappropriate in the surveyors' interpretive guidelines for nursing homes and the prevalence of use.
  
  
  METHODS
  Quasi-experimental.
  
  
  METHODS
  One thousand one hundred forty-one nursing homes in four U.S. states.
  
  
  METHODS
  Residents living in one of the included nursing homes in operation during 1997 (before Beers; n=130,250) and 2000 (after Beers; n=164,889).
  
  
  METHODS
  Inclusion of specific medications deemed potentially inappropriate in the surveyors' interpretive guidelines for nursing homes.
  
  
  METHODS
  Logistic regression models adjusting for clustering effects of residents residing in homes provided estimates of the relationship between the survey process and use of any medications targeted as potentially inappropriate as part of the survey process, as well as those deemed inappropriate but not included.
  
  
  RESULTS
  The use of any potentially inappropriate medication decreased from 42.5% in 1997 to 39.8% in 2000. After adjustment for resident characteristics, residents were less likely to receive any potentially inappropriate medication (odds ratio (OR)=0.85, 95% confidence interval (95% CI)=0.84-0.87), those considered high-severity drugs (those with a high likelihood of a clinically significant adverse event) (OR=0.67, 95% CI=0.65-0.69), or Beers' medications not included in the surveyors' guidelines (OR=0.76, 95% CI=0.74-0.79) in 2000 than in 1997 after the changes to the drug regulations and interpretive guidelines.
  
  
  CONCLUSIONS
  Targeting specific drugs in the surveyor's interpretive guidelines as a method to reduce potentially inappropriate medication use may not produce desired gains in medication-use quality improvement. Alternative strategies for nursing homes should be evaluated.
authors.affiliation: Department of Community Health, Brown Medical School, Providence, Rhode Island 02903, USA. Kate_Lapane@Brown.edu
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hughes
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Quilliam
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004363:Drug Utilization / Q000592:standards*; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009735:Nursing Homes; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care