title: Results of a longitudinal analysis of national data to examine relationships between organizational and market characteristics and changes in antipsychotic prescribing in US nursing homes from 1996 through 2006.
abstract: OBJECTIVE
  The aim of this work was to examine the association between organizational characteristics, market characteristics, and changes in antipsychotic medication use in US nursing homes over time.
  
  
  METHODS
  This was a longitudinal study comparing antipsychotic use in US nursing homes from 1996 through 2006 using Medicare and Medicaid data (the Online Survey Certification And Reporting system) and US Department of Health and Human Resources Health Resources and Services Administration data (the Area Resource File). The 3 outcomes of interest were increasing, decreasing, or stable use of antipsychotic medications. The primary independent variables were organizational characteristics (eg, for-profit status, chain membership) and market characteristics (eg, Medicaid reimbursement, levels of competition).
  
  
  RESULTS
  Antipsychotic use increased from 16.4% in 1996 to 25.9% in 2006 (P < 0.05). A multinomial generalized estimating equations model, controlling for facility, staffing, and resident factors, suggested that increased antipsychotic use was associated with for-profit facilities (adjusted odds ratio [AOR], 1.58; 95% CI, 1.51-1.65; P < or = 0.001). Decreased antipsychotic use was associated with chain membership (AOR, 0.82; 95% CI, 0.79-0.85; P < or = 0.001), higher levels of competition (AOR, 1.22; 95% CI, 1.16-1.29; P < or = 0.001), and a higher Medicaid reimbursement rate (AOR, 0.88; 95% CI, 0.85-0.92; P < or = 0.001).
  
  
  CONCLUSIONS
  Antipsychotic use increased in US nursing homes from 1996 through 2006 and was associated with certain organizational characteristics and market characteristics. Future interventions to reduce antipsychotic use in nursing homes will have to focus on these factors.
authors.affiliation: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. castlen@pitt.edu
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Castle
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
authors.forename: Steven M
authors.initials: SM
authors.lastname: Handler
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D019538:Health Care Surveys; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D015233:Models, Statistical; D009735:Nursing Homes / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D014481:United States
chemical_list: D014150:Antipsychotic Agents