title: The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective analysis of NH clinical assessment data from 1999 to 2008 comparing NHs subject to public reporting of physical restraints with nonreporting NHs.
  
  
  METHODS
  Medicare- and Medicaid-certified NHs in the United States.
  
  
  METHODS
  Observations (N = 3.9 million) on 809,645 residents with severe cognitive impairment in 4,258 NHs in six states.
  
  
  METHODS
  Public reporting of physical restraint use rates.
  
  
  METHODS
  Use of physical restraints and antipsychotic medications.
  
  
  RESULTS
  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, P < .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, P < .001). Approximately 36% of the increase in antipsychotic use may be attributable to public reporting of physical restraints.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health Studies, University of Chicago, Chicago, Illinois.
authors.forename: R Tamara
authors.initials: RT
authors.lastname: Konetzka
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Brauner
authors.forename: Joseph
authors.initials: J
authors.lastname: Shega
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Werner
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000494:pharmacology*; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology*; D003704:Dementia / Q000188:drug therapy* / Q000523:psychology; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009735:Nursing Homes; D012149:Restraint, Physical / Q000009:adverse effects / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotics; nursing homes; public reporting; quality; restraints