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Background Methods Results Conclusions Antipsychotic and other psychotropic medication use is prevalent among community‐dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care (“the Partnership”) and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.Among community‐dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010–2017 Medicare fee‐for‐service claims using interrupted time series analyses across three periods (“Pre‐Partnership”: July 1, 2010 to March 31, 2012; “Post‐Partnership”: April 1, 2012 to January 31, 2015; “Five Star Quality Rating”: February 1, 2015 to December 31, 2017).We included 1,289,401 community dwellers with dementia contributing 26,609,697 person‐months. The mean age was 80 years, most were female (70%), approximately 80% were non‐Hispanic Whites, 10% were non‐Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre‐Partnership (β = −0.06, 95% CI: −0.08, −0.05) and post‐Partnership (β = −0.02, 95% CI: −0.02, −0.01). Post‐Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (β = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community‐dwelling older adults with dementia.These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community‐dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community‐dwellers with dementia. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Federal policies targeting antipsychotic use among nursing home (NH) residents may have increased reporting of diagnoses for approved uses, including schizophrenia, Tourette's syndrome, and Huntington's Disease (called “exclusionary diagnoses” because they exclude residents from the antipsychotic quality metric). We assessed changes in new exclusionary diagnoses among long‐stay NH admissions specifically with dementia following federal policies.Retrospective, quarterly, interrupted time‐series analysis (2009–2018) of new long‐stay NH residents with dementia and no exclusionary diagnoses reported before NH admission. The National Partnership and the addition of facility level antipsychotic use to the Five Star Quality Rating system were key time exposures. Outcome was quarterly facility level predicted percentage of exclusionary diagnoses within 2 years of admission stratified by NH characteristics.For 264,095 long‐stay admissions, mean percentage of new exclusionary diagnoses was 2.2% before the Partnership. After the Partnership, there was an unadjusted increase in the percentage over time (slope change, 0.044, p = 0.018), but the percentage never exceeded 2.9%. The Partnership contributed to a one‐time decrease in diagnoses in NHs with an intermediate percentage of Black residents (−1.29%, p = 0.004). Before the Partnership, diagnoses were increasing among not‐for‐profit relative to for‐profit NHs (0.044; p = 0.012), but after the Partnership, the pattern reversed. For‐profit NHs saw an increase (+0.034, p = 0.002); not‐for‐profit NHs experienced a decrease (−0.014, p = 0.039). Quality Rating modifications had no significant effect.Exclusionary diagnosis reporting among long‐stay NH residents with dementia, the group most at risk from antipsychotics, did not increase in response to federal policies. Evaluation of reasons for the observed increase in exclusionary diagnoses among non‐dementia NH residents is warranted along with continued attention to how to incentivize the appropriate use of medications in residents with dementia that is crucial for high‐quality NH care. [ABSTRACT FROM AUTHOR]