Darlene McKenzie

The validity of Medicaid pharmacy claims for estimating drug use among elderly nursing home residents : The Oregon experience

This study compared computerized Medicaid pharmacy claims data for nursing home residents with chart data to establish how well the claims data identified those receiving drugs within three different psychoactive drug classes (yes/no for each class) and how well the claims estimated total within-class average daily dose. Percent agreement, positive predictive value (PPV), and negative predictive value (NPV) for drug exposure were over 85% for each class. Kappas were excellent for antipsychotics and antidepressants, and good for anxiolytics. Correspondence was lower for average daily dose. Using an algorithm that credits some but not all doses associated with overlapping claims, correlations ranged from 0.97 to 0.66. Agreement on therapeutic dose was excellent for antipsychotics (kappa = 0.81) and fair to good for antidepressants and anxiolytics (kappa = 0.63, and kappa = 0.52, respectively). The findings suggest that Medicaid pharmacy claims data are reasonably accurate for quality assurance and accreditation purposes.

The bathing of older adults with dementia. Easing the unnecessarily unpleasant aspects of assisted bathing

OVERVIEW:Older adults who need assistance with bathing often find the activity to be both physically and emotionally demanding, as do their caregivers. Research has identified several contributing factors, including pain; fatigue and weakness; confusion; anxiety resulting from being naked in front o

Changes in Antipsychotic Drug Use Following Shifts in Policy: A Multilevel Analysis

This case study of antipsychotic drug use in nursing homes illustrates the potential benefits and limits of multilevel hierarchical linear analysis in long-term care research. Multilevel (MLn) logistic regression models were used to assess changes in exposure and average daily dose and their associations with resident and facility characteristics following implementation of the 1987 Omnibus Budget Reconciliation Act regulations. Data were obtained for 8,158 elderly Oregon Medicaid residents residing in 128 facilities between July 1991 and December 1994. Findings support the general hypothesis that resident characteristics are the main determinants of drug use and that drug use decreased over time among some resident populations and some facility types. Although challenges were encountered in the use of the MLn software, hierarchical modeling has advantages that make it attractive for long-term care multilevel applications such as the drug use study reported here.