Highlights
- •What is the primary question addressed by this study? To examine racial differences in the change in the frequency of schizophrenia diagnosis among nursing home residents with ADRD following the public reporting of nursing home antipsychotic use, and sources of such racial differences.
- •What is the main finding of this study? The increase in the frequency of schizophrenia diagnosis during the study period was greater for Black residents with ADRD as compared with whites. Such racial differences were related to NHs’ racial composition, but racial differences in the growth of schizophrenia diagnosis persisted within a NH after accounting for NH factors.
- •What is the meaning of the finding? Efforts are needed to reexamine policies that may incentivize inaccurate diagnosis and exacerbate racial differences in nursing home care.
ABSTRACT
Objective
To examine racial differences in the frequency of schizophrenia diagnosis codes used
among nursing home (NH) residents with Alzheimer's Disease and Related Dementias (ADRD),
pre and post the implementation of public reporting of antipsychotic use in NHs.
Methods
The 2011–2017 Minimum Data Set and Medicare Master Beneficiary Summary File were linked.
We identified long-stay NH residents (i.e., those who had quarterly or annual assessments)
with ADRD aged 55 years and older (N = 7,734,348). Outcome variable was defined as
the diagnosis of schizophrenia documented in the MDS assessments. Main variables of
interest included individual race (black versus white), the percent of blacks in a
NH and time trend. Multivariate regressions were estimated.
Results
The frequency of schizophrenia diagnosis codes among NH residents with ADRD steadily
increased over the study period, and blacks experienced a greater increase than their
white counterparts. For example, the overall likelihood of having schizophrenia diagnosis
increased 1.9 percentage points (95% confidence interval [CI]: 0.019, 0.020, p < 0.01)
from 2011 to 2017 among whites, while blacks had an addition 1.3 percentage points
increase (95% CI: 0.011, 0.015, p < 0.01). The increase in the likelihood of having
schizophrenia diagnosis code was higher in NHs with higher percent of blacks: the
increase from 2011 to 2017 was 2.6 percentage point (95% CI: 0.023, 0.029, p < 0.01)
higher in NHs with the highest percent of blacks, compared to NHs with lowest percent
of blacks. Racial differences in the growth of schizophrenia diagnosis also existed
within a NH after accounting for NH factors.
Conclusion
Following the implementation of public reporting of antipsychotic use in NH, black
residents experienced a greater increase in the likelihood of having schizophrenia
diagnosis than white NH residents. NHs with a higher proportion of blacks had a greater
increase in schizophrenia diagnosis, and blacks experienced an increased likelihood
of schizophrenia diagnosis than whites within a NH. Further research is needed to
determine a causal relationship between the federal policy mandating public reporting
and disparities in schizophrenia diagnostic coding.
Key Words
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Article info
Publication history
Published online: October 26, 2021
Accepted:
October 19,
2021
Received in revised form:
October 1,
2021
Received:
July 22,
2021
Identification
Copyright
© 2021 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
