Measure Information Form

Measure Set: Assisted Living Community (ALC)

Set Measure ID: ALC-01

Performance Measure Name: Off-Label Antipsychotic Drug Use

Description: Residents with an off-label antipsychotic drug prescribed.

Rationale: Nearly two out of five individuals in assisted living are living with some type of dementia. For these individuals and as illness progresses, behavior often becomes a key form of communication. This can be challenging for families and staff, and too often, antipsychotic medication is used in an attempt to modify behavior.

The use of antipsychotic medication to treat behavior associated with dementia is not supported clinically and is considered off-label by the FDA, which issued a “black box” warning for the elderly with dementia. They increase the risk of death, falls and fractures, hospitalizations, and other complications resulting in poor health and high costs. Additionally, antipsychotic drugs are expensive, costing Medicare hundreds of millions. American Health Care Association/National Center for Assisted Living (AHCA/NCAL). https://www.ahcancal.org/Assisted-Living/About-NCAL/Pages/default.aspx

Type Of Measure: Process

Improvement Noted As: Decrease in the rate

Risk Adjustment: No.

Data Collection Approach:

Denominator: The total number from the data element Assisted Living Community Resident is the Denominator.

• This number will be entered into the Direct Data Submission Platform (DDSP) tool.

Numerator: Count number of residents with a Yes to Off-Label Antipsychotic Drug Prescribed; the total number is the numerator.

• This number will be entered into the Direct Data Submission Platform (DDSP) tool.

Example: You are abstracting cases for the month of June. On June 30th there are 35 residents living at the assisted living community. Your denominator will be 35. When you look back through the 35 resident’s records, there were 2 residents that were prescribed an antipsychotic for off-label use. Your numerator will be 2.

Denominator = 35
Numerator = 2

Data Accuracy: N/A

Measure Analysis Suggestions: None

Sampling: No.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

American Health Care Association/National Center for Assisted Living (AHCA/NCAL) https://www.ahcancal.org/Assisted-Living/About-NCAL/Pages/default.aspx

American Geriatrics Society 2023 updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. American Geriatrics Society Beers Criteria® Update Expert Panel. J Am Geriatr Soc. 2023;71(7):2052-2081.

Original Performance Measure Source / Developer: American Health Care Association/National Center for Assisted Living (AHCA/NCAL)