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. (American Health Care Association/National Center for Assisted Living [AHCA/NCAL], 2024). 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 American Geriatrics Society Beers Criteria® Update Expert Panel (2023) continues to stress the need to avoid antipsychotics and other medications for behavioral problems of dementia and delirium as their use is frequently associated with harm. 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 (Rashid et al., 2022). They increase the risk of death, falls and fractures, hospitalizations, and other complications resulting in poor health and high costs. (American Geriatrics Society Beers Criteria® Update Expert Panel, 2023).

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 Geriatrics Society Beers Criteria® Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71 (7), 2052–2081. https://doi.org/10.1111/jgs.18372
• American Health Care Association/National Center for Assisted Living. (2024, January 25). Just the facts: Assisted living is a safe, high- quality long-term care option for America’s seniors. https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Just-The-Facts-Assisted-Living-Is-A-Safe,-High-Quality-Long-Term-Care-Option-For-America’s-Seniors.aspx
• Rashid, N., Wetmore, J. B., Irfan, M., & Abler, V. (2022). Adverse outcomes associated with off-label agents used to treat dementia patients with psychosis: A case-control Medicare database study. American Journal of Alzheimer’s Disease & Other Dementias, 37. https://doi.org/10.1177/15333175221081374

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