After the implementation of the Centers for Medicare and Medicaid Services’ (CMS) public reporting of nursing home antipsychotic use, the proportion of residents with different forms of dementia also diagnosed with schizophrenia increased—and more so among patients who were Black compared with White. Researchers published their findings in The American Journal of Geriatric Psychiatry. 

“Future research is needed to examine the root cause for this increase,” researchers wrote, “and to re-examine policies that may incentivize inaccurate diagnosis and exacerbate racial disparities in nursing home care.”

The study included nearly 3 million long-stay nursing home residents with different forms of dementia. Researchers linked the Minimum Data Set and Medicare Master Beneficiary Summary File for the years 2011 through 2017 to investigate the prevalence of schizophrenia diagnosis and race variables. Under current CMS policy, nursing homes are not penalized for antipsychotic use for residents with schizophrenia diagnosis codes.

Tools for Assessing Cognition in Patients With Schizophrenia

The frequency of schizophrenia diagnosis codes among residents with different forms of dementia grew steadily throughout the study period, researchers found. The likelihood of having schizophrenia diagnosis increased 1.9 percentage points from 2011 to 2017 among patients with dementia who were White, and an additional 1.3 percentage points beyond that for patients with dementia who were Black.

In facilities with the highest percentages of Black residents, the increased likelihood of having a schizophrenia diagnosis code was 2.6 percentage points higher than nursing homes with lowest percentages of patients who were Black. Even within individual nursing homes, schizophrenia diagnosis trends were greater among black patients, according to the study.

“The increase in the diagnosis of schizophrenia, if motivated by the CMS’ antipsychotic reduction policy, may result in residents being exposed to treatment with significant risks of adverse effects and poor health outcomes that further exacerbate the long-standing racial disparities in care quality among nursing home residents with [different forms of dementia].”

Reference

Cai S, Wang S, Yan D, Conwell Y, Temkin-Greener H. The diagnosis of schizophrenia among nursing home residents with ADRD: does race matter? The American Journal of Geriatric Psychiatry. Published online October 26, 2021. doi: https://doi.org/10.1016/j.jag