CALTCM leaders, including Deb Bakerjian, Karl Steinberg, Janice Hoffman and I, actively participated in round two of all-day meetings of the California Partnership to Improve Dementia Care.  The meetings, July in Sacramento, Glendale late August, are a continuation of the work of the Centers for Medicare & Medicaid Services Region IX (CMS), the California Department of Public Health (CDPH) and a diverse group of stakeholders which launched the California Partnership to Improve Dementia Care and Reduce Unnecessary Antipsychotic Medication Drug Use in Nursing Homes in 2012.

The goal of the partnership was to reduce the use of antipsychotic medication by at least 15 percent by December 31, 2012, and by at least 30 percent by June 30, 2013.  The California Culture Change Coalition volunteered to serve as lead for the next phase of the partnership together with a broad group of diverse yet committed partnership stakeholders—also including our friends at CAHF, HSAG, and the consumer advocacy group, CANHR.              

The Partnership is focused on one goal: Reducing Inappropriate Psychotropic Drug Use in Elder Care. Work groups include: Consumer Awareness, Education, Enforcement, and Informed Consent.

It’s quite interesting to participate in discussions with a room full of  top decision makers from among high level federal and state enforcers, advocacy organizations, provider associations, and providers, and the Boards of Nursing, Pharmacy and Medicine. A serious group bent on a serious mission.

The early numbers are trickling in… psychotropic medication use in the presence of a dementia diagnosis has decreased statewide. (15.6%*) California nationwide is doing better than other states by a wide margin, in psychotropic drug reduction, even after the adjustments for size/population/number of skilled beds per capita and other data points. (2013 Q1 National “Off  Label Psychotropic Drug Use =21.5; CA average 17.1%*)  (*Source: CMS Nursing Home Compare Quality Measure, 2013.)

California, however, still has pockets of high use and despite the very laudable reductions; there is still work to be done and more successful reductions on the horizon.

Each stakeholder brings the expertise and resources of their organization to the table. Ideas fly quickly. Discussion is lively. Many points of view are considered.  Connections are made; business cards are exchanged.  It is not only about the use of these dangerous drugs, but about the overall improvement in care provided to each individual with dementia in our long term health care system.  At the end of the day, on both days, the amount of work done in such a short time seemed almost as overwhelming as the amount of work left to do.

Focusing leadership attention and the new quality assessment performance improvement process (QAPI) on individual facility or practice group off label psychotropic drug use is a great start to improve dementia care and answer surveyor interest in these dangerous drugs.

The Partnership is being convened primarily by the Culture Change Coalition of California, on which I have the privilege of serving as a Board member, as does John Fullerton (also on CALTCM’s Board).  It appears that the Culture Change Coalition and the other stakeholders present at the meeting recognized the brain trust and track record CALTCM has demonstrated in process improvement, and funding to carry practical messages out to the homes is anticipated for CALTCM’s assistance with this worthy endeavor.  A final stakeholder summary meeting occurs September 26th. Through this Partnership, we at CALTCM are hoping for more opportunities to share our expertise with our LTC colleagues.