Culture Change and Nursing Home Quality of Care

Grabowski, David C.; O’Malley, A. James; Afendulis, Christopher C.; Caudry, Daryl J.; Elliot, Amy; Zimmerman, Sheryl

doi:10.1093/geront/gnt143

Cited by 109 publications

(99 citation statements)

References 12 publications

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“…30 Notably, in the year prior to culture change implementation, these NHs also had high health and quality of life deficiencies (45.9 and 0.7, respectively) compared to NHs with high culture change implementation (41.2 and 0.6). Thus, these reductions in deficiencies brought them in line with the deficiency levels of NHs with higher implementation.…”

Section: Discussionmentioning

confidence: 93%

Does the Introduction of Nursing Home Culture Change Practices Improve Quality?

Miller¹,

Lepore

Lima³

et al. 2014

J American Geriatrics Society

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Objectives To understand whether nursing home (NH) introduction of culture change practices is associated with improved quality Design NH-level panel study using multivariate fixed-effects statistical modeling to estimate the effect of culture change introduction on quality outcomes Setting and Participants 824 U.S. NHs with culture change practice involvement beginning between 2005 and 2010 Measurements A culture change practice score (derived from a 2009/10 national NH survey) was used to stratify analyses by NHs with high practice implementation (scores in the top quartile; n=217) versus other NHs (n=607). NH-level outcomes included 1) prevalence of seven care practices and three resident outcomes; 2) a NH’s health-related and quality-of-life weighted survey deficiencies; and, 3) the average number of hospitalizations per resident year. Results For NHs with high practice implementation, introduction of culture change was associated with a significant decrease in the prevalence of restraints, tube feeding and pressure ulcers; an increase in the proportion of residents on bladder training programs; and, a small decrease in the average number of hospitalizations per resident year (coefficient −0.04, standard error (SE) 0.022; p=0.06). For NHs having lower practice implementation (practice scores in lower-three quartiles), introduction was associated with fewer health-related (coefficient −5.26; SE 3.05; p=0.09) and quality-of-life (coefficient −0.10; SE 0.049; p=0.04) survey deficiencies. However, these NHs also had small statistically significant increases in the prevalence of residents with urinary tract infections and in the average hospitalizations per resident year (coefficient 0.03; SE 0.014; p=0.02). Conclusion The introduction of NH culture change appears to result in significant improvements in some care processes and outcomes in NHs having high practice implementation. For other NHs, culture change introduction results in fewer survey deficiencies.

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Section: Discussionmentioning

confidence: 93%

Does the Introduction of Nursing Home Culture Change Practices Improve Quality?

Miller¹,

Lepore

Lima³

et al. 2014

J American Geriatrics Society

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“…Previous work described the association between quality of care and staffing patterns, 41e44 and quality of care and designation as a successful "culture change" site, 45,46 as well as the importance of nursing homes as an end-of-life setting. 4,38,43,47 However, no reports have focused explicitly on associations between organizational context and symptom burden or trajectories of symptom burden in the last year of life.…”

Section: Practice and Policy Implicationsmentioning

confidence: 99%

Dying in a Nursing Home: Treatable Symptom Burden and its Link to Modifiable Features of Work Context

Estabrooks

Hoben

Poss

et al. 2015

Journal of the American Medical Directors Association

101

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Symptom burden increases as the end of life approaches but differs between high- and low-context facilities and between residents with and without dementia. Trajectories of treatable, burdensome symptoms at the end of life in nursing homes should be a priority focus for quality improvement. Modifiable features of organizational context that are linked to symptom burden offer new potential strategies and interventions for quality improvement.

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“…Five-star quality rating information was used for the known group comparison as a part of the construct validity, given that nursing homes with better care are likely to incorporate personcentered care (Edvardsson et al, 2009;Grabowski et al, 2014). The Nursing Home Compare website from the Center for Medicare and Medicaid Services (CMS) provides a rating for each nursing home with one to five stars to help consumers, their families, and caregivers easily compare nursing home quality (www.medicare.gov/nursinghomecompare).…”

Section: Five-star Quality Rating Systemmentioning

confidence: 99%