The Kansas PEAK 2.0 Program Facilitates the Diffusion of Culture-Change Innovation to Unlikely Adopters

Hermer, Linda; Cornelison, Laci; Kaup, Migette L.; Poey, Judith L.; Stone, Robyn; Doll, Gayle

doi:10.1093/geront/gnw210

Cited by 16 publications

(18 citation statements)

References 14 publications

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“…Higher-tier NHs (i.e., those with greater financial resources and higher quality outcomes)(12) appear to have been early adopters of culture change transformation. (13, 14) In comparing NHs identified as “culture change providers” to non-identified NHs, Grabowski and colleagues(13) found culture change providers were more often nonprofit and affiliated with continuing care retirement communities (CCRCs), had more private-pay residents, higher nurse aide staffing rates, and fewer healthcare survey deficiencies. Additionally, this study and another(15) found higher adoption was associated with NHs being in states with higher Medicaid rates and with pay-for-performance (p4p) reimbursement programs that included culture change quality measures.…”

Section: Introductionmentioning

confidence: 99%

“…In fact, a study of culture change adoption in Kansas (that has such a Medicaid p4p program) found that over time the p4p program was successful in expanding culture change adoption to NHs more representative of the states’ NHs as a whole, compared to the Kansas’ early adopters that were disproportionately higher-tier NHs. (14)…”

Section: Introductionmentioning

confidence: 99%

“…(4, 5) Using nationally representative NH survey data linked to other NH-, county-, and state-level information, we examine characteristics associated with greater practice implementation. Of particular interest is whether NHs with greater culture change practice implementation still represent higher tier NHs, (12–14, 17) and whether Medicaid p4p programs continue to be associated with greater practice implementation. (13, 15)…”

Section: Introductionmentioning

confidence: 99%

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The Prevalence of Culture Change Practice in US Nursing Homes

et al. 2018

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Background and Objectives: Given the dynamic nursing home (NH) industry and evolving regulatory environment, depiction of contemporary NH culture-change (person/resident-centered) care practice is of interest. Thus, we aimed to portray the 2016/17 prevalence of NH culture change-related processes and structures and to identify factors associated with greater practice prevalence. Research Design and Methods: We administered a nationwide survey to 2,142 NH Administrators (NHA) at NHs previously responding to a 2009/10 survey. Seventy-four percent of administrators (1,583) responded (with no detectable non-response bias) enabling us to generalize (weighted) findings to US NHs. From responses, we created index scores for practice domains of resident-centered care, staff empowerment, physical environment, leadership, and family and community engagement. Facility-level covariate data came from the survey and the Certification and Survey Provider Enhanced Reporting system. Ordered logistic regression identified the factors associated with higher index scores. Results: Eighty-eight percent of administrators reported some facility-level involvement in NH culture change, with higher reported involvement consistently associated with higher domain index scores. NHs performed the best (82.6 /100 weighted points) on the standardized resident-centered care practices index, and had the lowest scores (54.8) on the family and community engagement index. Multivariable results indicate higher index scores in NHs with higher leadership scores and in states having Medicaid pay-for-performance with culture change-related quality measures. Conclusion: The relatively higher resident-centered care scores (compared to other domain scores) suggest an emphasis on person-centered care in many US NHs. Findings also support pay-for-performance as a potential mechanism to incentivize preferred NH practice.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Prevalence of Culture Change Practice in US Nursing Homes

et al. 2018

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“…In addition, homes should be provided with objective feedback on their progress rather than relying on their self-assessments, which could be done by relatively inexpensive means, for example, video conferences. Finally, policymakers should offer financial incentives that are sizable enough to attract for-profit nursing homes, as the Kansas program has succeeded in doing (Hermer et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…A set of potential confounder variables (Table 1) was chosen because they had previously been shown to distinguish culture change adopters from nonadopters and to be associated with nursing home quality of care (as discussed at length in Hermer et al, 2017). They were included in all analysis models as potential confounders.…”

Section: Methodsmentioning

confidence: 99%

Person-Centered Care as Facilitated by Kansas’ PEAK 2.0 Medicaid Pay-for-Performance Program and Nursing Home Resident Clinical Outcomes

Hermer

Cornelison

Kaup

et al. 2018

Innovation in Aging

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Purpose of the StudyPerson-centered care (PCC) is intended to improve nursing home residents’ quality of life, but the closer bonds it engenders between residents and staff may also facilitate improvements to residents’ clinical health. Findings on whether adoption ameliorates resident clinical outcomes are conflicting, with some evidence of harm as well as benefit. To provide clearer evidence, the present study made use of Kansas’ PEAK 2.0 Medicaid pay-for-performance (P4P) program, which incents the adoption of PCC. The program is distinctive in training facilities’ staff on adopting PCC through a series of well-defined stages and providing regular feedback about their progress.Design and MethodsA retrospective cohort study was performed with 349 Kansas facilities spread across several well-defined PCC adoption stages, ranging from nonadoption to comprehensive adoption. The outcomes were thirteen 2014–2016 Nursing Home Compare long-stay resident clinical measures and a composite measure incorporating only nonimputed data for those 13 outcomes. Observed facility demographic differences were controlled for with propensity score adjustment. Treatment effect analyses were run with each outcome, with the predictor variable of program stage.ResultsSeven of the 13 clinical measures plus the composite measure indicated better health for residents in homes at higher program stages, relative to those in nonparticipating homes, including a 49% lower prevalence of major depressive symptoms in strongly adopting facilities.ImplicationsThe findings suggest that greater PCC adoption through PEAK participation is associated with better quality of care. Policymakers in other states may want to consider implementing a program modeled on PEAK 2.0.

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