title: Person-centered care practices and quality in Department of Veterans Affairs nursing homes: is there a relationship?
abstract: OBJECTIVE
  To examine variation in culture change to a person-centered care (PCC) model, and the association between culture change and a composite measure of quality in 107 Department of Veterans Affairs nursing homes.
  
  
  METHODS
  We examined the relationship between a composite quality measure calculated from 24 quality indicators (QIs) from the Minimum Data Set (that measure unfavorable events), and PCC summary scores calculated from the 6 domains of the Artifact of Culture Change Tool, using 3 different methods of calculating the summary scores. We also use a Bayesian hierarchical model to analyze the relationship between a latent construct measuring extent of culture change and the composite quality measure.
  
  
  RESULTS
  Using the original Artifacts scores, the highest performing facility has a 2.9 times higher score than the lowest. There is a statistically significant relationship between the composite quality measure and each of the 3 summary Artifacts scores. Depending on whether original scores, standardized scores, or optimal scores are used, a facility at the 10th percentile in terms of culture change compared with one at the 90th percentile has 8.0%, 8.9%, or 10.3% more QI events. When PCC implementation is considered as a latent construct, 18 low performance PCC facilities have, on an average, 16.3% more QI events than 13 high performance facilities.
  
  
  CONCLUSIONS
  Our results indicate that culture change to a PCC model is associated with higher Minimum Data Set-based quality. Longitudinal data are needed to better assess whether there is a causal relationship between the extent of culture change and quality.
authors.affiliation: Center for Organization, Leadership and Management Research, VA Boston Healthcare System, Boston, MA 02130, USA. jennifer.sullivan@va.gov
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sullivan
authors.forename: Michael
authors.initials: M
authors.lastname: Shwartz
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
authors.forename: Erol A
authors.initials: EA
authors.lastname: Peköz
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Christiansen
authors.forename: Mariana
authors.initials: M
authors.lastname: Gerena-Melia
authors.forename: Dan
authors.initials: D
authors.lastname: Berlowitz
mesh_terms: D001499:Bayes Theorem; D003953:Diagnosis-Related Groups; D006302:Health Services Research; D006801:Humans; D009735:Nursing Homes / Q000592:standards*; D015279:Organizational Culture; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs