Culture change and nursing home quality of care.
OBJECTIVE
Culture change models are intended to improve the quality of life for nursing home residents, but the impact of these models on quality of care is unknown. We evaluated the impact of the implementation of nursing home culture change on the quality of care, as measured by staffing, health-related survey deficiencies, and Minimum Data Set (MDS) quality indicators.


METHODS
From the Pioneer Network, we have data on whether facilities were identified by experts as "culture change" providers in 2004 and 2009. Using administrative data, we employed a panel-based regression approach in which we compared pre-post quality outcomes in facilities adopting culture change between 2004 and 2009 against pre-post quality outcomes for a propensity score-matched comparison group of nonadopters.


RESULTS
Nursing homes that were identified as culture change adopters exhibited a 14.6% decrease in health-related survey deficiency citations relative to comparable nonadopting homes, while experiencing no significant change in nurse staffing or various MDS quality indicators.


CONCLUSIONS
This research represents the first large-scale longitudinal evaluation of the association of culture change and nursing home quality of care. Based on the survey deficiency results, nursing homes that were identified as culture change adopters were associated with better care although the surveyors were not blind to the nursing home's culture change efforts. This finding suggests culture change may have the potential to improve MDS-based quality outcomes, but this has not yet been observed.
*Address correspondence to David C. Grabowski, Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115-5899. E-mail: grabowski@med.harvard.edu.
David C
DC
Grabowski
A James
AJ
O'Malley
Christopher C
CC
Afendulis
Daryl J
DJ
Caudry
Amy
A
Elliot
Sheryl
S
Zimmerman
D000368:Aged; D000369:Aged, 80 and over; D006306:Health Surveys; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration*; D015279:Organizational Culture; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000379:methods*; D011787:Quality of Health Care / Q000592:standards*
Nursing homes; Person-centered care; Quality of care