title: Does the introduction of nursing home culture change practices improve quality?
abstract: OBJECTIVE
  To understand whether nursing home (NH) introduction of culture change practices is associated with improved quality.
  
  
  METHODS
  NH-level panel study using multivariate fixed-effects statistical modeling to estimate the effect of culture change introduction on quality outcomes.
  
  
  METHODS
  Eight hundred twenty-four U.S. NHs with culture change practice involvement beginning between 2005 and 2010.
  
  
  METHODS
  Directors of nursing and nursing home administrators.
  
  
  METHODS
  A culture change practice score (derived from a 2009/10 national NH survey) was used to stratify NHs according to practice implementation (high (scores in the top quartile; n = 217) vs other (n = 607)). NH-level outcomes included prevalence of seven care practices and three resident outcomes, health-related and quality-of-life weighted survey deficiencies, and 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 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) 0.02, P = .06). For NHs with lower practice implementation (practice scores in lower three quartiles), introduction was associated with fewer health-related (coefficient -5.26, SE 3.05; P = .09) and quality-of-life (coefficient -0.10, SE 0.05; P = .04) survey deficiencies, although these NHs also had small statistically significant increases in the prevalence of residents with urinary tract infections and in average hospitalizations per resident year (coefficient 0.03, SE 0.01, P = .02).
  
  
  CONCLUSIONS
  The introduction of NH culture change appears to result in significant improvements in some care processes and outcomes in NHs with high practice implementation. For other NHs, culture change introduction results in fewer survey deficiencies.
authors.affiliation: Center for Gerontology and Health Care Research; Department of Health Services, Policy and Practice.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
authors.forename: Michael
authors.initials: M
authors.lastname: Lepore
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lima
authors.forename: Renee
authors.initials: R
authors.lastname: Shield
authors.forename: Denise A
authors.initials: DA
authors.lastname: Tyler
mesh_terms: D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005242:Fecal Incontinence / Q000453:epidemiology / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000458:organization & administration*; D015279:Organizational Culture; D009936:Organizational Innovation; D018802:Patient-Centered Care; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control; D058996:Quality Improvement; D011787:Quality of Health Care; D011788:Quality of Life; D012149:Restraint, Physical / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology / Q000517:prevention & control; D014552:Urinary Tract Infections / Q000453:epidemiology
keywords: culture change; nursing home; outcomes