title: Diffusion of palliative care in nursing homes: lessons from the culture change movement.
abstract: BACKGROUND
  Studies have found that nursing homes (NHs) that rely heavily on Medicaid funding are less likely to implement innovative approaches to care, such as palliative care (PC) or resident-centered approaches commonly referred to as "culture change" (CC). However, a nationally representative survey we previously conducted found that some high Medicaid facilities have implemented these innovative approaches.
  
  
  OBJECTIVE
  The purpose of this study was to identify the factors that enable some high Medicaid NHs to implement innovative approaches to care.
  
  
  METHODS
  We conducted telephone interviews with 16 NH administrators in four categories of facilities: 1) low PC and low CC, 2) low PC and high CC, 3) high PC and low CC, and 4) high PC and high CC. Interviews explored strategies used to overcome barriers to implementation and the resources needed for implementation.
  
  
  RESULTS
  We had expected to find differences between low and high NHs but instead found differences in NHs' experiences with CC and PC. Since the time of our national survey in 2009-2010, most previously low CC NHs had implemented at least some CC practices; however, we did not find similar changes around PC. Administrators reported numerous ways in which they had received information and assistance from outside entities for implementing CC. This was not the case for PC where administrators reported relying exclusively and heavily on hospices for both their residents' PC needs and information related to PC.
  
  
  CONCLUSIONS
  PC advocates could learn much from the CC model in which advocates have used multipronged efforts to institute reform.
authors.affiliation: Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA; Health Services Research Program, Providence Veterans Administration Medical Center, Providence, Rhode Island, USA. Electronic address: Denise_Tyler@Brown.edu.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Tyler
authors.affiliation: Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Renée R
authors.initials: RR
authors.lastname: Shield
authors.affiliation: Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
mesh_terms: D018864:Cultural Diversity; D004059:Diffusion of Innovation; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006707:Homes for the Aged; D008484:Medicaid / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: Nursing homes; diffusion of innovation; long-term care; palliative care; patient-centered care