title: New Evidence on the Green House Model of Nursing Home Care: Synthesis of Findings and Implications for Policy, Practice, and Research.
abstract: OBJECTIVE
  To synthesize new findings from the THRIVE Research Collaborative (The Research Initiative Valuing Eldercare) related to the Green House (GH) model of nursing home care and broadly consider their implications.
  
  
  METHODS
  Interviews and observations conducted in GH and comparison homes, Minimum Data Set (MDS) assessments, Medicare data, and Online Survey, Certification and Reporting data.
  
  
  METHODS
  Critical integration and interpretation of findings based on primary data collected 2011-2014 in 28 GH homes (from 16 organizations), and 15 comparison nursing home units (from 8 organizations); and secondary data derived from 2005 to 2010 for 72 GH homes (from 15 organizations) and 223 comparison homes.
  
  
  RESULTS
  Implementation of the GH model is inconsistent, sometimes differing from design. Among residents of GH homes, adoption lowers hospital readmissions, three MDS measures of poor quality, and Part A/hospice Medicare expenditures. Some evidence suggests the model is associated with lower direct care staff turnover.
  
  
  CONCLUSIONS
  Recommendations relate to assessing fidelity, monitoring quality, capitalizing opportunities to improve care, incorporating evidence-based practices, including primary care providers, supporting high-performance workforce practices, aligning Medicare financial incentives, promoting equity, informing broad culture change, and conducting future research.
authors.affiliation: Cecil G. Sheps Center for Health Services Research and School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.affiliation: School of Nursing, University of Wisconsin-Madison, Madison, WI.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Bowers
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Lauren W
authors.initials: LW
authors.lastname: Cohen
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.affiliation: Health System Innovation and Research Program, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.affiliation: Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kemper
mesh_terms: D035843:Biomedical Research; D006291:Health Policy; D006801:Humans; D006278:Medicare / Q000191:economics; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000379:methods; D011787:Quality of Health Care; D014481:United States
keywords: Green House; culture change; evidence; nursing home; outcomes