title: Green House Adoption and Nursing Home Quality.
abstract: OBJECTIVE
  To evaluate the impact of the Green House (GH) model on nursing home resident-level quality of care measures.
  
  
  METHODS
  Resident-level minimum data set (MDS) assessments merged with Medicare inpatient claims for the period 2005 through 2010.
  
  
  METHODS
  Using a difference-in-differences framework, we compared changes in care quality and outcomes in 15 nursing homes that adopted the GH model relative to changes over the same time period in 223 matched nursing homes that had not adopted the GH model.
  
  
  RESULTS
  For individuals residing in GH homes, adoption of the model lowered readmissions and several MDS measures of poor quality, including bedfast residents, catheter use, and pressure ulcers, but these results were not present across the entire GH organization, suggesting possible offsetting effects for residents of non-GH "legacy" units within the GH organization.
  
  
  CONCLUSIONS
  GH adoption led to improvement in rehospitalizations and certain nursing home quality measures for individuals residing in a GH home. The absence of evidence of a decline in other clinical quality measures in GH nursing homes should reassure anyone concerned that GH might have sacrificed clinical quality for improved quality of life.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Afendulis
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Caudry
authors.affiliation: Geisel School of Medicine, The Dartmouth Institute, Dartmouth College, Lebanon, NH.
authors.forename: A James
authors.initials: AJ
authors.lastname: O'Malley
authors.affiliation: The Pennsylvania State University, University Park, PA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kemper
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
mesh_terms: D000368:Aged; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D007345:Insurance Claim Review; D006278:Medicare / Q000191:economics; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D009936:Organizational Innovation; D010359:Patient Readmission; D018802:Patient-Centered Care / Q000379:methods; D011787:Quality of Health Care; D014481:United States
keywords: Green House nursing home; Nursing homes; culture change; quality of care