title: A Longitudinal Assessment of the Effect of Resident-Centered Care on Quality in Veterans Health Administration Community Living Centers.
abstract: To examine whether changes in resident-centered care (RCC) over time were associated with changes in quality.
  
  
  
  Data sources were the Minimum Dataset quality indicators (which consist of measures of both prevalence and incidence of adverse events) and the Artifacts of Culture Change Tool (which measures RCC; FYs 2009-2012) from 130 Veterans Health Administration community living centers.
  
  
  
  A retrospective longitudinal study.
  
  
  
  Data were from VA secondary data sources.
  
  
  
  The overall relationship between RCC and quality was not statistically significant (p = .22), although there was a weakly significant negative relationship (i.e., increased RCC was associated with poorer quality) in the seven quarters after implementation of an automated version of the Artifacts Tool (p = .08). In facility-specific analyses, there were 15 facilities with a weakly significant (p < .10) positive relationship between RCC and quality and 21 with a weakly significant negative relationship. Adjusted cost per patient day was over 50 percent higher in the 21 facilities with a negative relationship than in the 15 facilities with a positive relationship (p < .05).
  
  
  
  The Artifacts score is a formal performance metric in the VA, and thus, facilities were explicitly incentivized to increase RCC. Using qualitative methods to identify characteristics that distinguished those facilities able to increase both RCC and quality from those that suffered declines in quality as RCC was improved is an important follow-up to this study.
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA.|Boston University School of Public Health, Boston, MA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sullivan
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA.|Boston University Questrom School of Management, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Shwartz
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Stolzmann
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Afable
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA.|Boston University School of Public Health, Boston, MA.
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
mesh_terms: D000368:Aged; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D015279:Organizational Culture; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration* / Q000592:standards
keywords: Nursing homes; Veterans Health Administration; quality; resident-centered care