*Address correspondence to David C. Grabowski, Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115-5899. E-mail:
Gerontologist. 2014 Feb;54 Suppl 1:S35-45. doi: 10.1093/geront/gnt143.
Culture change models are intended to improve the quality of life for nursing home residents, but the impact of these models on quality of care is unknown. We evaluated the impact of the implementation of nursing home culture change on the quality of care, as measured by staffing, health-related survey deficiencies, and Minimum Data Set (MDS) quality indicators.
From the Pioneer Network, we have data on whether facilities were identified by experts as "culture change" providers in 2004 and 2009. Using administrative data, we employed a panel-based regression approach in which we compared pre-post quality outcomes in facilities adopting culture change between 2004 and 2009 against pre-post quality outcomes for a propensity score-matched comparison group of nonadopters.
Nursing homes that were identified as culture change adopters exhibited a 14.6% decrease in health-related survey deficiency citations relative to comparable nonadopting homes, while experiencing no significant change in nurse staffing or various MDS quality indicators.
This research represents the first large-scale longitudinal evaluation of the association of culture change and nursing home quality of care. Based on the survey deficiency results, nursing homes that were identified as culture change adopters were associated with better care although the surveyors were not blind to the nursing home's culture change efforts. This finding suggests culture change may have the potential to improve MDS-based quality outcomes, but this has not yet been observed.
文化变革模式旨在提高养老院居民的生活质量，但这些模式对护理质量的影响尚不清楚。我们评估了养老院文化变革的实施对护理质量的影响，其衡量标准是人员配备、与健康相关的调查缺陷以及最低数据集（MDS）质量指标。
我们从 Pioneer 网络中获得了关于设施在 2004 年和 2009 年是否被专家认定为“文化变革”提供者的数据。我们使用行政数据，采用基于面板的回归方法，比较了在 2004 年至 2009 年期间采用文化变革的设施的质量结果与采用文化变革的设施的质量结果进行比较。
被认定为文化变革采用者的养老院在与健康相关的调查缺陷引用方面相对可比的非采用者减少了 14.6%，而在护士人员配备或各种 MDS 质量指标方面没有发生显著变化。
这项研究代表了对文化变革与养老院护理质量关联的首次大规模纵向评估。基于调查缺陷结果，被认定为文化变革采用者的养老院与更好的护理相关，尽管调查人员对养老院的文化变革努力并不盲目。这一发现表明，文化变革有可能改善基于 MDS 的质量结果，但这尚未得到观察。
