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Gerontologist. 2014 Feb;54 Suppl 1:S6-S16. doi: 10.1093/geront/gnt147.
Although nursing home culture change efforts are becoming more widespread, there have been few efforts to systematically compile the evidence related to the efficacy of culture change. This study uses an analytic framework to evaluate the existing evidence for the impact of culture change on nursing home quality. We focus on the nature and scope of culture change interventions, measurement of culture change and adherence to interventions, measurement of culture change outcomes, and the relationship between culture change and its outcomes.
We conducted a comprehensive review of peer-reviewed and gray literature published between 2005 and 2012 to identify intervention evaluations that addressed at least one culture change domain. Of 4,982 identified publications, 625 underwent full review; 27 peer-reviewed and 9 gray literature studies met inclusion criteria.
Studies varied widely in scope and outcomes. Most addressed more than one culture change domain; resident direction, home environment, and close relationships were most common. Few studies measured culture change implementation, but most used validated tools to measure outcomes. Although few studies reported negative outcomes, there was little consistent evidence of positive effects.
Nursing home culture change remains an evolving field. Although culture change has clear face validity, the current evidence does not give providers sufficient information for selecting interventions based on the expectation of improving outcomes. Rigorous research on implementation and outcomes of culture change is needed to determine the specific impact of culture change on quality and to provide guidance to providers and policy makers.
尽管养老院文化变革的努力越来越普遍，但很少有系统地整理与文化变革效果相关的证据的努力。本研究使用分析框架评估与文化变革对养老院质量的影响有关的现有证据。我们专注于文化变革干预措施的性质和范围、文化变革和干预措施遵守的测量、文化变革结果的测量以及文化变革与其结果之间的关系。
我们对 2005 年至 2012 年间发表的同行评审和灰色文献进行了全面审查，以确定至少涉及一个文化变革领域的干预评估。在确定的 4982 篇出版物中，有 625 篇经过了全面审查；27 篇同行评审和 9 篇灰色文献研究符合纳入标准。
研究在范围和结果上差异很大。大多数研究涉及多个文化变革领域；居民指导、家庭环境和密切关系最为常见。很少有研究测量文化变革的实施情况，但大多数都使用了经过验证的工具来测量结果。尽管很少有研究报告负面结果，但几乎没有确凿的证据表明有积极影响。
养老院文化变革仍然是一个不断发展的领域。尽管文化变革具有明显的合理性，但目前的证据并没有为提供者提供足够的信息，无法根据改善结果的预期来选择干预措施。需要对文化变革的实施和结果进行严格的研究，以确定文化变革对质量的具体影响，并为提供者和政策制定者提供指导。
