*Address correspondence to David C. Grabowski, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899. E-mail:
Gerontologist. 2014 Feb;54 Suppl 1:S65-75. doi: 10.1093/geront/gnt144.
A key directive of the Affordable Care Act of 2010 is to transform both institutional and community-based long-term care into a more person-centered system. In the nursing home industry, the culture change movement is central to this shift in philosophy. If policymakers are to further encourage implementation of culture change, they need to better understand the factors associated with implementation.
Using logistic regression (N = 16,835), we examined the extent to which resident, facility, and state characteristics relate to a nursing home being identified by experts as having implemented culture change over the period 2004 through 2011.
At baseline, the 291 facilities that were later identified by experts to have implemented culture change were more often nonprofit-owned, larger in size, and had fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. States experienced greater culture change implementation when they paid a higher Medicaid per diem.
To date, nursing home culture change has been implemented differentially by higher resource facilities, and nursing homes have been responsive to state policy factors when implementing culture change.
2010 年平价医疗法案的一个主要指令是将机构和社区为基础的长期护理转变为更加以患者为中心的系统。在养老院行业，文化变革运动是这一理念转变的核心。如果政策制定者要进一步鼓励文化变革的实施，他们需要更好地理解与实施相关的因素。
使用逻辑回归（N=16835），我们研究了居民、设施和州的特征与养老院被专家确定为在 2004 年至 2011 年期间实施文化变革的程度之间的关系。
在基线时，后来被专家确定为已经实施文化变革的 291 家设施通常是非营利性的，规模更大，拥有较少的医疗补助和医疗保险居民。实施者还具有更好的基线质量，健康相关调查缺陷较少，持照实用护士和护士助理的配置更多。当各州支付更高的医疗补助每日费用时，文化变革的实施程度更高。
迄今为止，护理院文化变革已在资源更丰富的机构中得到不同程度的实施，并且护理院在实施文化变革时对州政策因素做出了响应。
