Afendulis Christopher C, Caudry Daryl J, O'Malley A James, Kemper Peter, Grabowski David C
Department of Health Care Policy, Harvard Medical School, Boston, MA.
Geisel School of Medicine, The Dartmouth Institute, Dartmouth College, Lebanon, NH.
Health Serv Res. 2016 Feb;51 Suppl 1(Suppl 1):454-74. doi: 10.1111/1475-6773.12436. Epub 2016 Jan 6.
To evaluate the impact of the Green House (GH) model on nursing home resident-level quality of care measures.
DATA SOURCES/STUDY SETTING: Resident-level minimum data set (MDS) assessments merged with Medicare inpatient claims for the period 2005 through 2010.
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.
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.
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.
评估“绿屋”（GH）模式对疗养院居民层面护理质量指标的影响。
数据来源/研究背景：2005年至2010年期间居民层面的最低数据集（MDS）评估与医疗保险住院理赔数据合并。
采用双重差分框架，我们比较了15家采用GH模式的疗养院护理质量和结果的变化，以及223家同期未采用GH模式的匹配疗养院的变化情况。
对于居住在GH疗养院的个体，该模式的采用降低了再入院率以及多项质量不佳的MDS指标，包括卧床不起的居民、导尿管使用和压疮情况，但这些结果在整个GH机构中并不普遍，这表明GH机构内非GH“传统”单元的居民可能存在抵消效应。
采用GH模式使居住在GH疗养院的个体的再入院率和某些疗养院质量指标得到改善。GH疗养院没有其他临床质量指标下降的证据，这应能让任何担心GH可能为改善生活质量而牺牲临床质量的人放心。
