LiveWell Institute, Southington, Connecticut.
Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island.
Gerontologist. 2020 Nov 23;60(8):1411-1423. doi: 10.1093/geront/gnaa063.
Nursing home (NH) adoption of culture change practices has substantially increased in recent decades. We examined how increasing adoption of culture change practices affected the prevalence of health, severe health, and quality of life (QoL) deficiencies.
Novel data on culture change practice adoption from a nationally representative NH panel (N = 1,585) surveyed in 2009/2010 and 2016/2017 were used to calculate change in practice adoption scores in 3 culture change domains (resident-centered care, staff empowerment, physical environment). These data were linked to data on health, severe health, and QoL deficiencies and facility-level covariates. Multinomial logistic regression models, with survey weights and inverse probability of treatment weighting, examined how increased culture change practice adoption related to change in deficiencies.
We generally observed less increase in deficiencies when culture change practices increased. However, after weighting and controlling for baseline deficiencies and culture change scores, we found few statistically significant effects. Still, results show increased physical environment practices resulted in a higher likelihood of decreases or no change (vs increases) in QoL deficiencies; increased resident-centered care practices resulted in decreases or no change (vs increases) in health deficiencies; and increased staff empowerment practices resulted in a higher likelihood of no change (vs increases) in severe health deficiencies.
This study provides some evidence that culture change practices can help reduce the risk of increasing some types of deficiencies, but the impact of increases in each culture change domain related differently to different types of deficiencies.
在最近几十年中，养老院（NH）采用文化变革实践的情况大幅增加。我们研究了文化变革实践的采用率如何增加对健康、严重健康和生活质量（QoL）缺陷的流行程度的影响。
利用来自全国代表性 NH 小组（N = 1585）的关于文化变革实践采用的新颖数据，这些数据是在 2009/2010 年和 2016/2017 年进行调查的，用于计算 3 个文化变革领域（以居民为中心的护理、员工赋权、物理环境）中实践采用评分的变化。这些数据与健康、严重健康和 QoL 缺陷以及设施水平协变量的数据相关联。使用多项逻辑回归模型，结合调查权重和治疗反概率加权，研究了文化变革实践采用率的增加与缺陷变化之间的关系。
我们通常观察到，随着文化变革实践的增加，缺陷的增加幅度较小。然而，在加权和控制基线缺陷和文化变革评分后，我们发现很少有统计学上显著的影响。尽管如此，结果表明增加物理环境实践增加了 QoL 缺陷减少或不变（与增加相比）的可能性；增加以居民为中心的护理实践减少了健康缺陷的增加（与增加相比）；增加员工赋权实践增加了严重健康缺陷不变（与增加相比）的可能性。
本研究提供了一些证据表明，文化变革实践可以帮助降低某些类型的缺陷增加的风险，但每个文化变革领域的增加对不同类型的缺陷的影响不同。
