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.

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.

The no-cost PCC toolkit provides a new means to measure the quality of PCC delivery. As of February 2014, over 700 nursing homes have selected the Advancing Excellence in America's Nursing Homes PCC goal as a focus for quality improvement. The toolkit enables providers to incorporate quality improvement by moving beyond anecdote, and advancing more systematically toward honoring resident preferences.