Person-centered Care Practices and Quality in Department of Veterans Affairs Nursing Homes

Sullivan, Jennifer L.; Shwartz, Michael; Burgess, James; Peköz, Erol A.; Christiansen, Cindy L.; Gerena-Melia, Mariana; Berlowitz, Dan R.

doi:10.1097/mlr.0b013e3182763230

Cited by 31 publications

(43 citation statements)

References 13 publications

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“…27 Additionally, upon introduction of culture change, these NHs had a significant decrease in the proportion of residents with pressure ulcers and a small but marginally significant decrease in hospitalizations per resident year. With regard to pressure ulcers, a large study of Dutch NHs similarly found development of a resident council, which is an artifact of culture change, along with implementation of other quality initiatives, was associated with significant reduction in pressure ulcers.…”

Section: Discussionmentioning

confidence: 98%

Does the Introduction of Nursing Home Culture Change Practices Improve Quality?

Miller¹,

Lepore

Lima³

et al. 2014

J American Geriatrics Society

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Objectives To understand whether nursing home (NH) introduction of culture change practices is associated with improved quality Design NH-level panel study using multivariate fixed-effects statistical modeling to estimate the effect of culture change introduction on quality outcomes Setting and Participants 824 U.S. NHs with culture change practice involvement beginning between 2005 and 2010 Measurements A culture change practice score (derived from a 2009/10 national NH survey) was used to stratify analyses by NHs with high practice implementation (scores in the top quartile; n=217) versus other NHs (n=607). NH-level outcomes included 1) prevalence of seven care practices and three resident outcomes; 2) a NH’s health-related and quality-of-life weighted survey deficiencies; and, 3) the average number of hospitalizations per resident year. Results For NHs with high practice implementation, introduction of culture change was associated with a significant decrease in the prevalence of restraints, tube feeding and pressure ulcers; an increase in the proportion of residents on bladder training programs; and, a small decrease in the average number of hospitalizations per resident year (coefficient −0.04, standard error (SE) 0.022; p=0.06). For NHs having lower practice implementation (practice scores in lower-three quartiles), introduction was associated with fewer health-related (coefficient −5.26; SE 3.05; p=0.09) and quality-of-life (coefficient −0.10; SE 0.049; p=0.04) survey deficiencies. However, these NHs also had small statistically significant increases in the prevalence of residents with urinary tract infections and in the average hospitalizations per resident year (coefficient 0.03; SE 0.014; p=0.02). Conclusion The introduction of NH culture change appears to result in significant improvements in some care processes and outcomes in NHs having high practice implementation. For other NHs, culture change introduction results in fewer survey deficiencies.

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Section: Discussionmentioning

confidence: 98%

Does the Introduction of Nursing Home Culture Change Practices Improve Quality?

Miller¹,

Lepore

Lima³

et al. 2014

J American Geriatrics Society

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“…These initiatives were generally designed to foster homelike environment in nursing homes, residents’ quality of life, individualized care, and engagement of residents and families, all embraced as essential components of the “Cultural Change” movement in nursing homes (Koren, 2010; White et al, 2012; Sullivan, Shwartz, Burgess, Pekoz, and Christiansen et al, 2013). …”

Section: Introductionmentioning

confidence: 99%

Associations Between Family Ratings on Experience With Care and Clinical Quality-of-Care Measures for Nursing Home Residents

Tang

2015

Med Care Res Rev

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Several states are currently collecting and publicly reporting nursing home resident and/or family member ratings of experience with care in an attempt to improve person-centered care in nursing homes. Using the 2008 Maryland nursing home family survey reports and other data, this study performed both facility- and resident-level analyses, and estimated the relationships between family ratings of care and several long-term care quality measures (pressure ulcers, overall and potentially-avoidable hospitalizations, and mortality) after adjustment for resident characteristics. We found that better family evaluations of overall and specific aspects of care may be associated with reduced rates of risk-adjusted measures at the facility level (range of correlation coefficients: −0.01 to −0.31). Associations of overall experience ratings tended to persist after further adjustment for common nursing home characteristics such as nurse staffing levels. We conclude that family ratings of nursing home care complement other types of performance measures such as risk-adjusted outcomes.

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“…Nursing home structural characteristics (e.g. profit status) (Hillmer et al 2005) and philosophical orientation (Grabowski et al 2014; Sullivan et al 2013) have been linked to quality. Higher quality has been linked to lower CNA turnover and absenteeism (Castle, Engberg, and Men 2007) which could impact staffing practices.…”

Section: Discussionmentioning

confidence: 99%

Exploring Variation in Certified Nursing Assistant Assignments From the Perspective of Nursing Home Residents: A Comparison of Adopters and Nonadopters of Consistent Assignment

2017

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Objective To describe and compare certified nursing assistant (CNA) staffing between adopter and non-adopters of consistent assignment. Data sources One month of pre-existing CNA assignment and scheduling sheets from a purposive sample of 30 homes. Study design A descriptive comparative study was conducted to calculate and compare numbers of CNAs assigned per resident across homes. Data extraction Resident names and CNA assignments were abstracted from assignment records and entered into the Advancing Excellence consistent assignment tool to calculate numbers of CNAs assigned per resident. Principal findings Both variation and overlap existed in the number of CNAs per resident within and between homes. Adopters assigned significantly fewer CNAs per resident. Conclusions Research is needed to determine how assignment variations impact resident perceptions of quality.

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Person-centered Care Practices and Quality in Department of Veterans Affairs Nursing Homes

Abstract: Our results indicate that culture change to a PCC model is associated with higher Minimum Data Set-based quality. Longitudinal data are needed to better assess whether there is a causal relationship between the extent of culture change and quality.

Cited by 31 publications

References 13 publications

Does the Introduction of Nursing Home Culture Change Practices Improve Quality?

Does the Introduction of Nursing Home Culture Change Practices Improve Quality?

Associations Between Family Ratings on Experience With Care and Clinical Quality-of-Care Measures for Nursing Home Residents

Exploring Variation in Certified Nursing Assistant Assignments From the Perspective of Nursing Home Residents: A Comparison of Adopters and Nonadopters of Consistent Assignment

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