The Benefits of Culture Change in Nursing Homes-Obtaining Nationally Representative Evidence.
Julie C Lima, Pedro Gozalo, Melissa A Clark and 2 others
PMID 34425098WHAT IT FOUND
Nursing homes with self-reported increases in culture change did not have better resident quality outcomes than homes without increases.
Pressure ulcers, function, restraints, antipsychotics, infections, and locomotion were not better.
Key findings
01A single model was significant before adjustment, and it was not in the expected direction.
02All outcomes except worsening locomotion improved in both groups.
03The largest difference was worsening locomotion, but it did not remain significant after adjustment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Culture change was measured from administrator surveys, not direct observation, so homes may have reported practices differently than they were carried out. The study was observational, so homes were not randomly assigned to increase culture change, and other differences may have affected outcomes. Outcomes were limited to selected CMS quality indicators; quality of life and psychosocial outcomes were not examined. MDS data quality was poor during the transition period, so the team adjusted index dates. Many models were tested, and the only significant finding before adjustment was unexpected and likely spurious. Control homes also improved, possibly because of CMS quality monitoring, which may have reduced differences.
Declared interests
The supplied metadata lists NIH extramural research support. The article says CMS data were used under a Data Use Agreement and Brown University approved waivers. No author conflict-of-interest statement is included in the supplied text.
The easy way to misread this
Do not conclude that culture change cannot help nursing home residents. This study tested self-reported facility changes, not directly observed care, and it looked only at selected quality indicators; homes in both groups improved.