Nursing Home Culture Change Reduced Hospitalizations, Feeding Tubes and Bedsores

dr_susan_millerMedicalResearch.com Interview with:
Susan Miller, PhD
Professor of Health Services, Practice and Policy (Research) at the Center for Gerontology and Health Care Research
The Warren Alpert Medical School of Brown University

Medical Research: What are the main findings of the study?

Prof. Miller:  Upon introduction of culture change, the nursing homes that implemented culture change most extensively produced statistically significant improvements in the percent of residents on bladder training programs, the percent of residents who required restraints, the proportion of residents with feeding tubes, and the percent with pressure ulcers. They also showed a nearly significant reduction in resident hospitalizations. No quality indicator became significantly worse.

Among homes that implemented less culture change, the only significant improvement occurred in the number of Medicare/Medicaid health-related and quality of life survey deficiencies. Urinary tract infections and hospitalizations got slightly worse.


Medical Research: Were any of the findings unexpected?

Prof. Miller:  The large difference in the findings in nursing homes with extensive culture change practice implementation versus in homes with some but less extensive implementation was not totally expected. However, these findings may help to explain some of the previous equivocal findings from quality studies when the extent of culture change practice implementation was not considered or measured.

Medical Research: What should clinicians and patients take away from your report?

Prof. Miller:  The results help affirm that culture change can be effective in improving quality in nursing homes when the staff has embraced its resident-centered, flatter-management philosophy.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. Miller:  Future longitudinal studies examining the association between change in the extent and types of culture change practices implemented and changes in quality indicators are recommended.

Citation:

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

Susan C. Miller, Michael Lepore, Julie C. Lima, Renee Shield, Denise A. Tyler. Does the Introduction of Nursing Home Culture Change Practices Improve Quality? Journal of the American Geriatrics Society, 2014; DOI: 10.1111/jgs.12987

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