The quality of nursing home care remains a serious challenge. The Centers for Medicare & Medicaid Services and the nursing home industry have heralded culture change not only as a means to improve quality of life, but also quality of care. Unfortunately, there is a lack of empirical data regarding the effects of culture change on quality-of-care outcomes in nursing home residents. This cross-sectional causal-comparative study addressed the need for empirical data based on information from a sample of nursing homes (N = 97) in an East North Central and Southern Mountain state. Utilizing the Artifacts of Culture Change instrument, the researcher assigned participants to three groups (medical, hybrid, or social model of care), and used the quality measures to assess quality-of-care outcomes. Based on social ecology theory, it was expected that nursing homes using culture change as their operating model would have higher residents' quality-of-care outcomes than nursing homes using a medical model of care. The data collected suggest that there was no difference in residents' quality-of-care outcomes between nursing homes operating under a medical model of care and those operating under a social model of care when the aggregate quality measures were examined. However, when considered separately, the study found that residents in nursing homes operating under a social model of care were less restrained (p = .01, 95% CI [.0091, .1971], effect size = .07) and spent less time in bed or chair (p = .03, 95% CI [-.0078, .1996], effect size = .05) at the .05 level of significance, and had fewer high-risk pressure ulcers (p = .10, 95% CI [-.0230, .1343], effect size = .08) at the .10 level of significance than residents who received care from nursing homes operating under the medical model. Results should be cautiously interpreted because the exploratory study experienced limited statistical power and results may have been spurious. In conclusion, the study provides tentative support that culture change can be used as a means to enhance some quality-of-care outcomes in nursing home residents.
|Advisor:||Mueller, Dale M.|
|Commitee:||Deaton, John E., Witt, David R.|
|Department:||School of Public Service Leadership|
|School Location:||United States -- Minnesota|
|Source:||DAI-A 72/06, Dissertation Abstracts International|
|Subjects:||Gerontology, Health care management|
|Keywords:||Artifacts of culture change, Culture change, Nursing home, Quality measures, Quality of care|
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