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

Is There a Relationship?

Sullivan, Jennifer L., PhD*,†; Shwartz, Michael, PhD*,‡; Burgess, James F. Jr, PhD*,†; Peköz, Erol A., PhD*,‡; Christiansen, Cindy L., PhD; Gerena-Melia, Mariana, PhD§; Berlowitz, Dan, MD, MPH∥,†

doi: 10.1097/MLR.0b013e3182763230
Original Articles

Objective: To examine variation in culture change to a person-centered care (PCC) model, and the association between culture change and a composite measure of quality in 107 Department of Veterans Affairs nursing homes.

Methods: We examined the relationship between a composite quality measure calculated from 24 quality indicators (QIs) from the Minimum Data Set (that measure unfavorable events), and PCC summary scores calculated from the 6 domains of the Artifact of Culture Change Tool, using 3 different methods of calculating the summary scores. We also use a Bayesian hierarchical model to analyze the relationship between a latent construct measuring extent of culture change and the composite quality measure.

Results: Using the original Artifacts scores, the highest performing facility has a 2.9 times higher score than the lowest. There is a statistically significant relationship between the composite quality measure and each of the 3 summary Artifacts scores. Depending on whether original scores, standardized scores, or optimal scores are used, a facility at the 10th percentile in terms of culture change compared with one at the 90th percentile has 8.0%, 8.9%, or 10.3% more QI events. When PCC implementation is considered as a latent construct, 18 low performance PCC facilities have, on an average, 16.3% more QI events than 13 high performance facilities.

Conclusions: 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.

*Center for Organization, Leadership and Management Research (COLMR), VA Boston Healthcare System

Boston University School of Public Health, Boston, MA

Boston University School of Management, Boston, MA

§University of Massachusetts Amherst, Amherst

Center for Health Quality, Outcomes, & Economic Research (CHQOER) Edith Nourse Rogers Memorial VAMC, Bedford, MA

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Funded by Veterans Health Administration HSR&D grant IIR-06-260.

The authors declare no conflict of interest.

Reprints: Jennifer L. Sullivan, PhD, Center for Organization, Leadership, and Management Research (COLMR), VA Boston Healthcare System, 150 S. Huntington Ave. (152M), Boston, MA 02130. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.