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Green House Adoption and Nursing Home Quality

Keywords: Nursing homes; quality of care; Green House nursing home; culture change.

Objective: To evaluate the impact of the Green House (GH) model on nursing home resident-level quality of care measures.

Data Sources/Study Setting: Resident-level minimum data set (MDS) assessments merged with Medicare inpatient claims for the period 2005 through 2010.

Study Design: Using a difference-in-differences framework, we compared changes in care quality and outcomes in 15 nursing homes that adopted the GH model relative to changes over the same time period in 223 matched nursing homes that had not adopted the GH model.

Principal Findings: For individuals residing in GH homes, adoption of the model lowered readmissions and several MDS measures of poor quality, including bedfast residents, catheter use, and pressure ulcers, but these results were not present across the entire GH organization, suggesting possible offsetting effects for residents of non-GH “legacy” units within the GH organization.

Conclusions: GH adoption led to improvement in rehospitalizations and certain nursing home quality measures for individuals residing in a GH home. The absence of evidence of a decline in other clinical quality measures in GH nursing homes should reassure anyone concerned that GH might have sacrificed clinical quality for improved quality of life.

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