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PPO 09-279 – HSR&D Study

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PPO 09-279
Evaluating Culture Change in VA Community Living Centers: Feasibility Issues
Sonne Lemke PhD
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: April 2010 - March 2011

BACKGROUND/RATIONALE:
VA Community Living Centers (CLCs) are involved in culture change efforts to improve the quality of life for residents. To evaluate culture change, measures of key concepts are needed.

OBJECTIVE(S):
This project was a step toward development of a CLC culture change evaluation. The aims were to (1) access existing databases and assess the quality and utility of their data for evaluation of CLC culture change and (2) identify measurement gaps and options for addressing them.

METHODS:
The project evaluated the Artifacts of Culture Change survey (ACC; adoption of resident-centered care), the All Employee Survey (AES; organizational functioning and climate), and the Phibbs Long-Term Care Staffing Data (staffing levels, resident and staff attributes). The utility of these databases was evaluated, the alignment between units of analysis and timeframes in these databases was explored, and databases were integrated and compared. Based on these analyses and systematic literature review, measurement gaps were identified.

FINDINGS/RESULTS:
Culture change measures have significant limitations. No measure was available in CLCs prior to 2008, no item responses were collected until introduction of a revised measure in 2011, and scores on the new measure are not commensurate with the ACC data. Nevertheless, ACC scales appear useful for evaluation: most ACC scales did not show a ceiling effect, ACC scores increased over time, and the relative standing of CLCs was reasonably stable. Phibbs Nurse Staffing data also appear useful. In a CLC sample, they had good agreement with direct report of staffing level and staff composition. Discrepancies highlight the importance of unit definition in joining databases. AES scores appear to be reliable measures of the work environment; CLCs vary on the AES, and staff within a CLC tend to agree. AES data were available for 125 of 134 CLCs that completed the ACC and for most CLC subunits identified in other databases.

IMPACT:
Preliminary findings have been incorporated in research proposals and were presented to the long-term care research community. Additional presentations and publications are planned.

PUBLICATIONS:

Book Chapters

  1. Lemke S. Veterans Health Administration: a model for transforming nursing home care. In: Scheidt RJ, Schwarz B, editors. Environmental Gerontology: What Now? New York, NY: Routledge; 2012. Chapter 12. 197-218 p.
Conference Presentations

  1. Lemke S, Brennan PL. Transforming environments: Care-based settings. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 2013 Nov 23; New Orleans, LA.
  2. Lemke S. Evaluating culture change in VA Community Living Centers: Measurement issues. Poster session presented at: VA HSR&D Field-Based Long-Term Care Meeting; 2010 Jun 9; Fairport, NY.


DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: none
Keywords: Patient Preferences, Quality of Life
MeSH Terms: none