A Longitudinal Assessment of the Effect of Resident-Centered Care on Quality in Veterans Health Administration Community Living Centers.

ObjectiveTo examine whether changes in resident-centered care (RCC) over time were associated with changes in quality. Data Sources/Study SettingData sources were the Minimum Dataset quality indicators (which consist of measures of both prevalence and incidence of adverse events) and the Artifacts of Culture Change Tool (which measures RCC; FYs 2009-2012) from 130 Veterans Health Administration community living centers. Study DesignA retrospective longitudinal study. Data Collection/Extraction MethodsData were from VA secondary data sources. Principal FindingsThe overall relationship between RCC and quality was not statistically significant (p=.22), although there was a weakly significant negative relationship (i.e., increased RCC was associated with poorer quality) in the seven quarters after implementation of an automated version of the Artifacts Tool (p=.08). In facility-specific analyses, there were 15 facilities with a weakly significant (p<.10) positive relationship between RCC and quality and 21 with a weakly significant negative relationship. Adjusted cost per patient day was over 50 percent higher in the 21 facilities with a negative relationship than in the 15 facilities with a positive relationship (p<.05). ConclusionsThe Artifacts score is a formal performance metric in the VA, and thus, facilities were explicitly incentivized to increase RCC. Using qualitative methods to identify characteristics that distinguished those facilities able to increase both RCC and quality from those that suffered declines in quality as RCC was improved is an important follow-up to this study.