Regarding the paired t-test results with pre-adopters KCCI scores, for all seven KCCI dimensions rated, the mean 2014 scores were significantly higher than the mean 2015 scores (Table
2). Multivariate analyses also revealed a significant effect of Year for all seven KCCI dimensions analyzed: Resident Choice (
F(1,76) = 7.82,
p = 0.0065), Nursing Home Environment (
F(1,76) = 15.87,
p = 0.0002), Relationships (
F(1,76) = 20.78,
p < 0.00005), Staff Empowerment (
F(1,76) = 25.84,
p < 0.00005), Nursing Home Leadership (
F(1,76) = 14.31,
p = 0.0003), Shared Values (
F(1,76) = 12.28,
p = 0.0008) and Quality Improvement (
F(1,76) = 13.46,
p = 0.0005). No other results from these analyses were significant.
Table 2
Pre-Adopters Scores by KCCI Dimension and Year
Resident Choice | 3.30 (0.042) | 3.16 (0.041) | 2.8514** |
Nursing Home Environment | 2.97 (0.034) | 2.83 (0.042) | 3.9114**** |
Relationships | 3.16 (0.034) | 3.01 (0.034) | 4.4785**** |
Staff Empowerment | 2.67 (0.042) | 2.46 (0.045) | 4.8952**** |
Nursing Home Leadership | 3.04 (0.041) | 2.85 (0.041) | 3.8196**** |
Shared Values | 3.43 (0.037) | 3.28 (0.037) | 3.4761**** |
Quality Improvement | 2.90 (0.038) | 2.76 (0.034) | 3.6629**** |
Finally, pre-adopters were compared to adopters (Table
3) in each of the seven KCCI dimensions, and by staff role (Table
4). For the first KCCI dimension, Resident Choice, there was a significant effect of Group (pre-adopters vs. adopters) (
F(1,643) = 96.24,
p = 0.00005), with pre-adopters’ ratings being lower than those of adopters, reflecting their relative lack of achievement at implementing PCC practices. Additionally, there was a Group by Year interaction (
F(1,643) = 14.19,
p = 0.0002), with pre-adopters rating their perceived PCC achievement in this dimension higher in 2014 than in 2015, whereas adopters did the opposite, rating their perceived achievement in this dimension higher in 2015 than 2014. There was also an effect of Role (Table
4;
F(1,643) = 4.87,
p = 0.0277), with aides providing higher ratings than management (across Groups and other factors). None of the other variables were significant. For the second KCCI dimension, Nursing Home Environment, the findings were relatively similar. Again there was an effect of Group, with pre-adopter’s ratings overall lower than those for adopters (Table
3;
F(1,643) = 71.34,
p < 0.00005). Again, pre-adopters rated this domain higher in 2014 than 2015, opposite the pattern of adopters, as reflected in the significant Group by Year interaction (
F(1,643) = 11.86,
p = 0.006). In this case, there was no effect of Role, nor of any other variables in the model. For the third KCCI dimension, Relationships, again pre-adopter’s scores were lower than those of adopters (
F(1,643) = 40.97,
p < 0.00005), and again pre-adopters rated their perceived Relationship achievement as greater before their Foundation year than afterward, in contrast to adopters (
F(1,643) = 12.98,
p = 0.0003) who rated their perceived Relationships achievement as higher on post-testing (2015) than on pre-test (2014). Additionally, aides and other direct care workers rated this outcome as higher than management-level staff (Role:
F(1.643) = 9.46,
p = 0.0022). Finally, there was a modest effect of Turnover Percentage, with staff at facilities with higher turnover tending to rate their achievement along the Relationships dimension as lower (
F(1,643) = 4.32,
p = 0.0382). For the fourth KCCI dimension, Staff Empowerment, again there was an effect of Group (
F(1,643) = 93.87,
p = 0.00005) and a significant Group by Year interaction (
F(1,643) = 13.78,
p = 0.0002), with the same patterns as above. There was also an effect as before with Role (
F(1,643) = 7.37,
p = 0.0068), but no other significant associations. For the fifth KCCI dimension, Nursing Home Leadership, again there was an effect of Group (
F(1,643) = 31.65,
p < 0.00005) and a Group by Year interaction (
F(1,643) = 11.96,
p = 0.0006), both with the same patterns as above. Additionally, there was an effect of Role, again with direct care workers rating achievement as higher (
F(1,643) = 26.90,
p < 0.00005), and no other significant effects. For the KCCI dimension of Shared Values, the patterns were as with Nursing Home Leadership: a significant effect of Group (
F(1,643) = 30.21,
p < 0.00005), a significant Group x Year interaction (
F(1,643) = 10.79,
p = 0.0011), a significant effect of Role (
F(1,643) = 8.64,
p = 0.0034), and no other significant results. Finally, for the KCCI dimension of Quality Improvement, the pattern of results differed slightly. As before, there was a main effect of Group (
F(1,643) = 32.13,
p < 0.00005), with adopters rating their perceived Quality Improvement achievement in this domain higher than pre-adopters. However, there was also a significant effect of Year, with an overall preponderance of higher scores in 2015 than 2014 (
F(1,643) = 5.58,
p = 0.0144). Still, there was a marginally significant interaction between Group and Year, with pre-adopters tending to rate 2014 more highly than 2015, opposite the pattern of adopters (
F(1,643) = 3.04,
p = 0.0818). Finally, there was an effect of Role as with several of the prior dimensions: Aides rated their homes’ achievement in this area more highly than did management (
F(1,643) = 22.20,
p < 0.00005).
Table 3
Pre-Adopters vs. Adopters Scores by KCCI Dimension
Pre-Adopters | (n = 82) | (n = 82) |
Resident Choice*** | 3.30 (0.042) | 3.16 (0.041) |
Nursing Home Environment** | 2.97 (0.034) | 2.83 (0.042) |
Relationships*** | 3.16 (0.034) | 3.01 (0.034) |
Staff Empowerment*** | 2.67 (0.042) | 2.46 (0.045) |
Nursing Home Leadership*** | 3.04 (0.041) | 2.85 (0.041) |
Shared Values*** | 3.43 (0.037) | 3.28 (0.037) |
Quality Improvement+ | 2.90 (0.038) | 2.76 (0.034) |
Adopters | (n = 86) | (n = 86) |
Resident Choice | 3.53 (0.041) | 3.62 (0.028) |
Nursing Home Environment | 3.18 (0.046) | 3.23 (0.038) |
Relationships | 3.29 (0.039) | 3.32 (0.035) |
Staff Empowerment | 2.93 (0.057) | 3.00 (0.048) |
Nursing Home Leadership | 3.15 (0.052) | 3.20 (0.040) |
Shared Values | 3.53 (0.042) | 3.58 (0.02) |
Quality Improvement | 3.05 (0.047) | 3.02 (0.037) |
-
Table 4
Direct Care Workers vs. Management Staff KCCI Scores by Dimension
KCCI Domain | (n = 344) | (n = 323) |
Resident Choice* | 3.43 (0.022) | 3.36 (0.029) |
Nursing Home Environment | 3.06 (0.022) | 3.03 (0.029) |
Relationships*** | 3.22 (0.019) | 3.12 (0.017) |
Staff Empowerment** | 2.80 (0.027) | 2.69 (0.036) |
Nursing Home Leadership**** | 3.12 (0.023) | 2.91 (0.035) |
Shared Values*** | 3.58 (0.020) | 3.38 (0.031) |
Quality Improvement**** | 2.97 (0.021) | 2.81 (0.029) |