Evidence Behind the Green House and Similar Models of Nursing Home Care

Sheryl Zimmerman; Lauren W Cohen


Aging Health. 2010;6(6):717-737. 

In This Article

Design & Methods

Identifying the Essential Elements of the Green House Model

The first step in establishing the evidence was to identify the essential elements of this model; thus, an exhaustive list of The Green House structures and processes was compiled based on a review of The Green House Project Guide Book and training curriculum, websites, and research articles.[201] This list totaled 97 elements, certainly many more than are expected to be requisite and easily or fully adopted. Consequently, an expert panel comprised of nine individuals, including The Green House model adopters and researchers, was convened to determine which elements were essential. Then, two Green House model experts compiled a qualitative operational synthesis of each element as it is evidenced in homes currently in existence.

Literature Review

A literature review examined the evidence behind the elements identified as essential to The Green House model. Searches using words and synonyms addressing all essential elements were conducted in PubMed/Medline, PsycInfo and Cochrane, focusing on articles published within the last 20 years. Reference sections of articles were also reviewed and internet searches were conducted. Articles were considered only if they included more than level 'D' evidence based on the National Heart, Lung and Blood Institute categorization, meaning they had to provide more evidence than panel consensus and judgment.[12] Using these criteria, the majority of the literature was level C evidence (based on nonrandomized trials or observational studies) or in very few cases level B evidence (randomized trials with a limited body of data). A total of 370 potentially relevant articles were identified. Of these, nine were discarded due to English language requirements, and eight could not be obtained. Abstracts for the remaining 353 articles were reviewed for relevance, and 253 articles were selected for in-depth review. Nine were deemed irrelevant or poorly conducted, leaving a final sample of 244 articles. The results that follow synthesize the most informative work derived from 150 articles; they do not reflect, for example, isolated qualitative findings that may have been idiosyncratic to the sample under study.


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