International Partnership Leverages Evidence-Based Practices to Improve Long-Term Care Quality

Study Shows U.S./Canadian Partnership is Making Strides Toward Helping Resource-Strapped Organizations Improve Patient Outcomes

BOSTON – A study published in the Journal of the Medical Directors Association demonstrated that a partnership between long-term care organizations in two countries working in collaboration with researchers and national health care organizations can generate changes that improve quality of care for residents. Authors of “The Seniors Quality Leap Initiative: An International Collaborative to Improve Quality in Long-term Care” include lead author John Hirdes, Ph.D., Professor, School of Public Health and Health Systems, University of Waterloo; Paul Katz, M.D., Professor, College of Medicine, Florida State University; John Morris, Ph.D., Director Emeritus of Social and Health Policy Research in the Hinda and Arthur Institute for Aging Research at Hebrew SeniorLife; Tammy Retalic, Chief Nursing Officer and Vice President, Patient Care Services, at Hebrew Rehabilitation Center ; and Cyrelle Muskat, Director, Quality, Systems, and Wellness and Manager, Seniors Quality Leap Initiative at Baycrest Health Sciences.

Using evidence to drive quality improvement is often a daunting task for individual organizations providing long-term care. Although these facilities care for some of the most vulnerable patients, they vary widely in their ability to collect and analyze data that would help put evidence-based practices in place to improve patient care. An evidence-based practice is any practice that relies on scientific research for guidance and decision-making.

The study reports on the work of the Seniors Quality Leap Initiative (SQLI). The membership is currently drawn from Canada and the United States. The participating long-term care homes include for-profit and not-for-profit organizations in different geographic regions with two distinctive systems of government, health policy, and funding models.

SQLI leverages the collective expertise of its members to enhance both quality of care and quality of life for its many thousands of residents. By demonstrating that meaningful change in two countries with disparate long-term care environments is possible through sharing evidence-based practices, SQLI offers a potentially new model for system-wide quality improvement.

According to Dr. Hirdes, “This collaborative community of practice is a replicable real-life demonstration that scientifically sound evidence can be used to improve the quality of long term care.” Organizations participating in SQLI work together to improve care processes in ways that enhance quality through a shared commitment to:

  • Identifying needs;
  • Employing flexible, but practical initiatives; and
  • Evaluating the impact of those initiatives through a transparent reporting mechanism.

“SQLI created a safe zone that encouraged each participating organization to identify gaps in evidence- based practice,” Retalic said. “Using the organizations’ internal quality improvement processes, each member organization identified and implemented process improvement strategies designed to improve their own internal results with the goal of improving the overall scores for the SQLI collaborative. The format resulted in open conversations about difficult challenges that ultimately improved practices for all the member sites.”

The study relied on ongoing clinical assessment records related to pain management and included long-term care residents and patients in 14 organizations in Canada and the U.S. between 2014 and 2017. The most recent analytic samples involve 11,123 unique residents/patients in 68 facilities associated with 14 different long-term care organizations. Data shows improving care related to pain resulted in notable improvements in quality in specific facilities, as well as within the network as a whole.

“The objective of SQLI is first to improve the targeted quality outcome and second to assess how well these sites measure up against all facilities in the U.S. and Canada,” said Dr. Morris. “Standards have been established and the SQLI goal is to be among the best performing facilities in North America.”

Funding to support the SQLI collaborative is based on member contributions as well as a grant from the Centre for Aging and Brain Health Innovation in Toronto.

About the Hinda and Arthur Marcus Institute for Aging Research
Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research is committed to the conduct of high-quality research that discovers the mechanisms of age-related disease and disability; leads to the prevention, treatment and cure of disease; advances the standard of care for older people; and informs public decision making.

About Hebrew SeniorLife
Hebrew SeniorLife, a Harvard Medical School affiliate, is a national senior services and academic leader uniquely dedicated to investigating, understanding, and enhancing the experience of aging. Based in Boston, the nonprofit organization, founded in 1903, provides communities and health care for seniors, research into aging, and education for geriatric care providers. For more information about Hebrew SeniorLife, visit and our blog, or follow us on Facebook, Instagram, Twitter, and LinkedIn.