International Partnership Produces Positive Quality Improvement

November 23, 2020

A study in the November issue of JAMDA demonstrated that a joint initiative between organizations in two countries encouraged quality transitions through a shared commitment to identifying needs; employing flexible, practical initiatives; and evaluating the impact of those initiatives.

In The Seniors Quality Leap Initiative [SQLI]: An International Collaborative to Improve Quality in Long-Term Care, the authors described an initiative involving a Canadian and a U.S. community of practice. The SQLI uses empirical evidence based on risk-adjusted indicators to guide efforts to improve the quality of care in nursing homes. A specific emphasis on improving care related to pain resulted in notable improvements in the quality of clinical care in some facilities, as well as throughout the network.

The SQLI is comprised of homes from diverse regions of both countries. 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. Based on the results of a gap analysis and readiness-to-change survey, each organization in the SQLI developed a quality improvement plan. Instead of imposing a “one-size-fits-all solution,” organizations were given the flexibility to employ strategies to address gaps in care unique to each of them. The authors say, “This allows for simultaneous exploration of diverse solutions that could then be compared in subsequent reports back to the full network.”

In demonstrating the ability to effect meaningful change—including improvements in pain management—in two countries with different long-term care environments, the SQLI offers a potentially new paradigm for systemwide quality improvement. The authors note, “This collaboration provides a replicable real-life demonstration that empirically sound evidence can be used to drive large-scale changes in quality.”

This study was conducted by researchers at the School of Public Health, University of Waterloo, Waterloo, Ontario, Canada; Hebrew Senior Life, Boston, MA; Baycrest, Toronto, Ontario, Canada; and Florida State University, Tallahassee, FL.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.