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Editor’s Note: This is the first of four AHRQ Views blog posts written by the Agency’s National Advisory Council members about their discussions on advancing healthcare quality in different care settings. The Council provides advice to AHRQ's director on Agency activities and priorities. This blog does not necessarily represent the views of AHRQ.

Long-term care is vital to patient recovery, rehabilitation, and safety. This needs to be a key focus of quality measurement and improvement and must include both clinical outcomes and consumer expectations, especially the voices of patients, their families and caregivers, and the healthcare teams that care for them.

Are these voices missing? How much time have we spent asking long-term care patients and their families what quality means to them? Have we asked healthcare workers delivering long-term care about what quality means to them and how it could be better?

As long-term care differs from acute care, definitions and quality measurements must also vary. It’s time to have these crucial conversations.

Long-term care includes finite stays, such as for post-surgical rehabilitation and for patients who need permanent skilled nursing services.  Care access gaps exist across the board, and quality conversations must include prompts for understanding and reducing these gaps.

Measures should be implemented that evaluate whether access gaps are reduced and whether these gaps are reduced for all long-term care patients, since long-term care may not just happen in nursing homes or other long-term care institutions. Conversations must also consider long-term care in homes; however ‘homes’ is defined.

Transitions between healthcare settings are an area ripe for conversation. What works and what doesn’t work? What do our acute care teams need to tell long-term care teams about patients who move to long-term care, and vice-versa? What frustrates patients transitioning to long-term care, and how can we improve this transition?

Long-term skilled nursing care for a loved one goes beyond basic needs such as food, water, and shelter. The concept of “home” implies comfort, security, safety, independence, and a sense of belonging. Along with talking with current and prospective residents about what matters most to them, two other vital groups should also be consulted:

• Family members are necessary and valued care team members in long-term care settings. Consider the development of resident and family advisory councils, already popular in hospitals, for long-term care. What matters to families?  How do we measure what matters? Once measured, how do we report the outcomes in a public-facing format so families can use meaningful results to make placement decisions?
• The healthcare team in long-term care is an untapped resource for information. The onsite team knows what works and what does not, from resident caregivers to providers to activity coordinators and administrators. They see what impacts safety. It is essential to involve the group by asking for their opinions and seeking suggestions for innovation and measurement.

Long-term care is an important Learning Health System. Defining a valuable set of quality measures for long-term care is the starting point for collecting data, which are analyzed to generate meaningful knowledge and interventions to improve long-term care practice.

By involving patients, families, and staff, we can get to the heart of what outcomes matter most and how to measure and implement interventions to improve the quality of long-term care. Thinking creatively promotes innovation that designs the future of long-term care.

Catherine H. Ivory is Senior Director of Nursing Research at Vanderbilt University Medical Center and Executive Nursing Administration and Associate Professor at the Office of Evidence-Based Practice and Nursing Research at Vanderbilt University School of Nursing. Komal Bajaj is Chief Quality Officer and Clinical Director, NYC Health + Hospitals Simulation Center Professor, Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine. Jiajie Zhang is Dean, Professor, and Glassell Family Foundation Distinguished Chair in Informatics Excellence, School of Biomedical Informatics, University of Texas Health Science Center at Houston. Kannan Ramar is a Professor of Medicine, Chief Safety Officer, and Assistant Dean of Clinical Learning Environment Optimization School of Graduate Medical Education, Mayo Clinic.

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