1. The performance metrics idea is not a new one. CIHI already posts these for long term care homes. These metrics are risk-adjusted, benchmarked, related to resident outcomes, and can permit comparisons within Canada and beyond.

https://yourhealthsystem.cihi.ca/hsp/?lang=en  https://twitter.com/IrfanDhalla/status/1334997690049040388
2. It is a testament to our fragmented system that the related recommendation by the LTC commission is seen as novel.

That said, the quality indicators for LTC have been used by communities of practice to improve outcomes for LTC residents...
3. For example, this @CFHI_FCASS sponsored study used these QIs to support a community of practice approach to reduce antipsychotic use in LTC.

https://www.jamda.com/article/S1525-8610(20)30321-2/fulltext

and...
A Canadian Cohort Study to Evaluate the Outcomes Associated with a Multicenter Initiative to Reduce...

To evaluate the impact of a multicenter intervention to reduce potentially inappropriate antipsychotic use in Canadian nursing homes at the individual and facility levels.

https://www.jamda.com/article/S1525-8610(20)30321-2/fulltext
4. The Seniors Quality Leap Initiative involves Canadian and US LTC homes - including privately operated ones - and uses the quality indicators to improve outcomes in LTC residents, such as pain. https://www.jamda.com/article/S1525-8610(20)30649-6/abstract
The Seniors Quality Leap Initiative (SQLI): An International Collaborative to Improve Quality in...

To describe an innovative Canadian and US community of practice that employs empirical evidence based on risk-adjusted indicators to guide collaborative initiatives to improve the quality of care in...

https://www.jamda.com/article/S1525-8610(20)30649-6/abstract
5. However, we cannot simply make a recommendation and wave a magic wand so that communities of practice can coalesce and suddenly improve care.

Room must be made in care processes to allow for quality improvement AND physicians must also participate, including specialists.
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