Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Services Research & Administration

First Committee Member

David W. Palm, PhD

Second Committee Member

Stephen Peters, MA

Third Committee Member

Jungyoon Kim, PhD

Fourth Committee Member

Hyo Jung Tak, PhD


As the number of people 65 and older increases due to the baby boomer population, there will be a greater demand for long-term care (LTC) services. Quality improvement in LTC is essential to ensure positive health outcomes, patient satisfaction, and reduction in healthcare costs. The purpose of this systematic literature review is to identify the current quality initiatives for LTC in the United States and evaluate the outcomes, effects, and values of each quality initiative identified to support the claim that current the quality initiatives have a limited effect on quality improvement in LTC settings. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach was used to determine which peer-reviewed journal articles were going to be included. After analyzing the journal articles, the quality initiatives identified included implementing increasing the use of advanced practice registered nurses (APRNs), increasing staff training and education, improving communication between healthcare providers, incorporating telehealth for palliative care, providing online long-term care resources, and implementing infection prevention and control programs. These quality initiatives showed positive results in decreasing emergency room visits, decreasing catheter-acquired urinary tract infections (CAUTIs), decreasing hospitalizations, and increasing Medicare star ratings. A few recommendations surrounding the need for having standardized quality initiatives and measures, increasing research on the effects of the current initiatives, increasing funding, and changing health policies were incorporated to improve the current issues surrounding quality improvement initiatives in LTC.