The Center for Health Policy Evaluation in Long-Term Care


 Who We Are

The Center for Health Policy Evaluation in Long-Term Care is a collaborative research effort aimed at improving the quality of care for our nation’s elderly and disabled populations. Our multidisciplinary team has expertise in public health, medicine, nursing, epidemiology, policy, nutrition, economics, health services research, quality improvement, long-term care workforce, measure development, quality of life, dementia, customer satisfaction, program implementation, and healthcare administration, management, and leadership.

 What We Do

Our faculty leverage their range of skills, experiences, and partnerships to translate health policies and legislation into a real-world understanding of their impact on the lives of post-acute and long-term care residents and providers. Working across a range of stakeholders, we use this understanding and a systems-thinking approach to improve lives by providing solutions for quality care.


Our Senior Research Fellow, Dr. Lindsay Schwartz, has been selected as a 2019 Gerontological Society of America Fellow. Congratulations, Dr. Schwartz!

​​​Fellowship is the highest class of membership within the Society and is an honor recognizing outstanding and continuing work in gerontology. You may read more about the announcement at AAAS’s EurekAlert! website.

Marsida Domi, a Center Researcher, participated in generating an important action brief on incorporating information on social determinants of health into datasets used to measure healthcare outcomes.

This work was done through Ms. Domi’s participation on the National Quality Partners™ Social Determinants of Health Data Integration Action Team. It can be downloaded here​.

The Center for Health Policy Evaluation in Long-Term Care presented at the 2019 Annual Research Meeting (ARM) for AcademyHealth:

CoreQ: Development of a Universal Satisfaction Score for SNF and AL Residents and Families – Lindsay Schwartz: Senior Research Fellow, PhD, FGSA
This poster discusses the development of CoreQ, a set of five long-term care customer satisfaction measures for both residents and families, highlighting the importance of a standard, short customer satisfaction measures to allow providers to benchmark their performance, help residents and families in decision-making, and let states and others use the information for accountability.
All CoreQ measures have the same three core questions, with an additional question for SNF short-stay discharge and assisted living resident surveys. Existing literature and satisfaction surveys were reviewed, and cognitive testing was conducted with residents and family members on questions and responses. Psychometric testing identified three core questions that when combined into an aggregate score resulted in a stable score ranging from 0 to 100. The researched showed that CoreQ scores were correlated with important quality measures, such as the Five-Star Quality Rating System and staff turnover, in the direction as expected and statistically significant (p=<0.05). Scores were distributed across the possible range and reflected meaningful differences in quality by sorting facilities from high to low quality. Similar to satisfaction measures in other settings, the CoreQ has been endorsed by the National Quality Forum.
To learn more about this research and how to incorporate the CoreQ questions into your customer satisfaction surveys, visit Dr. Schwartz’s poster abstract may be viewed here.
The Characteristics of Nursing Homes That Stop the Baldrige Journey and the Impact Stopping Has on Quality – Kiran Sreenivas: Associate Center Director, MS, CPHQ
This study looks at the relationship between quality and a facility’s Baldrige journey. Prior matched case-control studies have shown that nursing homes following the Baldrige journey for excellence have significantly better quality than those that do not. Those following the Baldrige journey may apply for recognition through a Baldrige-based Quality Award at the American Health Care Association/National Center for Assisted Living. Quality Awards remains in active status for three years, after which reapplication is required to maintain status or move to the next level. Facilities that stop the Baldrige journey by allowing their award to lapse compared to those actively continuing on their journey by reapplying show worse performance on Five-Star, hospitalization, and staffing, despite other facility characteristics being similar.
Kiran Sreenivas’s poster abstract may be viewed here.

​Our Research

 Posters and Abstracts

 White Papers and Briefs


Lindsay Schwartz

  • New Data on Quality of Life and Care for Persons with Dementia in Assisted Living and Other Settings. Gerontological Society of America Annual Scientific Meeting, Boston, MA, November 15, 2018. Symposium Role: Co-Chair. 
  • Quality in Assisted Living: International and Cultural Findings and Recommendations. International Association of Gerontology and Geriatrics 2017 World Conference, San Francisco, CA, July 24, 2017. Symposium Role: Discussant 
  • Cross-Cutting Quality Measures: Where Have We Been and Where Are We Going? Measuring Quality in Assisted Living. Gerontological Society of America Annual Scientific Meeting, New Orleans, LA, November 16, 2016. Role: Pre-Conference workshop panelist. 
  • Using Data to Dig Deeper into Assisted Living: Function, Engagement, and Quality. Gerontological Society of America Annual Scientific Meeting, New Orleans, LA, November 18, 2016. Symposium Role: Discussant. 
  • State Policy Issues in Residential Care/Assisted Living Settings for Older People and Working Age Person with Physical Disabilities. National Home and Community Based Services Conference, Washington, DC, August 30, 2016. Role: Discussant. 
  • The Evolution of Health Care in Residential Long-Term Care: Areas for Research and Strategies for Measurement. Health Care in Assisted Living. Gerontological Society of America Annual Scientific Meeting, Orlando, FL, November 17, 2015. Role: Pre-conference workshop panelist. 
  • The National Study of Long-Term Care Providers: A New Resource for Researchers, Providers, and Policymakers. CDC’s National Conference on Health Statistics, Bethesda, MD, August 26, 2015. Role: Panelist.

 Peer Reviewed Publications

Lindsay Schwartz

  • Edvardsson, D., Baxter, R., Corneliusson, L, Anderson, R., Schwartz, L. (2019). Advancing Long-Term Care Science Through Using Common Data Elements: Candidate Measures for Care Outcomes of Personhood, Well-Being, and Quality of Life. Gerontology and Geriatric Medicine.
  • Caffrey, C., Harris-Kojetin, L., Rome, V., & Schwartz, L. (2018). Relationships Between Residential Care Community Characteristics and Overnight Hospital Stays and Readmissions: Results From the National Study of Long-Term Care Providers. Seniors Housing & Care Journal, 26(1), 38-49.
  • Marsteller JA, Hsu YJ, Wen M, Wolff J, Frick K, Reider L, Scharfstein D, Boyd C, Leff B, Schwartz L, Karm L, Boult C. Effects of Guided Care on Providers’ Satisfaction with Care: A Three-Year Matched-Pair Cluster-Randomized Trial. Population Health Management 2013.

​Our Staff

 David Gifford: Center Director, MD, MPH

David Gifford, MD, MPH, serves as Director of the Center for Health Policy Evaluation in Long Term Care at the American Health Care Association, where he also serves as the Sr VP for Quality and Regulatory Affairs since 2011. He established the Center and the Quality Department at AHCA. His interests are in improving and measuring quality in LTC as well as how regulatory and payment policies impact quality. He has developed 8 new quality measures for nursing homes that all received NQF endorsement. He oversees a team of data analysis working with national MDS data, Medicare Claims, and Cost Reports to develop quality measures and conduct policy evaluations. Dr. Gifford also serves on the Board of the Advancing Excellence in America’s Nursing Homes campaign and the Baldrige Foundation Board and chairs the Department of Veterans Affairs Geriatric and Gerontology Advisory Committee. He serves on the NQF Measures Applications Partnership (MAP). He is a former Director of the Rhode Island State Department of Health, where he received the National Governor’s award for Distinguished Service Award for State Officials. He led efforts to expand public reporting of quality for home health and nursing homes and to make the nursing home survey process more person centered. Prior to that he served as Chief Medical Officer for Quality Partners of Rhode Island where he directed CMS’ national nursing home-based quality improvement effort. He also is on the Brown University faculty in the Schools of Medicine and Public Health as well as being a member of Brown’s Center for Quality and Innovation in LTC. He received his medical degree from Case Western Reserve University and conducted his geriatric fellowship at UCLA where he also earned his Master’s in Public Health while a Robert Wood Johnson Clinical Scholar.

 Katherine Almendinger: Associate Center Director, MS

Katherine Almendinger is a Director of Research at the American Health Care Association in Washington, DC. She supports AHCA’s members on their journey to quality improvement as they navigate policy, legislative, and regulatory oversight changes. Her work also advances long-term and post-acute care research, informs AHCA’s legislative efforts, and helps guide conversations with CMS on how these changes impact the sector.

Prior to joining the AHCA team, Katherine worked at the Research Data Assistance Center (ResDAC), where she served as an MDS topic expert and helped researchers access and use CMS data. Her other work has been primarily in clinical research. Katherine is currently working toward earning her DrPH in health policy and management at Johns Hopkins University with a specialization in quality and patient safety. She received her MS in epidemiology from Harvard University and her BS in chemistry and molecular biology from the University of Minnesota.

 Kiran Sreenivas: Associate Center Director, MS, CPHQ

Kiran Sreenivas is a Research Director at American Health Care Association (AHCA) in Washington, DC. He supports AHCA’s Quality Initiative, LTC Trend Tracker, and other projects aimed at improving lives and delivering solutions for quality care. His passion is helping others use data to make informed decisions.

Prior to joining AHCA, he worked four years at America’s Essential Hospitals on a collaborative to reduce hospital readmissions and hospital-acquired conditions, such as pressure ulcers and surgical site infections. Kiran is currently working on earning a Doctor of Public Health at Johns Hopkins University. He received his master’s in health policy at George Washington University and his bachelor’s in biology at Northwestern University.

 Holly Harmon: Senior Clinical Fellow, RN, MBA, LNHA, FACHCA

Holly Harmon, RN, MBA, LNHA, FACHCA brings both passion and a wealth of practical, real-world, clinical and operational experience to her role as Associate Vice President, Quality & Clinical Affairs at AHCA. Her extensive service in a wide array of settings including post-acute care, long term care, residential care, assisted living, independent living, a psychiatric hospital and occupational health have provided her with insights, knowledge, skills and innovative ideas which she exuberantly shares with others.
In addition to her vast clinical experience, Ms. Harmon has put her dynamic energy into leading the statewide Maine Culture Change Coalition/LANE as President, the Maine Partnership to Improve Dementia Care in Nursing Homes as Co-Chair, Vice-President of American College of Health Care Administrators, Maine Chapter and the Maine LANE Co-Convener for the national Advancing Excellence in America’s Nursing Homes Campaign. She also served as the Director of Quality Improvement & Regulatory Affairs at the Maine Health Care Association.
She puts her boundless energy and warm and energetic personality into training, education and presenting both, nationally and locally. She has made simplifying the complex world of long term and post-acute care policy and practice an art.

 Lindsay Schwartz: Senior Research Fellow, PhD

As Associate Vice President of Workforce and Quality Improvement for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), Dr. Schwartz develops and implements quality improvement initiatives, including quality measurement development and data collection and oversees workforce initiatives. She is a nationally recognized expert on quality in assisted living and workforce issues in long-term care. Dr. Schwartz was part of the development team for the CoreQ, a customer satisfaction measure for long term care settings. She led the process for National Quality Forum (NQF) endorsement for the assisted living CoreQ measures, the first AL-specific measures to be endorsed by NQF. Dr. Schwartz earned her Ph.D. from the Johns Hopkins University Bloomberg School of Public Health in the Department of Health Policy and Management. During graduate school she worked as a research assistant for the National Health and Aging Trends Study (NHATS) and completed a Health Fellowship in the U.S. Senate Health, Education, Labor, and Pensions Subcommittee on Aging and Retirement. Prior to attending graduate school, Dr. Schwartz worked in home and community-based services in different roles including as direct care staff and as a case manager for an Area Agency on Aging. She serves as current Chair of the Center for Excellence in Assisted Living (CEAL) Board of Directors, Co-Convener for the Gerontological Society of America’s (GSA) Assisted Living Interest Group, and as a mentor for the Robert Wood Johnson Foundation’s Health Policy Research Scholars program. In 2019, she was awarded fellow status through the Gerontological Society of America (GSA) in the Social Research, Policy, and Practice Section. This is the highest class of membership in GSA and an acknowledgement of outstanding contributions to the field of aging. Dr. Schwartz earned her B.S. in Psychology and a minor in Business from Indiana University.   

 Sara Rudow: Senior Director of Regulatory Services, MPA

rudow.pngSara Rudow, M.P.A., has worked for over ten years on policy analysis and implementation to support the delivery of high quality health care and social services to vulnerable populations. As AHCA’s Senior Director of Regulatory Services, Sara leads AHCA’s efforts to develop and promote systemic changes to regulations, policies, and practices to foster a more transparent and effective survey/regulatory process and to share information, develop resources, and provide advocacy on critical regulatory and quality issues facing nursing centers.

Prior to coming to AHCA, Sara led projects analyzing federal health care programs serving the elderly, disabled, and economically vulnerable and provided technical assistance to federal grantees. She also worked as an analyst at the US Government Accountability Office, assessing and providing recommendations to improve the implementation of federal health care programs. Rooted in her early experiences as a caseworker in a residential treatment center for young people with multiple disabilities, Sara is committed to bringing the voices of care providers into the policymaking process. Sara earned her B.A. in Political Science from Columbia University and her M.P.A. in Social and Health Policy from Cornell University.

 Marsida Domi: Researcher, MPH

Marsida Domi is a senior research analyst at the American Health Care Association (AHCA) in Washington, D.C. Marsida is passionate about leveraging data and robust methods to address disparities in the quality of care patients receive. She leads AHCA’s measurement development and NQF endorsement efforts, achieving NQF endorsement for 7 measures including five customer satisfaction measures for nursing homes and assisted living facilities, as well as discharge to community and hospitalization measures. She led AHCA’s efforts on the NQF SES Trial Period, testing the impact of including socioeconomic factors in quality measures. She also oversees evaluations of the impact of Medicaid policies on quality as well as AHCA’s design and support to states implementing Medicaid Value-Based Purchasing programs. She has served on Batelle’s “Quality Measure Development: Supporting Efficiency and Innovation in the Process of Developing CMS Quality Measurement” Technical Expert Panel.
Prior to joining AHCA, she has worked with various organizations conducting clinical trials in leukemia and lymphoma, designing and implementing studies in breast and gynecologic cancers, and conducting economic evaluations in lung cancer clinical trials. 
Marsida received her Master’s in Public Health (MPH) from the Mailman School of Public Health at Columbia University in Comparative Effectiveness and Outcomes Research and her bachelor’s in Economics from Brown University.

 Terry Hawk: Researcher, MS

Terry Hawk is a Research Analyst at the American Health Care Association (AHCA) in Washington, DC. He supports AHCA’s Feedback Report production, Data Use Agreements, and other projects aimed at dataset building and analyses. His interests include utilizing data to objectively answer questions around the field of Long-Term Care.

Prior to his time at AHCA, Terry received his master’s in Nutritional Science with a focus on nutrition policy and project evaluation and a bachelor’s in biomedical studies.

 Michael Leitson: Senior Data Manager

ahca_mleitson.jpgMichael Leitson is a Senior Data Manager at the American Health Care Association in Washington, D.C. He supports the acquisition, construction, standardization, security, automation and management of data used in research. His interests include streamlining data processes to easily obtain data to improve the quality of care and designing data warehouses to improve retrieval of data.
Prior to joining AHCA, Michael worked as a business analyst of various capacities for a hospital and a nursing home organization, as well as institutions of higher education. He received his master’s in Applied Statistics and bachelor’s in Mathematics, both from Kennesaw State University.