Major Depression

Care for Adults and Adolescents - Implementation and Improvement

Adolescent holding his head while speaking to clinician at her desk

Quality standards are a go-to resource for quality care. They are concise sets of easy-to-understand statements based on the best evidence.

Without a clear implementation strategy, most guidelines or standards have little impact. To support the use of the quality standards, each one comes with a customized implementation plan that is developed by the advisory committee for that standard.

The implementation plan is informed by evidence-based strategies and broad consultations with the providers, patients, and organizations impacted by the standard. Regional and local context are also considered in the development of the plan.

The implementation plan for the quality standard on major depression care is currently under development. A "getting started" guide will be available in the Spring of 2017. Additional supports will follow and may include policy recommendations, order sets, decision aids, audit and feedback tools, and care pathways.

Watch this space to learn more about the implementation plan and its recommendations, or contact us at QualityStandards@HQOntario.ca.

What is the case for change?

In Ontario, major depression is the most common mental illness. According to HQO’s “Taking Stock” report (2015), almost 5% of Ontarians aged 15 and older reported symptoms of this condition in the past year (p.17). Data also suggests that between 2006 and 2014, no improvement has been achieved in the quality of care received by Ontarians living with major depression.

For example, data indicates that between 2006 and 2014 the proportion of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for major depression fluctuated between 9.7% (minimum value) and 11.3% (maximum value)¹. (Figure 1).

Figure 1

To learn more about why this standard is needed, please review the Information and Data Brief for this standard.

¹Quality Standards, Major Depression - Care for Adults and Adolescents (slide 12). Data sources: National Ambulatory Care Reporting System, Registered Persons Database, provided by the Institute for Clinical Evaluative Sciences. Crude rates.

What does it mean for patients/caregivers?

"One of the turning points in my own journey was realizing that in order to be well and stay well, I needed to be a partner in my own care. This meant learning about treatment options that are available, and advocating (or asking someone to advocate) for the most appropriate option. When patients and healthcare professionals partner to achieve a common goal, the relationship contributes to one’s wellness. One cannot underestimate the knowledge and experience that a person with lived experience brings to their own health care; drawing on that wisdom demonstrates a respect for the individual, which builds trust and rapport, and may lead to better health outcomes as well."

- Rachel Cooper, expert panel member

What does it mean for providers?

"Implementing the major depression quality standard represents an opportunity to advance quality in a way that we have never had before and that no other province in Canada has had. Implementing the quality standards will represent a paradigm change. The biggest change relies on replacing non-evidence based interventions with evidence based interventions. With a spirit of innovation and a willingness to engage in partnerships, and at times a little more or less runway, this is absolutely doable. [This paradigm shift] is going to provide better service user experience, a different lens that is more aligned with recovery and better clinical outcomes for the patient. I hope organizations are going to embrace the opportunity to reduce the gap between the emergence of evidence and the delivery of best practices to their patients. And if patients and family members have these statements in front of them they will be more informed about the best evidence-based treatments, they will request and ask the right questions to make sure they get the best evidence based treatments."

- Dr. Phil Klassen, expert panel member

What do I need to get started?

The implementation plan for the quality standard on major depression care is currently under development. Additional supports will follow and may include policy recommendations, order sets, decision aids, audit and feedback tools, and care pathways.

Watch this space to learn more about the implementation plan and its recommendations, or contact us at QualityStandards@HQOntario.ca for more information.

Evidence to Improve Care