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Dr. Joshua Tepper

Share Feedback on Our New Quality Standards

We’ve posted the latest drafts of our first three Quality Standards. Please read them and share your comments.

Back in November, I wrote about the importance of evidence in a learning health system and discussed a new roadmap to guide our evidence development efforts over the next three years.

A key element of that roadmap involves supporting the adoption of a growing range of Quality Standards for areas of care in Ontario in need of quality improvement. A Quality Standard is a concise set of evidence-based statements that articulate what high quality care looks like for a particular condition or service area. In doing so, each standard gives clinicians and administrations an effective way to monitor their own care (against the standard) and identify opportunities for improvement.

Perhaps most importantly, each standard tells patients exactly what their care should like and what they can expect along their journey. Clear communication leads to less confusion and miscommunication.

As an initial step toward this realizing this goal, in February we announced the development of our first three Quality Standards. The standards relate to mental health care, one of three emerging areas of focus in our Strategic Plan and indeed in Ontario itself. Challenges in accessing services, transitioning between points of care, and equity have dogged mental health care in our province. So it made sense to start here, with three standards that focus on Major Depression, Schizophrenia, and Behavioural Symptoms of Dementia.

This week, we’ve posted drafts of each of these standards. I encourage you to submit feedback to help us make each standard even stronger.

After taking on board everyone’s comments, we will formally release the three standards in the fall. With the support of our partners, we will broadly distribute each one among health professionals, patients, caregivers and the public, with a view toward supporting uptake across Ontario’s health system.

For now, I’d like to focus on the Quality Standard for major depression. One of the most common mental illnesses is still met with significant gaps in the quality of care people receive. Many of these gaps relate to access and follow-up visits. For example, only one of three people discharged from hospital for a primary diagnosis of depression or other mood disorders receive the recommended follow-up visit with a physician within seven days.

In my own practice, I’ve seen some of the challenges that people with depression face. I’ve worked with patients with depression who haven’t been able to readily access psychotherapy or who didn’t want to even talk about taking medication. The stigma of this condition seemed to weigh upon them almost as heavily as the symptoms themselves. There are few conditions that can be described as “cataclysmic” without exaggeration. Depression is one of them.

Our new Quality Standard for major depression addresses the estimated 7% of people in Ontario who meet the criteria for major depression and applies to those with suspected major depression too. It provides 13 quality statements that speak to suicide risk assessment and intervention, shared decision making, treatment after diagnosis, monitoring treatment adherence and antidepressants and optimizing, switching or adding therapies to offer relief.

To give you a glimpse of the work that went into creating this standard, we spoke with Dr. Peter Voore, co-chair of the Major Depression Expert Panel and Anita Barnes, a patient on the same panel.

Barnes offered an important perspective in developing the standard by sharing her lived experiences. “As someone who has lived with depression for many decades, it is very challenging and not always comfortable to talk about my experiences. I think it is great that Health Quality Ontario is starting to explore patient participation,” she said.

 “It is important for health care professionals to hear the stories of patients as a way to give feedback on what’s working and not working and where there is need for improvement… The ultimate hope is that it will be easier for individuals that are struggling with depression to have access to support and treatment in a timely manner. I hope the standards will encourage the importance of a holistic approach to treatment, which will include adjunct treatments.”

Dr. Voore is a psychiatrist who has worked in emergency and general psychiatry and administration and medical education for over 25 years. He is now the Medical Director of Ambulatory Care and Structured Treatments at the Centre for Addiction and Mental Health. “Quality Standards are an excellent approach to improving care,” said Dr. Voore. “I think this is a potential method for significant improvement in care and ensuring more people get access to high-quality, evidence-based care across the province.”

I want to thank all the experts – patients, clinicians and others who work in the health care system – who volunteered to serve on one of our Quality Standard advisory committees for each standard for volunteering their time. Your voices added another layer to our work and your lived experiences informed each standard in an important way.

Our other two standards are for schizophrenia and dementia. The Schizophrenia standard focuses broadly on care for people aged 18 years and older with schizophrenia and more specifically on care for people in an emergency department setting or admitted to a hospital. It confronts gaps in care related to follow-up visits and the current very high rate of readmissions. With 11 quality statements, it provides guidance for people in between care settings and addresses screening for substance use, comprehensive assessment, physical activity and health eating, smoking cessation, cognitive behavioural therapy and family intervention.

The Behavioural Symptoms of Dementia standard concentrates on care for people with dementia exhibiting behaviours such as agitation or aggression in an institutional setting. This is another area of care with wide variation, especially relating to the use of physical restraints and antipsychotic medication. The standard comprises 14 quality statements that focus on transitions in care, appropriate care environments, caregiver training and education, medication reviews, monitoring psychotropic medications, individualized care plans and nonpharmacological interventions.

I look forward to seeing how these Quality Standards will evolve following our call for feedback from people like you. It’s important to note that these Quality Standards won’t just live on our website. They will encourage quality improvement efforts and help us monitor and report on the quality of care across the province. 

Setting and maintaining well-articulated standards of care like these is important. Each standard sets the bar for excellent quality care and supports active improvement. It is our hope that one day we will create a full library of Quality Standards detailing a wide variety of conditions so that patients and providers alike could find a list of standards related to a specific ailment or concern. This is just the start. We look forward to your feedback.

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