Download Quality Standard

Mental Health Quality Standards
Guiding Evidence Based, High Quality Mental Health Care
AGHPS
November 25, 2016
www.HQOntario.ca
Objective
• Why Quality Standards?
• What is a Quality Standard?
• Mental Health Quality Standards
– Major Depression
– Dementia with Agitation or Aggression
– Schizophrenia
• Support for Quality Standards
– Data and Information Briefs
– Implementation plans and Resources to
support QI
www.HQOntario.ca
1
WHY QUALITY STANDARDS?
www.HQOntario.ca
Recommending health system standards of care:
Part of HQO’s legislated mandate
(c) to promote health care that
is supported by the best
available scientific evidence
by,
(i) making recommendations
to health care organizations
and other entities on
standards of care in the
health system, based on or
respecting clinical practice
guidelines and protocols
www.HQOntario.ca
The percentage of long-term care home residents
without psychosis using antipsychotic medications
has decreased over the past four years.
www.HQOntario.ca
4
Across long-term care homes, the percentage of
residents without psychosis using antipsychotic
medications varied from 0.7% to 57.1%.
www.HQOntario.ca
5
Follow Up After Leaving Hospital - Mental Health
Doctor visit within seven days of leaving hospital after treatment for a
mental illness or an addiction
www.HQOntario.ca
Patients First
www.HQOntario.ca
•
Support evidence based
quality improvement to
address variation/gaps in
care across sectors
(primary care, homecare,
acute care, LTC, etc…) that
are caused by factors
outside of patient choice
•
Provide patients and the
public with information,
based on the best evidence,
to help them know what to
look for in their care
Introducing: HQO Quality Standards
•
Concise: five to 15 statements versus the hundreds that can appear in many practice
guidelines
•
Accessible: for clinicians to easily know what care they should be providing; and for
patients to know what care to expect
•
Measurable: each statement is accompanied by one or more quality measure
•
Implementable they come with quality improvement tools and resources targeted to
each standard, to fuel adoption
www.HQOntario.ca
:
8
Quality Standards: How?
1. Scoping and Initiation
(4 months)
Determine scope, initiate
project, and engage partners
and stakeholders
• Open Call for advisory
committee (AC) members and
co-chairs
• Identification of key
stakeholders and potential
partners
• Scoping options and
background analysis
2. Development
(9 months)
Develop quality statements
and indicators with AC, plan
for implementation and
adoptoin
Pre-Standard:
Topic Identification and
Prioritization
3. Finalization/launch
(3 months)
Finalize Quality Standard and
Board approval. Adoption
supports available for use by
the field.
Open call and stakeholder
engagement; apply
prioritization criteria
www.HQOntario.ca
• 2-4 cttee meetings
• Draft posted for
public comment;
stakeholder “field
testing”
• Implementation
planning
9
• Internal
Approval
• Implementation
begins
Quality Standards
www.HQOntario.ca
10
The Statement
The Indicators
The Audience Statements
www.HQOntario.ca
Defintions
11
Patient Engagement in Quality Standards




Membership on Quality Standards Advisory Committee
Focus groups and key informant interviews on topic specific content (when necessary)
Public comment period for each Quality Standard
Consultations on the Patient Reference Guide
www.HQOntario.ca
12
QUALITY STANDARDS FOR
MENTAL HEALTH
www.HQOntario.ca
13
www.HQOntario.ca
14
Quality Standard: Scope
•
•
•
www.HQOntario.ca
Adults aged 18 years and older with a primary
diagnosis of schizophrenia (including related
disorders such as schizoaffective disorder) who
are seen in an emergency department or
admitted to an inpatient setting.
Includes guidance for the care of people who are
transitioning from the inpatient setting to the
community.
While focused on hospital care, some of the
interventions described are likely to take place
outside of the hospital, following their initiation or
a referral in hospital.
15
Quality Standard: Content
www.HQOntario.ca
16
www.HQOntario.ca
17
Quality Standard: Scope
•
•
•
www.HQOntario.ca
Intended for use in hospitals, emergency
departments, long-term care facilities and
transitions between these locations for care
Feedback about the name of the standard
Decisions regarding scope (focus on issues
specific to agitation and aggression versus
issues common to all individuals and families
affected by dementia)
18
Quality Standard: Content
www.HQOntario.ca
19
www.HQOntario.ca
20
Quality Standard: Scope
•
•
•
www.HQOntario.ca
Adults and adolescents 13 years of age or older
receiving care for major depression in all settings
by a number of providers.
Does not apply to women with postpartum
depression or to children under 13 years of age.
Focuses on unipolar major depression. Some
statements refer specifically to people with major
depression that is classified as mild, moderate,
or severe.
21
Quality Standard: Content
www.HQOntario.ca
22
SUPPORT FOR QUALITY STANDARDS
www.HQOntario.ca
Case for Quality
www.HQOntario.ca
24
Implementation
•
•
Without a clear implementation strategy, most guidelines or
standards have little impact
Two major activities for each standard:
Quality Standards (QS)
Implementation Plan
•
•
Each plan would be unique for a given standard
Each implementation plan would be created by a Quality
Standards Advisory Committee
–
•
www.HQOntario.ca
Take action to implement
plan and improvements
Implementation plan would be informed by evidence informed strategies,
broad consultations including regional/local context
Implementation plan forms basis of formal ‘recommendations’ for
each standard, is a ‘system’ plan
25
Implementation
•
•
•
•
•
•
•
•
Develop the QS
Implementation Plan
Take action to
implement the plan, and
quality improvements
Readiness assessment
including regional context
Policy or regulatory implications
Use of levers (contracts, QIP,
QBP funding)
Identified needs for clinical tools
Proposed Quality Improvement
strategies
Partners (specific to each of
above)
Resources / costs
Expectations on timing (what
can start immediately or is
longer term)
•
Getting started guide (every
standard)
Other examples of tools (vary,
based on needs, specific user):
•
Clinical pathways*
•
Decision aids*
•
Order sets, methods to embed
in systems of care*
•
Audit & Feedback*
•
Education / training
*Associated QI strategies
Future topics
• Heavy menstrual bleeding (Winter 2017)
• Hip fracture (Winter 2017)
• Wound care (Spring 2017)
• Vaginal birth after C-section (Winter 2017)
• Dementia care (for people living in the community) (Fall 2017)
• Opioid use disorder (Winter 2018)
• Prescribing opioids for pain (Winter 2018)
• Schizophrenia care (for people in the community) (Winter 2018)
• End-of-life care (Partnership with OPCN) (2018)
www.HQOntario.ca
27
…..in 5 years from now
•
•
•
•
•
www.HQOntario.ca
100+ HQO quality standards exist that would influence
care of majority of the people in Ontario
Patients and providers turn to quality standards as a
resource to support quality care
Routine use and reflection on data, increased
understanding of unwarranted variation
Cohesive implementation and quality improvement
strategies are directing resources and engaging providers
where its needed most to support high quality care
Improved quality care……verified through ongoing
monitoring of progress
28
www.HQOntario.ca
FOLLOW@HQOntario