0. Mental Health Quality Standards
Guiding Evidence Based, High Quality Mental Health Care
AGHPS
November 25, 2016

1. 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
Points 1 and 2
Why are we doing this?
What is the problem we are trying to solve?
What is a Quality Standard? What will they look like?
How we will do this work
Point 3- update on MH standards
To give an overview of the scope and statement areas within each standard
Point 4- To adverstise open-calls for upcoming Quality Standards as well as the open call for topics.

2. Why quality Standards?

3. 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

4. The percentage of long-term care home residents without psychosis using antipsychotic medications has decreased over the past four years.

5. Across long-term care homes, the percentage of residents without psychosis using antipsychotic medications varied from 0.7% to 57.1%.

6. Follow Up After Leaving Hospital - Mental Health Doctor visit within seven days of leaving hospital after treatment for a mental illness or an addiction
Doctor visit within seven days of leaving hospital after treatment for a mental illness or an addiction
More than two-thirds of patients hospitalized for a mental illness or addiction do not see a doctor for follow-up within seven days of leaving the hospital
Ensuring that patients who have been hospitalized for a mental illness or an addiction see a doctor for follow-up within a week of leaving the hospital is recognized as a measure of quality for mental health and addictions care. As we saw in Chapter 3, follow-up visits after hospitalization are also a measure of how well different parts of the health system are working together. Follow-up visits with a family doctor or a specialist such as a psychiatrist can help to smooth the patient’s transition from around-the-clock care in hospital to managing on their own back at home or elsewhere in the community.
Since the rates we report here are based on physician billing data; they do not capture follow-up visits to clinics led by nurse practitioners, community health centres, psychologists or community mental
health and addiction programs. Therefore, these results likely under report the extent of follow-up care after hospitalization for a mental health or addiction condition in Ontario.
About 30% of Ontario patients hospitalized for treatment of a mental illness or an addiction saw a doctor within seven days of discharge from hospital. This rate did not improve between 2008/09 and
2013/14 (Figure 5.3), and it is lower than the follow-up rate for other chronic conditions such as heart failure (44.1%) and chronic obstructive pulmonary disease (36.6%) (Figure 3.1). Results vary substantially by region in 2013/14, from a low of 16.3% in the North West LHIN region to a high of 37.7% in the Toronto Central LHIN region (Figure 5.4).

7. Patients First
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

8. 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

9. Quality Standards: How?
Determine scope, initiate project, and engage partners and stakeholders
1. Scoping and Initiation
(4 months)
Open Call for advisory committee (AC) members and co-chairs
Identification of key stakeholders and potential partners
Scoping options and background analysis
Develop quality statements and indicators with AC, plan for implementation and adoptoin
2. Development
(9 months)
2-4 cttee meetings
Draft posted for public comment; stakeholder “field testing”
Implementation planning
Finalize Quality Standard and Board approval. Adoption supports available for use by the field.
3. Finalization/launch
(3 months)
Internal Approval
Implementation begins
Pre-Standard: Topic Identification and Prioritization
Open call and stakeholder engagement; apply prioritization criteria

10. Quality Standards
Patients First plan discusses taking more standardized approaches to the implementation of quality standards – ensuring the high quality and consistent care is in place across ON
What are quality standards?
Concise sets of 5-15 strong (“should do”), measurable, evidence-based statements guiding care in a topic area
Developed in topic areas identified as having high potential for better quality care in Ontario
Each quality statement accompanied by quality indicator(s)
Every quality standard will be accompanied by a plain language summary for patients and caregivers
Strong emphasis on implementation through a variety of vehicles (monitoring/reporting, QBPs, QIPs, etc.)
Strong emphasis on partnerships with organizations and communities of practice in the topic area to support development and implementation of each Standard

11. The Audience Statements Defintions
The Statement
The Indicators
The Audience Statements
Defintions

12. 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
Patient reference guide consultations asked following of patient groups:
Groups were given time to ask questions of clarification about HQO and the QS program before their attention was drawn to the Patient Reference Guides to which the following questions were asked:
Would a tool like this be useful to you on your health journey?
Would this information be useful in helping you be clear on what care to expect?
Would this tool inform your conversation with your health care providers?
When might be the most ideal time to receive this information?
Is the information in the patient reference guides clear?
Is there another format that would be more suitable? 
Groups included:
Ontario Dementia Advisory Group
CAMH Empowerment Council
Trillium Health Partners Patient and Family Advisory Council

13. Quality Standards for Mental HEalth

15. Quality Standard: Scope
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.

16. Quality Standard: Content

18. Quality Standard: Scope
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)

19. Quality Standard: Content

21. Quality Standard: Scope
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.

22. Quality Standard: Content

23. Support for quality Standards

24. Case for Quality

25. Implementation
Without a clear implementation strategy, most guidelines or standards have little impact
Two major activities for each standard:
Each plan would be unique for a given standard
Each implementation plan would be created by a Quality Standards Advisory Committee
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
Quality Standards (QS) Implementation Plan
Take action to implement plan and improvements

26. Develop the QS Implementation Plan
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)
Take action to implement the plan, and quality improvements
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
Much better, like this

27. Future topics • Hip fracture (Winter 2017) • Wound care (Spring 2017)
• 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)
Not totally sure why we are talking about this here (same with next slide). I would move to the end or an appendix. Next slide could go back with comms if needed. The purpose of this deck is to really introduce the QI/Reporting/Comms piece

28. …..in 5 years from now
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