Mental Health Quality Standards Guiding Evidence Based High

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? • Open Call for advisory committee (AC) members and 1. Scoping and Initiation co-chairs (4 months) • Identification of key Determine scope, initiate stakeholders and potential project, and engage partners and stakeholders • Scoping options and background analysis • 2 -4 cttee meetings 2. Development • Draft posted for (9 months) public comment; Develop quality statements stakeholder “field and indicators with AC, testing” plan for implementation • Implementation and adoptoin planning 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 9 • Internal Approval • Implementation begins

Quality Standards www. HQOntario. ca 10

The Statement The Audience Statements www. HQOntario. ca The Indicators Defintions 11

Patient Engagement in Quality Standards ü ü 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