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Quality Standards for Quality Care

Living with dementia in a long-term care home without being automatically restrained with anti-psychotic drugs if you experience agitation or aggression.

Receiving a follow-up visit from a physician within seven days anywhere in Ontario if you have a major depressive illness, no matter where you live.

Getting the proper follow-up care after hospital discharge if you are a patient with schizophrenia, including a visit with a qualified health care provider within seven days of discharge.

All of these examples represent good quality care and should be – but are often not what Ontarians with these conditions receive.

Now, Health Quality Ontario has worked with physicians, patients and a wide group of other experts to create quality standards and supporting tools to help close the gap between what we know is good care and current practice.

Quality standards are different from Clinical Practice Guidelines (CPGs) which provide a very comprehensive overview of a clinical topic. CPGs can include many recommendations, some of which are based on low-quality evidence and in areas where experts disagree. Many recommendations suggest physicians can choose between options. In contrast, quality standards focus on areas where there is strong consensus, usually based on high-quality evidence.

These standards are concise, evidence-based actions that can be implemented by providers and health organizations. They are intended to achieve three main aims:

  • Help health care professionals offer care based on best available evidence
  • Help patients, residents, families and caregivers know what to discuss with their clinicians.
  • Help health care organizations measure, assess and improve their quality of care by offering indicators to track progress

Each quality standard consists of four components:

  • A patient reference guide informing them about what quality care looks like and to help them ask the right questions about their own care.
  • A clinical guide for health care professionals outlining evidence-based quality care
  • An implementation plan and tools and resources to support the implementation of the standard
  • Information to outline current performance and indicators that can be used to measure improvement

The first three quality standards released by Health Quality Ontario focus on; major depression care for adults and adolescents; schizophrenia care for adults in hospitals; and the behavioural symptoms of dementia.

Each of these topics was selected to help improve the status quo.

Major depression is the most common mental illness in Ontario affecting nearly 7% of adults annually. In Ontario, only one in three people discharged from hospital for a primary diagnosis of depression or other mood disorders receives the recommended follow-up visit with a physician within 7 days.

There are significant gaps in the quality of care that people with schizophrenia receive in Ontario. For example, only 25% of people discharged from a schizophrenia- or psychosis-related hospitalization receive the recommended follow-up visit with a physician within 7 days.

More than 200,000 people over the age of 65 in Ontario are living with dementia, with an estimated 66% of these living in long-term care homes. Many of these individuals experience what are sometimes called behavioural symptoms. Data shows the number of long-term care home residents with improved behavioural symptoms has not improved in the last four years.

Without thoughtful consideration of implementation, standards can often have a limited effect, so a comprehensive implementation plan will accompany each standard.

For health care providers, the quality standard provides focused advice based on the best available evidence. Health Quality Ontario plans to review these standards regularly and update them as required.

The implementation tools and resources are intended to support providers in reflecting and adjusting practice as appropriate. The standards are informed by both evidence and perspectives of frontline doctors and other clinicians. The standards acknowledge the need to recognize that system issues also need to be addressed to meet the goals that are set out. They also recognize the uniqueness of each patient and are not intended to eliminate patient centered care.

Another important element of quality standards is that each standard has one or more quality indicator. A small number of health outcomes are chosen as the most important measures of success of the entire standard and these are mapped to indicators that reflect the goals of the standard. These outcomes and the associated indicators guide the development of the quality standard so that every statement within the standard aids in achieving the chosen outcomes.

In the coming months, Health Quality Ontario will be releasing several more quality standards on important topics ranging from hip fractures, to use of opioids for pain relief, to end-of-life care. By December 31st 2018 we hope to have 12 standards published and more to come.

All standards are developed through evaluation of the best available evidence and decided upon by doctors and other clinicians, patients with lived experience and their families and caregivers. Health Quality Ontario welcomes public input and comment on draft versions of the standards and is also periodically seeking suggestions for new topics. Representatives are sought to serve on quality standards advisory committees which oversee the development of each standard.

Successful implementation of quality standards will mean a big step forward in the care that residents of Ontario receive

Quality care can be achieved, but only if we all work together.

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