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Dr. Irfan Dhalla and Dr. Chris Simpson

Doing it right – quality standards to improve care

Patients across Ontario should expect to receive excellent care from our health system. And it usually delivers. But in too many instances, the quality of care people receive can vary depending on where they live.

For example, people with a diagnosis of heavy menstrual bleeding living in the northeast are more than ten times as likely to receive a hysterectomy as people living in Toronto. Similarly, people hospitalized with a hip fracture have a likelihood of dying within 30 days of admission that varies from 3% to 16% across the 50 highest volume hospitals in the province.

Some variation in care is always to be expected because of differences in patients’ underlying health conditions or in their treatment preferences. However, wide unwarranted regional variations in practices and outcomes are often a symptom of a system that lacks focus. Several decades ago, renowned health services researcher Dr. John E. Wennberg and colleagues at the Dartmouth Institute of Health Policy and Clinical Practice in the US determined that such regional variations point to a lack of “evidence-based standards of practice”.

Two years ago, Health Quality Ontario launched an initiative to address this important issue head-on and reduce unwanted clinical variations in care.

Quality standards outline for clinicians and patients what high quality care looks like for a specific condition. They focus on medical conditions or diseases where there are large variations in how care is delivered, or where there are gaps between the care provided in Ontario and the care patients should receive. Quality standards are based on the best available evidence and decided upon by expert advisory committees comprised of patients or caregivers and health care professionals with experience in dealing with the relevant condition.

Since October 2016, Health Quality Ontario has released 18 quality standards with 14 more in development. Clinical topics are selected based on the degree and impact of variations in care, and the ability of a standard to improve the quality of care. The quality standards are meant to be a foundation for evidence-based quality improvement and can be used to help determine where resources are best used.

Physicians rightfully resist “cookbook medicine” – demands that they follow a set approach in treating patients with certain diagnoses. Patients deserve individualized care. But patients also deserve to be offered care that is consistent with the best available evidence.

Do approaches to reducing unwanted variations in care work? An analysis conducted by The Economist Healthcare Intelligence Unit looking at studies that have tried to evaluate this question over the past six years found that 20 of the 34 studies identified found a significant improvement in the use of health care services through use of either evidence-based approaches such as quality standards, medical technologies, or care-delivery system interventions.

Health Quality Ontario is committed to supporting the development and dissemination of quality standards in areas of clinical care where patients and front-line health care providers believe improvements can be made. Importantly, each standard includes a patient guide to help patients asked informed questions of their healthcare providers as well as recommendations for adoption.

We are interested in your views about quality standards and their potential to improve care in Ontario. We invite you to join us on Feb. 5 at 1 pm (EST) on Twitter to discuss them using the #HQOchat hashtag:

Q1. How can quality standards be used to improve care in Ontario?
Q2. Are there examples of where quality standards are already having an impact?
Q3. Should organizations be required to show how they are using quality standards?
Q4. What more can be done to get clinicians and patients using quality standards and their accompanying patient guides?

We are looking forward to discussing these issues with you on Twitter on Feb. 5 at 1 (EST): Join us at #HQOchat

Dr. Irfan Dhalla, is VP, Evidence Development and Standards at Health Quality Ontario and Dr. Chris Simpson is Chair of HQO’s Ontario Quality Standards Committee


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