This research report describes the contributions of the Quebec team to the project entitled "Continuous Enhancement of Quality Measurement in Primary Mental Health Care : Closing the Implementation Loop". The main aim of this project is to support efforts at improving the quality of primary mental health care. The identification of a small set of quality measures achieving consensus was the mean retained to habilitate stakeholders to better document their practices on crucial aspects for the quality of health care services. The intervention practices targeted were directly clinical and organizational.
The project’s contributions can be broken down into two components: activities to support the pan-Canadian project; and, in Quebec – more specifically in the provincial capital region-the research project endeavored to generate awareness among stakeholders about the need to improve the quality of primary mental health care and services.
The first two sections of the report begin with a brief overview of the pan-Canadian project, including the process in three steps, with information on Quebec participation. More detailed information can be found on the project website: http://www.ceqm-acmq.com. The third and last section, making up the major part of this report, deals with the study carried out in Quebec.
Since this project focuses on quality, quality improvement, and quality measurement, these concepts were defined very early on in the project (Appendix 1). The definition of the concept of quality used in this project is that of the Institute of Medicine in 1992. This definition states that quality is "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge". This definition combines individual and community concerns and is consistent with the current trend towards evidence-based data. A 2003 report published by the Conseil médical du Quebec, "L'imputabilité médicale et la gouvernance clinique") expanded on the quality concept by drawing on another Institute of Medicine publication from 2001. It uses a number of attributes to define quality. This involves fair and prompt access to modern, reliable treatment based on evidence or scientific proof that is appropriate to needs and delivered in a timely manner by qualified professionals. A service organization that promotes quality is therefore based on best practices. This service organization aims at efficiency, that is, a sound cost-benefit ratio, labor productivity, and appropriate use of resources. It also targets patient health outcomes that translate into a decrease in risk factors; a reduction in disease incidence, complications, and disabilities; enhanced quality of life, and fewer premature deaths. The presence of quality also involves a positive experience for the patient and caregiver with the care team, particularly with respect to interpersonal relationships; aspects such as waiting, access, and continuity; exchange of information; the importance given of user choice and involvement; and characteristics found in the physical care environment.
According to the World Health Organization (2003), quality improvement is a process of ongoing efforts geared to improve performance, which involves identifying problems, trying solutions, and following up solutions on a continuing basis. All of the measures sought aimed at intelligently targeting improvement efforts while equipping stakeholders to document their practices regularly. Therefore, it should be specified that, for the purposes of this project, achieving the targeted improvement is not based on establishing standards or targets, nor does it seek to assign blame. It typically involves self-comparison over time.
The definition selected to describe a quality measure comes from the Canadian Council on Health Services Accreditation: « a measurement tool, screen or flag that is used as a guide to monitor, evaluate and improve the quality of client care, clinical support services and organizational functions that affect outcomes ». Indeed, the quality measures sought are standardized measures adapted to mental-health services delivered in a primary health care setting and used to facilitate health improvement.