On behalf of the Hospitals Advisory Committee (HAC), the Ontario Hospital Association (OHA) coordinates the Mental Health and Addictions Funding Initiative to explore funding approaches that would improve quality of care for Ontarians, beginning with a focus on schizophrenia care. After more than two years, the project involves two streams: one focused on care within hospitals, and one focused on the entire patient journey across clinical settings.
In our last update in June 2022, we described the early stages of the Schizophrenia Integrated Care Initiative, which explores approaches that bridge the hospital-based and community-based quality standards for schizophrenia care. Four existing Ontario Health Teams and integrated care networks are currently participating as prototype organizations.
Selecting A Starting Point for Quality Improvement Across the Continuum of Care
One of the key steps in the project is selecting which of the quality statements making up Ontario Health's Quality Standard for Schizophrenia Care in the Community to focus on first. Working groups composed of frontline clinicians, decision support, and administrative leaders as well as a panel of people with lived experience considered which of the fifteen quality statements the participating networks could most effectively measure for quality improvement.
Ultimately, four quality statements were selected:
- Quality Statement 1: Care Plan and Comprehensive Assessment - Adults with schizophrenia have a care plan that is regularly reviewed and updated, and that is informed by a comprehensive assessment.
- Quality Statement 5: Access to Community-Based Intensive Treatment Services - Adults with schizophrenia have timely access to community-based intensive treatment services based on their needs and preferences.
Quality Statement 8: Treatment with Long-Acting Injectable Antipsychotic Medication - Adults with schizophrenia are offered the option of a long-acting injectable antipsychotic medication.
Quality Statement 11: Cognitive Behavioural Therapy for Psychosis and Other Psychosocial Interventions - Adults with schizophrenia are offered cognitive behavioural therapy for psychosis and other evidence-based psychosocial interventions, based on their needs.
Now that these four statements have been selected, a data-focused sub-group of experts from community mental health, hospitals and primary care will select feasible indicators to measure activity and progress. Then, the four participating integrated care networks will draw on the expertise of clinicians, academics, and their own partners with lived experience to find quality improvement initiatives they can conduct in their own communities.
Partners with Lived Experience Help Shape Improvement
In addition to mental health providers, two panel sessions in May and June engaged people with lived experience and their caregivers. These partner panels were made up of people who have been diagnosed with schizophrenia, or people with children, siblings, parents or grandparents living with it. Input from the panel has been extremely valuable, bringing forward ideas and observations that might otherwise have been missed. For example, the panel suggested extending the work to consider opportunities to support people who have been diagnosed with schizophrenia even prior to their admission to hospital.
The panel also provided valuable insight during the process of choosing quality statements, where some differences emerged between the observations of the clinical working group and the partners with lived experience. While health care providers initially assumed that all patients were already receiving comprehensive assessments, the panel identified this as a gap, so it was added as a quality statement to be addressed during the initiative.
We have benefited enormously from these partners' willingness to share their experiences and challenges, and their passion for improving the system so that people who are diagnosed with schizophrenia in the future don't have to face the same challenges. Their dedication as part of this initiative and in other contexts has been inspiring – for example, one panel member, Ilyas Khanis, has also worked with the Canadian Consortium for Early Intervention in Psychosis to produce Parallel Realities, a podcast in which young people and families share stories about what it was like to experience, receive treatment for, and recover from psychosis.
Data Collection Expected to Begin in the New Year
As Ontario continues its progress towards integrated care, the Schizophrenia Integrated Care Initiative is a crucial step within the mental health space. At meetings in November, data experts will finalize indicators to be measured, and then improvement initiatives and data collection will begin in early 2023. We are grateful for the contributions of all participants in this integrated care initiative – especially partners with lived experience – as we continue to move this important work forward.
Learn more about the Mental Health and Addictions Funding Initiative. With any questions, please contact pbf@oha.com.