Project Summary

Continuous Enhancement of Quality Measurement (CEQM) in Primary Mental Health Care: Closing the Implementation Loop
A Primary Health Care Transition Fund National Envelope Project

The goal of CEQM was to improve the quality of mental health care for all Canadians by fostering quality measurement in Primary Mental Health Care. It aimed to achieve this goal through building pan-Canadian consensus on a small set of quality measures. These measures can be used in quality improvement efforts at various levels of the health system including the practice level. The project reached the end of its Primary Health Care Transition Funded work on September 30th 2006.

Breaking New Ground

While other jurisdictions (e.g. the United Kingdom and United States) are examining how to improve the quality of primary mental health care, CEQM built on this work in a Canadian context. It also:

A Legacy for Primary Mental Health Care – green light for action

A three stage process lead to a final set of 30 consensus measures. This project identified measures that Canadians view as important - providing both practical means for implementing quality measurement, as well as strategic direction in policy development and research. However further work is required to continue the iterative process of implementation required for a complex undertaking such as CEQM.


National Consensus subproject

Data Infrastructure subproject

Measurement Implementation subproject


Over 500 people from every province/territory in Canada representing –


National Consensus

All measures are available in our Quality Measures database – you can search for individual measures best suited to your interests.

Examples of CEQM Quality Measures

Domain Measure Title
Patients With Mood Disorders Education about Depression
Patient and families should be educated on:
•  The causes, symptoms and natural history of major depression
•  Treatment options (trial and error approach)
•  What to expect during the course of treatment
•  How to monitor symptoms and side effects
•  Follow-up protocols (office visits and/or telephone contacts)
•  Early warning signs of relapse or recurrence
•  Length of treatment.
Patients With Acute Conditions Risk Assessment for Self Harm
Healthcare professionals attending a person who has self-harmed should conduct and record a comprehensive and respectful assessment of (in order of urgency):
1.  risk
2.  current emotional and mental state
3.  psychosocial needs
4. main clinical and demographic factors associated with risk of further self-harm and/or suicide.
Continuity Secondary Care Discharge Plans
Development of a discharge plan addressing monitoring and follow-up actions for adults with low prevalence psychiatric disorders (e.g., schizophrenia) who have received specialist mental care and have been transferred back to primary health care.


Data Infrastructure

This project identified needs for standard measurement approaches, and the value of electronic data capture as a tool for quality improvement, an approach that both meets the quality measurement needs of the mental health primary care sector as well as ensures standardized measurement practices across the country.

Measurement Implementation

Creation of a practical checklist for organizations to identify facilitators and barriers to implementing quality measurement.

Key Findings

National Consensus

Data Infrastructure

There are significant gaps in the information that is available to calculate measures in Primary Mental Health Care. Electronic Health Records, when available, and if standardized, will become a possible source of data for quality improvement efforts in PHC and other areas of health care in the future.

Measurement Implementation

The Readiness to Implement Quality Measurement Checklist is an internal management tool that allows an organization to assess its position regarding implementing quality measurement. The checklist is brief but comprehensive, based on a systematic literature review and pilot test ed with a heterogeneous group of stakeholders.

Summary of Implications – a roster of key messages

Uniqueness of initiative

Breadth and depth of initiative

Builds momentum for primary health care transition

Project Lead

Paul S. Waraich, MD, MHSc, FRCP (C)
Adjunct Professor, CARMHA
Centre for Applied Research in Mental Health & Addiction
Faculty of Health Sciences, Simon Fraser University
Assistant Professor
Department of Psychiatry
Faculty of Medicine, University of British Columbia

Centre for Applied Research in Mental Health & Addiction (CARMHA)
Faculty of Health Sciences
Simon Fraser University

Department of Psychiatry
Faculty of Medicine
University of British Columbia

Project Sponsor

Primary Health Care Transition Fund
(National Envelope), Health Canada



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The views expressed herein do not necessarily represent the official policies of Health Canada