National Consensus Summary
Most people with mental health problems are seen in primary health
care (PHC) settings. Yet significant discrepancies exist between
the services currently provided and current knowledge about effective
CEQM was intended to help address this care gap through building
consensus regarding a set of quality measures that are evidence-informed.
A three stage consensus process lead to a final list of 30 consensus
measures. Stage One employed a two round process that built consensus
around priority areas (domains) for measurement. Stage Two populated
these domains with potential measures through literature reviews
and an expert survey. In Stage Three, a subset of these measures
was incorporated into a two round postal Delphi survey which used
ratings of relevance, “actionability” and overall importance
to identify the final measures.
Over 500 people from every province and territory in Canada -
representing consumers/advocates, clinicians, academics and government
decision makers from regional, provincial and federal levels, actively
participated in this project. A small group of people with expertise
in First Nations and Rural health issues was also included. A rigorous
sampling strategy to ensure balanced participation amongst regions
and stakeholders was utilized.
Stage One had a 91% response rate and identified 20 priority
domains. In Stage Two several hundred potential measures were identified.
In Stage Three 160 measures were rated by 212 final respondents
(80% response rate) leading to a final set of 30 consensus quality
measures. Respondents placed special emphasis on measures associated
with self harm and depression.
The highest degree of variation in ratings occurred around “actionability”.
Consumers and Quebec respondents had the most distinct results.
The largest differences between stakeholders were for measures
associated with the domains of personal resources, co-morbidity
and rehabilitation. The most significant consideration used by
respondents to rate measures was “quality of life” for
people in care.
Respondents emphasized an actionable, pragmatist orientation
to measurement that may be appropriate for primary mental health
care. The significant inter-stakeholder and inter-regional variation
meant that consensus methods were important to achieving nationally
agreed upon results. All measures will be available in a web based
inventory allowing the end-user to search for individual measures
best suited to their respective interests. These findings, achieved
through a rigorous, evidence informed process based on national,
regional and multi-stakeholder input, give a “green light” for
action in primary mental health care reform.
v17 Sep 27, 2006
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