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Top 30 Quality Measures

Secondary Care Discharge Plans Overall Rank: 5 Best in Domain
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.
Domain : Continuity
Services are offered as a coherent and coordinated succession of events in keeping with the health needs and personal context of patients. Health care is linked to other services to support successful treatment.
Rationale
Development of an action orientated discharge plan including identification of a relapse signature and relapse drill; and support to primary care staff in monitoring relapse signature signs and responding as necessary for patients aged 25-64 years with low prevalence psychiatric disorders who have received specialist mental care and been transferred back to primary care for monitoring compared to discharge or transfer documentation from specialist to primary care services without a relapse signature for monitoring.

Despite transfer to primary care, recognition of a continuing duty of care on the part of the specialist service, even if extending only to the duty to ensure that people remain in contact with service providers so that they can potentially be meaningful monitoring of possible impending relapse.

Desired outcome is improved retention in continuity and quality of care of people with long-term psychiatric disorders.
Primary Reference
Meadows GN. Overcoming barriers to reintegration of patients with schizophrenia: developing
a best-practice model for discharge from specialist care.
Med J Aust. 2003 May 5;178 Suppl:S53-6.
PMID: 12720523
Level of Evidence
III: Preliminary research evidence only or evidence based on consensus opinion only.

Summarized CommentsAdd Comment
  • Actionability is lower for PHC providers because they may not be alerted to a discharge. Actionability may be higher for regional health authorities or secondary care.
  • Self-management plans and tools should be included in the discharge plan.
  • It would be very difficult to track this data in the real world without an electronic health record
Variation in Results
Ratings-based Rank
Relevance 5
Actionability 10
Overall Importance 7
 
Stakeholder Rank
Academics 2
Clinicians 1
Consumers 11
Decision Makers 14
 
Special Group Rank
First Nations 26
Rural Areas 18
Federal Stakeholders 14
Regional Rank
BC AB SK MB ON QC NB NS PE NL YT NT NU
5 5 31 1 2 16 40 13 15 43 3 20 16
 
Overall Rank

      

5


SW04d (B1129)

 
Distribution of Survey Respondent Ratings
Relevance
100
90
80
70
60
50
40
30
20
10
0
0 0.53 0 0.72 0.35 1.42 8.19 29.03 59.76
1 2 3 4 5 6 7 8 9
Low High
Actionability
100
90
80
70
60
50
40
30
20
10
0
0 1.07 1.08 1.44 2.29 4.89 13.02 37.68 38.53
1 2 3 4 5 6 7 8 9
Low High
Overall Importance
100
90
80
70
60
50
40
30
20
10
0
0.71 7.97 91.32
3 2 1

3 = can live without
2 = nice to have
1 = indispensable

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