- Nadiya Sunderji, MD, MPH, Psychiatrist-in-Chief, Waypoint Centre for Mental Health Care, Assistant Professor, Department of Psychiatry, University of Toronto, Ontario, Canada
The objective of this project was to validate the previously developed Quality Improvement For Collaborative Care (QI4CC) framework to ensure relevance and applicability across Canada, and to recommend quality measures to evaluate Collaborative Mental Health Care (CMHC) initiatives in primary care. We conducted 33 interviews with key informants including providers, researchers and administrators, as well as consultations with a Canadian working group on shared care and with CMHC consumers. Data collection and analysis were concurrent; we iteratively refined our interview guide and used qualitative content analysis with a triangulated team approach to refine the framework based on participants’ perspectives. The validated framework contains 13 broad domains describing the aims of CMHC, the key processes to achieve those aims, and the necessary infrastructure and supports for successful CMHC implementation. The revised framework highlights: i) client and family experience as distinct from the construct of client care outcomes; ii) equity as a key objective of population-based care, and iii) capacity building of mental health-related knowledge and skills in primary care. We recommend practice-level indicators that reflect the prioritized domains of access and timeliness (e.g. decision support and wait times), client care outcomes (e.g. client functioning and quality of life), client inclusion and participation (e.g. in their own care and at the program/organizational level), and equity and population-based care (e.g. capturing and using population data to drive more proactive care). Primary care organizations can utilize these indicators to evaluate and improve their CMHC programs, and potentially to contribute to new practice-based evidence on implementing effective CMHC.