Health Quality Ontario Standards (for Low Back Pain, Osteoarthritis, Opioids for Acute Pain and Chronic Pain)
Collaborator: Ontario Health, Health Quality Ontario – formerly Health Quality Ontario (HQO)
Issue and Impact:
What are quality standards and why do we need them?
- Quality standards inform clinicians and patients what quality care looks like, based on the most up-to-date evidence.
- HQO’s quality standards focus on conditions where there are large variations in ‘how’ care is delivered or gaps between the care provided in Ontario and the care patients should receive.
- They are grounded in the best available evidence.
Each quality standard includes:
- A patient guide
- An information brief
- Quality indicators for health care professionals and organizations to help them with their improvement efforts
- Recommendations for adoption at the system, regional and practice levels to help health care professionals and organizations adopt the standards. In addition, practical tools for quality improvement are included in the Getting Started Guide
Without quality standards, there’s a risk of:
- Variations between how each health care professional delivers care
- Gaps between the care provided in Ontario and the care patients should receive
How Quality Standards Help Create a Better Health Care System:
- Health care organizations and professionals to measure, reflect on their practice and improve the quality of their care.
- Health system planners create the environment for health care professionals and organizations to deliver quality care.
For several years, we have worked with HQO to co-develop policy and advocacy initiatives to advance a better health care system for people across Ontario.
Working with our chiropractic consultants, we are actively involved in developing quality standards, including related patient care guides. We’ve also had OCA members on the committee for writing the standards.
As draft quality standards are developed in Ontario, we provide feedback on them to ensure chiropractic modalities are included, where applicable. Our process includes engaging our members to provide feedback on HQO Quality Standard drafts, through various tactics. For example, in helping develop HQO’s standard for osteoarthritis, we hosted a virtual town hall for members to provide input on development and adoption of this quality standard.
To date, we have actively helped inform the following HQO quality standards:
- Osteoarthritis (published in 2018) – This quality standard addresses care for adults (18 years of age or older) with osteoarthritis of the knee, hip or hand joints. It outlines clinical assessment for diagnosis and early intervention with first-line treatments for people with osteoarthritis, including education, self-management, therapeutic exercise, physical activity and weight management, if needed. Its goal is to improve people’s ability to self-manage, increase access to rehabilitation services and clinical care, and improve their control of symptoms, such as pain.
Access the Osteoarthritis Quality Standard to learn more about it.
- Opioid Prescribing for Acute Pain (published in 2018)- This quality standard provides guidance on the appropriate prescribing, monitoring, and tapering of opioids to treat acute pain for people 15 years of age and older in all care settings. It does not: include opioid prescribing for chronic pain or end-of-life care; address the management of opioid use disorder in depth.
Access the Opioid Prescribing for Acute Pain Quality Standard to learn more about it
- Opioid Prescribing for Chronic Pain (published in 2018) – This quality standard provides guidance on the prescribing, monitoring and tapering of opioids to treat chronic pain for people 15 years of age and older in all care settings. It does not address opioid prescribing for acute pain, end-of-life care or the management of opioid use disorder in depth.
Access the Opioid Prescribing for Chronic Pain to learn more about it.
In response to our input, HQO’s Opioid Quality Standards recommend spinal manipulation for both chronic and acute pain management, in conjunction with an active physical therapy or exercise program. We also successfully advocated for chiropractors to be listed in the 2017 Canadian Guideline for Opioid Therapy and Chronic Non-Cancer Pain among the health care professions that physicians can refer to as an alternative to opioids.
- Low Back Pain (published in 2019) – This quality standard focuses on care for people who are 16 years of age and older with acute low back pain, with or without leg symptoms, such as radiculopathy caused by compression of a signal nerve root (a pinched nerve) and neurogenic claudication (painful cramping or weakness in the legs with walking or standing).
It examines the assessment, diagnosis and management of people with this condition by health care professionals across all health care settings, with a focus on primary care and community-based care provided by an interprofessional team of providers, including chiropractors, physiotherapists, nurse practitioners and physicians.
The standard provides guidance on:
- Reducing unnecessary diagnostic imaging
- Encouraging physical activity
- Providing education
- Giving reassurance
- Assisting with self-management support
- Prescribing pharmacological therapies
- Suggesting additional non-pharmacological therapies
Access the Low Back Pain Quality Standard to learn more about it.
Ongoing Work – Draft Quality Standard for Concussion
In early 2020, we engaged our members to provide input on a draft quality standard for concussions via an online survey and provided this feedback to HQO.