Improving the Performance of Cancer Services: p g A Framework and Recent Ontario Experience Terrence Sullivan President and CEO C Cancer Care Ontario C O i Canada
Planning: Newly diagnosed cancers by LHIN: 2007, 2012, 2017 2
More People Live With Cancer p Estimated number of Ontarians living with cancer diagnosed in the past ten years The number of The number of people living with cancer will increase by increase by 40% over the next ten years. 2007 2010 2017 Provided by: Surveillance Unit, Cancer Care Ontario y , Source: Ontario Cancer Registry 3
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Working Core Goals and Priorities for a High Performance Health Care System 1. HIGH QUALITY/SAFE CARE 2. ACCESS AND EQUITY Appropriate/ effective care Universal coverage Appropriate care (reduce under use, over Established set of benefits use, misuse) Affordable care S afe care (minimize errors) Equitable care Integrated/ coordinated care Minimal appropriate waiting and access Patient-centred care 3. EFFICIENT AND 4. SYSTEM CAPACITY TO HIGH VALUE CARE HIGH VALUE CARE IMPROVE IMPROVE Efficient delivery and administration Investment in innovation and research Care at the right time, in the right setting, Information infrastructure with right professional mix Educational system for health care Ongoing evaluation of effectiveness and providers/ administrators value Culture of performance improvement Balance autonomy and accountability Balance autonomy and accountability 5
Promising Practices to Achieve 4 Core Goals of High Performance Systems 4 Core Goals of High Canada (Ontario) England France Germany USA Performance Systems � Guideline culture and � National Institute for Health � Multidisciplinary approach: � Disease Management � Quality Oncology 1. Appropriateness � Consultation, Diagnosis and Safety adherence reporting and Clinical Excellence Program (guideline Practice Initiative (QOPI) � Thoracic surgery standards � Cancer Networks Th i t d d (NICE) clinical practice (NICE) li i l ti C N t k adherence) dh ) ( (guideline adherence via id li dh i � Minimum activity thresholds � Clinical practice guideline minimum activity & guidance voluntary chart organizational requirements and quality criteria compliance abstraction) � Certification of cancer � National Initiative on centres Cancer Care Quality (guideline adherence) � Wait times monitoring, � National Cancer Waits � Early detection (breast and � Health insurance coverage � State and local 2. Access and Equity reporting & improvement ti & i t P Project led to progress on j t l d t colorectal cancer) l t l ) f for all citizens ll iti programs to increase t i � Colorectal Screening cancer waits insurance coverage and � Colorectal Screening reduce disparities in cancer care � Improved data quality for � Progress review and � Specific financing system for � Integrated Oncology � Payment reform 3. Efficiency and Value pathology reports and stage monitoring (National Audit innovative drugs Centres demonstrations that link � incentive for appropriate capture; Office) payment to quality rather � Payment link to quality prescribing than volume standards standards � Performance reporting � Comprehensive cancer � Access to innovative drugs � Quality management � Upgrading cancer 4. System Capacity to Improve through Cancer System plan/strategy programs (analysis and registries � Cancer Services Quality Index (CSQI) reporting) � enrollment in clinical trials Collaborative (service redesign) http://www.cancercare.on.ca/documents/UK5_Pre-WorkshopReport.pdf 6
Common Elements of Performance Improvement: 1. Performance Knowledge 1.1 Measures / Performance Indicators of Cancer Care Cancer Care 1.2 S trategies for Collecting Data/ S ources of Quality Data of Quality Data 1.3 Performance Reporting 7
Common Elements of Performance Improvement : p 2. Active Levers for Performance Improvement 2.1 Institutional and Leadership Alignment on Directions 2.2 Commitment / Mobilization of S 2 2 C it t / M bili ti f S t k h ld takeholders - Commitment of clinician and clinician leaders - Engaging patients - Public engagement - Engagement of policy/ administrative decision makers 8
Common Elements of Performance Improvement : Common Elements of Performance Improvement : 3. Active Processes 3.1 Initiatives by Clinicians 3 2 Payment Mechanisms 3.2 Payment Mechanisms 3.3 Organizational S tandards/ Consolidation of S S ervices ervices 3.4 Flexible Work Force Initiatives 9
A Cancer Improvement Framework Arising from 5 Country Initiative Responsabilite et performance en cancerologie Sullivan, Dobrow, Schneider et al, Prat Organ Soins 2008;39(3):207-15 10
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Improving Quality & Program Standards Most U.S. hospitals fail to meet colon cancer standard: study Last Updated: Tuesday, September 9 2008 | 4:31 PM ET September 9, 2008 | 4:31 PM ET Comments 0 Recommend 6 CBC News Most hospitals in the U.S. fail to check colon cancer patients thoroughly for signs their ti t th hl f i th i tumour is spreading, say researchers. In the last 10 years, several oncology organizations that set guidelines in the U.S. and Canada have recommended examining at least g 12 lymph nodes to determine if colon cancer has spread. Whether cancer has passed through the lymph nodes is important to long- term survival. In the Journal of the National Cancer Institute In the Journal of the National Cancer Institute, Dr. Karl Bilimoria of Northwestern University in Chicago and his team said they found more than 60 per cent of nearly 1,300 hospitals in the U.S. failed to comply with the guideline. Wright, F et al. BMC Health Serv Res. 2006 Jan 16;6:4. 12
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