Cancer System Performance Measurement, Public Reporting and Quality Improvement in Ontario, Canada: the provincial perspective UICC World Cancer Congress Carol Sawka, MD FRCPC Vice President Clinical Programs and Quality Initiatives Cancer Care Ontario August 29, 2012
Overview 1. About Cancer Care Ontario (CCO) 2. How do we drive change? • CCO’s performance improvement cycle • Provincial and regional clinical leadership • Performance measurement and reporting tools: Internal and public reporting 3. A Quality Improvement Example 2
About Cancer Care Ontario Mandate • provincial government agency responsible for continually improving cancer services. • works to reduce the number of people diagnosed with cancer, and make sure patients receive better care Mission • Improve the performance of the cancer system by driving quality, accountability and innovation in all cancer-related services 3
Setting the context for healthcare in Canada Canada • > 33 million people, 9.9 million sq. km • 10 provinces, 3 territories • Healthcare: national strategy, provincial plans/ implementation • Cancer services uniquely organized in most provinces Ontario: • > 13 million people, 1.1 million sq. km. • Est. 77,000 incident cases in 2011 • Colorectal, Lung, Breast and Ovarian – high relative rates of survival internationally 4
Our Regional Structures Regional / Provincial Leadership Alignment & Coordination 1. Erie St. Clair 2. South West 3. Waterloo Wellington 4. Hamilton Niagara Haldimand Brant 5/6. Mississauga Halton/ Central West 7. Toronto Central 8. Central 9. Central East 10. South East 11. Champlain 12. North Simcoe Muskoka Today 13. North East Regional VPs; 14. North West Regional Clinical Leads; Regional Cancer Programs; Alignment with LHINs. 5
How do we drive change? & Performance improvement cycle Clinical accountability framework Extensive clinical engagement and joint clinical/administrative accountability for quality at provincial and regional levels 6
The Performance Improvement Cycle Identifying quality 1. Data/Information improvement opportunities • Incidence, mortality, survival Monitoring • Analysis Horizon-scanning performance • Indicator development and championing • Expert input innovation 4. Performance 2. Knowledge Management • Research production • Institutional agreements • Evidence-based guidelines • Quarterly review • Policy analysis • Quality–linked funding • Planning • Clinical accountability 3. Transfer • Publications Developing and • Practice leaders engaged Standardizing implementing • Policy advice development improvement • Public reporting and guidelines strategies • Technology tools • Process innovation 7
Provincial and regional leadership in Ontario Ministry of Health and Long-Term Care Cancer Quality Cancer Care Ontario Council of Ontario Provincial Leadership Council Clinical Council Clinical Accountability Prevention • Regional Cancer Programs Provincial Clinical Family Medicine • led by Regional Vice Screening • Programs with Presidents Cancer Imaging • Clinical Leads Pathology and Laboratory • Medicine Surgical Oncology • Systemic Treatment • Radiation Therapy • Other regional cancer Psychosocial Oncology • providers (e.g., home care, Patient Education • Survivorship hospice, etc.) • Palliative Care • 8
Clinical accountability structures Clinical Council and Provincial Program Committees • Prevention • Surgical Oncology • Family Medicine • Systemic Treatment • Screening • Radiation Therapy • Cancer Imaging • Psychosocial Oncology • Pathology and Laboratory • Patient Education Medicine • Survivorship • Palliative Care 9
Reporting instruments: internal and public facing Cancer*System* ! Quality*Index* Big*Dots* ! (CSQI)* Provincial!Level! Outcome!Indicators! Quarterly* Regional* Provincial*Level***************** Performance* Scorecard* Driver*Indicators* CCO*Special* Reports/* Program*Reports* Regional!Indicators! Li7le* Dots* Health*Professional*Level*Indicators* CQCO*Adapted*from*Heenan,*M.*Khan,*&*Binkley,*D.*(2010).*“From*boardroom*to*bedside:*How*to*define*and*measure*hospital* quality.”* Healthcare)Quarterly,)13 (1):*55T60.* * 10 Cancer Quality Council of Ontario
Public reporting (CSQI) within our quality framework Surveillance: incidence, mortality, survival prevalence Gaps guide Population Studies: risk factors & socio-demographic factors future work Quality Dimensions Accessible/ Patient Centred/ Timely Responsive Safe Effective Equitable Integrated Efficient MRFs: Smoking (adult), Lung surveillance by susceptibility (teens), alcohol SES Prevention consumption, physical inactivity, Modifiable Risk obesity, inadequate vegetable Factors (MRFs) by and fruit consumption SES Breast screening: Follow-up of Breast Screening Integrated Cancer Integrated Cancer Abnormal Results Cervical Screening Screen Participation Screening Participation Cervical screening : Follow-up of Colorectal Screening (women & income) Screening Abnormal Results (FOBT, Colonoscopy Breast (income, age) Colorectal Screening: Follow-up and Flex.Sig.) Cervix (income, age) of Abnormal Results Colorectal (Income) Synoptic pathology reporting Wait times for breast Patient Journey Reporting stage at diagnosis cancer assessment Diagnosis Lymph node sampling (colon) Colonoscopy wait time (positive FOBT) Thoracic surgery and Margin status (Prostate) Wait times for cancer Patient experience Wait Times from Radiation Machine HPB surgery standards Margin status (Rectum) surgery (satisfaction) Treating Colon diagnosis to chemo Efficiency and link to Mortality Multidisciplinary Case Conf.s Cancer by (breast, colon, lung) Treating NSC Lung Cancer by Wait times for Symptom assessment Guidelines Admission and ER visit guidelines radiation treatment (and symptom (Age, sex) Treatment within 4 weeks of Treating Colon Cancer by management) Wait Times Surgery to IV chemo guidelines Wait times for chemo interval (colon) Consultation with medical systemic treatment Consultation with Safe handling of oncologist (colon and breast) Medical Oncologist cytotoxics and CPOE Radiation treatment utilization (Age) IMRT Utilization Recovery Deaths in acute care Chemo in last 2 ED visits, ICU stay and End-of-Life hospital weeks of life (Age) chemotherapy in last 2 weeks of life Care LOS in last 6 months 11 CQCO’s Cancer System Quality Index (CSQI) is reported publicly on an annual basis www.csqi.on.ca
Overall CSQI 2012 summary 12
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