Better Cancer Services Every Step of the Way

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  • Better Cancer Services Every Step of the Way

    1. 1. Better Cancer Services Every1 Regional Performance Improvement & Quality in Cancer Services: Aligning Energy, Resources and Metrics Better cancer services every step of the way Terrence Sullivan PhD CEO, Cancer Care Ontario September 2009
    2. 2. Better Cancer Services Every Provincial-Regional Planning and Delivery of Cancer Services at a Glance Ministry of Health and Long-Term Care Cancer Care Ontario Integrated Cancer Program LHIN 1 Integrated Cancer Program LHIN 2 Integrated Cancer Program LHIN 3 Integrated Cancer Program LHIN 14 Cancer Quality Council of Ontario Other regional cancer providers Other regional cancer providers Other regional cancer providers Other regional cancer providers • Public agency • Purchasing agent • Information management • Standard setting • Chief cancer advisor to Ministry • Routine performance measurement & monitoring • Advisor to CCO ~ 30% of expenditures ~ 70% of expenditures
    3. 3. Better Cancer Services Every 2008-2011 Ontario Cancer Plan Six Goals 1. Reduce the incidence of cancer 2. Reduce the impact of cancer through effective screening & early detection 3. Ensure timely access to effective diagnosis and high quality cancer care 4. Improve the patient experience across continuum 5. Improve the performance of cancer system 6. Strengthen translation of research into improvements in cancer control Four Key Initiatives • Transform cancer screening • Streamline and speed up cancer diagnosis • Regional Cancer Programs to achieve high quality cancer services in every LHIN • Prepare our services to respond to molecular oncology Better cancer care every step of the way Ontario Cancer Plan 2008-2011
    4. 4. Better Cancer Services Every How are we Doing and How do we Manage? Cascading indicators • Macro = System • Meso = Region / Facility • Micro = Clinician /Program/ Care Team e.g., Population FOBT participation rate e.g., facility level wait times for cancer surgery e.g., % of stage 1 or 2 breast cancer cases treated with radiation following breast conserving surgery
    5. 5. Better Cancer Services Every Improve measurement Increase use of evidence Increase efficiency Increase access Reduce burden of cancer (improve outcomes) Primary input 25 indicators that measure progress against 5 system goals www.cancercare.on.ca/qualityindex2006
    6. 6. Better Cancer Services Every Choosing the indicators Modified Delphi panels Master List 689 indicators Initial filtering by working group 575 indicators 1st expert panel (9 practice leaders) 419 indicators 2nd expert panel (17 practice leaders) 179 indicators CQCO member panel 88 indicators 1st strategy mapping exercise 45 indicators 2nd strategy mapping exercise 35 indicators Feasibility assessment (Year 1) 25 indicators Systematic literature review Strategy-based scorecard
    7. 7. Better Cancer Services Every Visible System Level Public Reporting On Access and Quality
    8. 8. Better Cancer Services Every Focused Yearly Clinical Priorities 2009-10 Priority and Target Setting
    9. 9. Better Cancer Services Every 9 09/10 Priorities • Wait Times (Radiation, Systemic, Surgery, Colonoscopy) • Pathology Reporting • Stage Capture • Cancer Symptom Management (OCSMC) • Multidisciplinary Cancer Conferences (MCCs) • Thoracic Standards Implementation • HPB Standards Implementation • Regional Systemic Treatment Program (RSTP) • Intensity Modulated Radiation Therapy (IMRT)
    10. 10. Better Cancer Services Every Standard Provincial Target Current Performance Regional Systemic Treatment Program 100% of RSTP programs will have nursing/pharmacy leads identified New Target Regional Systemic Treatment Program 100% of RSTP hospitals will establish a process of identifying & reporting serious systemic treatment adverse events New Target Regional Systemic Treatment Program 100% of RSTP hospitals will have current policies & procedures related to safe handling of cytotoxic agents New Target 2009/10 Performance Targets
    11. 11. Better Cancer Services Every Standard Provincial Target Current Performance IMRT 25% of radiation treatment courses delivered using IMRT 20% MCC 50% of targeted disease sites in each hospital have standards-compliant MCCs New target 2009/10 Performance Targets
    12. 12. Better Cancer Services Every MCC Implementation in Ontario Ontario Goals: 1. Improve the quality of existing MCCs  Bringing them up to standard 2. Improve access/coverage of MCCs  More disease sites and more hospitals CCO Action • Published standard http:// www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=14320 • Providing tools and education to regional cancer programs • Supporting coordinators in each region • Supporting use of technology to enable MCCs across regions • Collecting of near-real time data on MCCs and monitoring progress
    13. 13. Better Cancer Services Every MCC Status • Performance Goal: Standards-compliant MCCs in all hospitals receiving surgery agreement funding • Standards-compliant means –Held weekly/biweekly, –Chair and coordinator in place –Prospective case review –Relevant disciplines attend • Approximately 20% of current MCCs are standards-compliant (Nov. 2008)
    14. 14. Better Cancer Services Every Thoracic Standards: Purpose • Ontario Cancer Plan 2004 Goal #1: Broaden the development and use of provincial standard and guidelines • Standards implementation will: improve the quality and the organization of thoracic cancer surgery services within each region • Standards are available at http://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=14332
    15. 15. Better Cancer Services Every Strategy for implementation • Strategic engagement of key stakeholders (Surgeons, Institutions and LHINs) • Regional plans • Consolidation of thoracic cancer surgery at the designated centres • Incentives (incremental funding) • Base forgiveness for those hospitals getting “out of the business” • Targets established for provincial and regional implementation • Public Reporting on regional compliance with standards
    16. 16. Better Cancer Services Every Screen shots from CSQI
    17. 17. Better Cancer Services Every
    18. 18. Better Cancer Services Every
    19. 19. Better Cancer Services Every Pay for Participation...
    20. 20. Better Cancer Services Every
    21. 21. Better Cancer Services Every Reimbursement Standards for Wait times Reductions in Thoracic Cancer Surgery (lung and esophageal) • Surgeons -Certification in Thoracic Surgery, or equivalent • Hospitals - commitment of resources, support services and organization etc. • Volumes • Level 1: 3+ surgeons; 150 lung, 20 esophagus • Level 2: 1+ surgeons; 50 lung, 7 esophagus
    22. 22. Better Cancer Services Every Improving Quality Number of self-reported Lung Cancer Surgeries by Hospital, April 1 2007 to March 31 2008 0 50 100 150 200 250 300 350 400 *U n ive rsity H e a lth N e tw o rk *Lo n do n H e alth S c ie n ce C e ntre *S t. Jo se p h ’s H e alth c a re H am ilto n *T h e O ttaw a H osp ita lC o rp o ra tio n *S ou th lake R e g io n alH e a lth C e ntre S u db u ry R eg io na lh osp ita lC o rp ora tio n *La ke rid g e H e a lth C o rp o ratio n *S t. Jo se p h ’s H e alth C e n tre *T h e T o ro n to E a s t G e ne ra lH o sp ita l *W illia m O sler H e a lth C en tre (B ra m p to n) *S t. M ary’s G en e ral H o spita l H otel-D ie u G ra c e H o spita l T rilliu m H e a lth C e ntre N ia g ara H e a lth S yste m *T h un d er B a y R e g io n a lH e a lth S c ie n ces C e n tre P e te rb o ro ug h R e gio n a l H ea lth C e n tre T h e S ca rbo ro ug h H o sp ita l R ou g e V alle y H ea lth S yste m *T h e C re d it V a lle y H o spita l H um b e r R ive r R e g io n alH o s pita l B lue w ater H e a lth H alto n H ea lth S e rv ices C o rp ora tio n N orth Y ork G e n e ra lH o sp ita l G re y B ru ce H ea lth S e rv ice s C o rp ora tio n T h e R oya lV icto ria H o s p italo f B arrie In c. Jo sep h B ra nt M e m oria l H osp ita l S u nn yb ro o k M a rkha m S tou ffville H o sp ita l M o un t S in a i H o sp ita l H am ilto n H e a lth S cien ce C en tre G ra n d R ive r H osp ita l N o rth B ay G e n e ra lH o sp ita l *K in g s to n G e ne ra lH osp ita l H o te lD ieu H o s p ital - K in g sto n H osp ita lM on tfo rt Q u e en sw ay R e n fre w S a ult A rea H o spita l S yd e n h am A lex a n dra M a rin e a n d G e n era lH osp ita l S t. T h o m as -E lg in C a m b ridg e M e m o ria l G u e lp h G e n e ra l H o s pita l B ra ntfo rd G e n e ra lH o sp ita l S t. M icha e l’s H o spita l Y o rk C en tra l H osp ita l Hospital (*Designated Centres are highlighted in dark purple) NumberofCases Threshold = 150  (06/07) 4 centres meet volume standard  (07/08) 7 centres meet volume standard Sundaresan, S., Langer, B., Oliver, t>, Schwartz, F., Brouwers, M., Stern, H. Standards for thoracic surgical oncology in a single payer healthcare system. Ann Thorac Surg. 2008 May:84(2): 693- 701.
    23. 23. Better Cancer Services Every http://csqi.cancercare.on.ca/cms/One.aspx?portalId=40955&pageId=41185
    24. 24. Better Cancer Services Every 24 IMRT • 25% of all radical courses will treated using IMRT by Q4, 2010
    25. 25. Better Cancer Services Every 25 Wait Time Targets • Systemic: – Referral to Consult 60% seen within 14 days – Consult to Treatment: 50% treated within 14 days • Surgery: – 85% of patients treated within 3 priority targets – LHIN Target 90th percentile wait time 55 days • Radiation: – Referral to Consult 80% seen within 14 days – Ready to Treat to Treat 85% treated within target
    26. 26. Better Cancer Services Every Draft 2009/10 Performance Targets Standard Provincial Target Current Performance Colonoscopy Colonoscopy: 65% of FOBT+ colonoscopies completed within target 59% Colonoscopy Colonoscopy: 75% of Fam History colonoscopies completed within target 71% FOBT Participation 35% FOBT participation in target population 24% (2 yr period Jan 06 – Dec 07) Thoracic Cancer Surgery 85% of thoracic cancer operations within LHIN are performed in designated centre by Sep 09 80%
    27. 27. Better Cancer Services Every
    28. 28. Better Cancer Services Every 28 Pathology Reporting • Synoptic reporting in discrete data field format implemented in 100% of hospitals for 5 common cancer resections by March, 2010 • 90% of discrete synoptic reports complete against CAP/CS standards
    29. 29. Better Cancer Services Every 29 Stage Capture • 100% of eligible hospitals reporting stage at diagnosis for 5 common cancers • 90% of all RCC and surgery only patients will have stage reported at diagnosis
    30. 30. Better Cancer Services Every 30 OCSMC • 90% of lung cancer patients screened for symptom severity using ESAS • 60% of all other cancer patients screened for symptom severity using ESAS
    31. 31. Better Cancer Services Every 31 MCCs/Standards Implementation • Standards compliant MCCs in place for 50% of incrementally funded disease sites • 85% of thoracic cancer-related operations are performed in a designated centre • 80% of HPB cancer-related operations are performed in a designated centre
    32. 32. Better Cancer Services Every 32 RSTP • 100% of RSTP hospitals will have current policies and procedures related to safe handling of cytotoxic agents in accordance with CCO guidelines • 100% of RSTP hospitals will have nursing and pharmacy RSTP administrative leads identified to manage strategic and operational issues related to implementation • 100% of RSTP hospitals will establish a process of identifying and reporting serious systemic treatment adverse events
    33. 33. Q1 Performance Summary 09/10
    34. 34. Better Cancer Services Every Note: Central’s 2009 referral to consult data is excluded due to data issues. Radiation C1R Volumes June YTD 2008/09 vs 2009/10 0 500 1,000 1,500 2,000 2,500 3,000 Erie St. Clair Hamilton NHB North West North East Toronto Central Odette Champlain South East Waterloo Wellington South West Central East Toronto Central PMH North Simcoe Muskoka Central West & Miss. Halton Central PROVINCE # of New Cases 10,200 10,250 10,300 10,350 10,400 10,450 Target for 2009/10 Apr-Jun 2008/09 Apr-Jun 2009/10 Scale Refers to Provincial Volumes Only Note: - PMH volumes are courses. Radiation Treatment Wait Times in the Province Percent of Patients Seen/Treated within Target for All Sites 30% 40% 50% 60% 70% 80% 90% Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun 2007-08 2008-09 2009-10 Referral to Consult - % of patients seen w/in target (14 days) Ready-to-Treat to Treat - % of patients treated w/in target (1,7, 14 days) Provincial Target for Ready-to-Treat to Treat Provincial Target for Referral to Consult Target for Ref-Con Target for RTT-Treat Data Source: iPort August 25, 2009 Radiation Therapy - Ready to Treat to Treatment Percent of Patients Treated Within Target (1,7,14 Days) June YTD 2008/09 vs 2009/10 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% South West Champlain Erie St. Clair Waterloo Wellington Toronto Central Odette Central East South East Central West & Miss. Halton North East Hamilton NHB Toronto Central PMH North West North Simcoe Muskoka PROVINCE Target for 2009/10 Apr-Jun 2008/09 Apr-Jun 2009/10 85% Provincial Target Radiation Therapy - Referral to Consult Percent of Patients Seen Within Target (14 Days) June YTD 2008/09 vs 2009/10 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Central Erie St. Clair South East South West Central West & Miss. Halton North Simcoe Muskoka Champlain North East Central East Toronto Central Odette Toronto Central PMH North West Hamilton NHB Waterloo Wellington PROVINCE Target for 2009/10 Apr-Jun 2008/09 Apr-Jun 2009/10 80% Provincial Target
    35. 35. Better Cancer Services Every Systemic Systemic Therapy - Referral to Consult Percent of Patients Seen Within Target (14 days) June YTD 2008/09 vs 2009/10 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% South West Champlain North Simcoe Muskoka Erie St. Clair North East Toronto Central PMH Central East South East Central Central West & Miss. Halton Toronto Central Odette Hamilton NHB Waterloo Wellington North West PROVINCE Target for 2009/10 Apr-Jun 2008/09 Apr-Jun 2009/10 60% Provincial Target Systemic Treatment Wait Times in the Province Percent of Patients Seen/Treated within Target for All Sites 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May June 2007-08 2008-09 2009-10 Referral to Consult - % of patients seen w/in target (14 days) Consult to Treatment - % of patients treated w/in target (14 days) Provincial Target - Referral to Consult Provincial Target - Ready-to-Treat to Treat Target for Ref-Con Target for Con-Treat Data Source: iPort August 25, 2009 C1S Volumes June YTD 2008/09 vs 2009/10 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 North Simcoe Muskoka Central Toronto Central Odette North East Toronto Central PMH North West South West Champlain South East Hamilton NHB Erie St. Clair Central West & Miss. Halton Waterloo Wellington Central East PROVINCE # of New Cases 9,320 9,340 9,360 9,380 9,400 9,420 9,440 9,460 9,480 9,500 9,520 Target for 2009/10 Apr-Jun 2008/09 Apr-Jun 2009/10 Scale Refers to Provincial Volumes Only Systemic Therapy - Consult to Treatment Percent of Patients Treated Within Target (14 days) May and June 2009 0% 10% 20% 30% 40% 50% 60% 70% Champlain North Simcoe Muskoka Toronto Central PMH South East Central East Central South West Central West & Miss. Halton Waterloo Wellington Hamilton NHB Toronto Central Odette North West Erie St. Clair North East PROVINCE Target for 2009/10 May 2009 June 2009 50% Provincial Target
    36. 36. Better Cancer Services EveryNotes: Wait times include treatment cases only and exclude lymphoma, skin and priority 1 cases. Surgery Cancer Surgery Percent of Patients Treated Within Target (14, 28 , 84 days) for All Priorities June YTD 2008/09 vs 2009/10 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% South West North East Champlain Central West & Miss. Halton Toronto Central Odette Toronto Central PMH South East Central East Hamilton NHB North Simcoe Muskoka Erie St. Clair North West Waterloo Wellington Central PROVINCE Target for 2009/10 Apr-Jun 2008/09 Apr-Jun 2009/10 80% Provincial Target Cancer Surgery Volumes June YTD 2008/09 vs 2009/10 0 500 1,000 1,500 2,000 2,500 Waterloo Wellington Champlain Central South East Hamilton NHB North West South West Central West & Miss. Halton Erie St. Clair Toronto Central PMH Toronto Central Odette North Simcoe Muskoka Central East North East PROVINCE Volumes 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 Target for 2009/10 Apr-Jun 2008/09 Apr-Jun 2009/10 Scale Refers to Provincial Volumes Only Cancer Surgery Wait Times in the Province Decision to Operate to Operation for All Priority Categories and All Specialties 30% 40% 50% 60% 70% 80% 90% Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun 2007-08 2008-09 2009-10 PercentofPatients 20 30 40 50 60 70 80 90 Days % of Patients Treated Within Target Provincial Target for % within target 90th Percentile Provincial Target for 90th Target Target for 90th Percentile Target for % of Patients w/in Target Data Source: iPort August 25, 2009 Cancer Surgery 90th Percentile Wait Time June YTD 2008/09 vs 2009/10 0 10 20 30 40 50 60 70 80 90 100 South West Toronto Central PMH Champlain Central West & Miss. Halton Central East Hamilton NHB Toronto Central Odette South East North Simcoe Muskoka Waterloo Wellington Central North West North East Erie St. Clair PROVINCE Days Target for 2009/10 Apr-Jun 2008/09 Apr-Jun 2009/10 48Provincial Target
    37. 37. Better Cancer Services Every Colonoscopy Colonoscopy Wait Times in the Province Percent of Colonoscopies Completed within Benchmark 20% 30% 40% 50% 60% 70% 80% Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June 2008-09 2009-10 +FOBT Family History Provincial Target for Family History Provincial Target for +FOBT Target for +FOBT Target for Family History Colonoscopy Percent of Positive FOBT Colonoscopies Completed Within Benchmark (8 Weeks) June YTD 2008/09 vs 2009/10 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% North West Toronto Central Odette Champlain Mississauga Halton North East Erie St. Clair Hamilton NHB Waterloo Wellington Central East South West South East Toronto Central PMH Central PROVINCE Target for 2009/10 Apr-Jun 2008/09 Apr-Jun 2009/10 65% Provincial Target Colonoscopy Percent of Family History Colonoscopies Completed Within Benchmark (26 Weeks) June YTD 2008/09 vs 2009/10 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Champlain North West Waterloo Wellington Erie St. Clair North East South East Mississauga Halton Toronto Central Odette Hamilton NHB Central East Central Toronto Central PMH South West PROVINCE Target for 2009/10 Apr-Jun 2008/09 Apr-Jun 2009/10 75% Provincial Target Colonoscopy Volumes June YTD 2008/09 vs 2009/10 0 500 1,000 1,500 2,000 2,500 Central Hamilton NHB North East South East Mississauga Halton Erie St. Clair Waterloo Wellington Toronto Central PMH Central East South West North West Champlain Toronto Central Odette PROVINCE 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 Target for 2009/10 Apr-Jun 08/09 Apr-Jun 09/10 Scale Refers to Provincial Volumes Only
    38. 38. Better Cancer Services Every Colonoscopy FOBT Participation in Target Population (men & women ages 50-74) 0% 5% 10% 15% 20% 25% 30% 35% 40% Toronto Central North Simcoe Muskoka North West North East South East HNHB Erie St. Clair South West Central West Central Mississauga Halton Central East Waterloo Wellington Champlain Ontario Target 2008-09 2004-2005 2006-2007 Provincial Target for 2008-0930% %
    39. 39. Better Cancer Services Every Stage Capture Stage Capture in the Province Combined Rate (RCC plus "surgery only") 80% 82% 84% 86% 88% 90% 92% 94% Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct 2007-08 2008-09 Combined Stage Rate Provincial Target Provincial Target Data Source: iPort August 19, 2009 Stage Capture Rate of All ICP Cancer Cases (RCC and Surgery Only) 0% 20% 40% 60% 80% 100% 120% North Simcoe Muskoka Central West & Miss. Halton South West Central Central East Toronto Central PMH North West Erie St. Clair Toronto Central Odette South East North East Champlain Waterloo Wellington Hamilton NHB Province April - Oct 2007 April - Oct 2008 Regional and Provincial Target 90% %
    40. 40. Better Cancer Services Every Notes: • Central and Central East June 2009 is not available. • Due to historic corrections of CVH disease information, an adjustment occurred in April 2009 related to the CVH OCSMC assessment rate. The decrease in assessment rates from 2008/09 to 2009/10 is a result of the refinement in capture of disease information. • Champlain excludes April 2009 due to data issues. Source: Cancer Care Ontario, ISAAC database (ESAS data) and Activity Level Reporting (Population data) Symptom Management Percent of 'Lung' Cancer Patients who were Screened at Least Once with ESAS Regional Cancer Centre Patients Only 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Central East Toronto Central Odette Hamilton NHB Champlain South West North West South East Central North East Waterloo Wellington Central West & Miss. Halton Erie St. Clair North Simcoe Muskoka Province 2009/10 Target Apr-Jun 2008-09 Apr-Jun 2009-10 90% Provincial Target Percent of 'All Other Cancers' Patients who were Screened at Least Once with ESAS Regional Cancer Centre Patients Only 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Toronto Central PMH Toronto Central Odette Central East North East Champlain South East Hamilton NHB South West Central Central West & Miss. Halton North West Waterloo Wellington Erie St. Clair North Simcoe Muskoka Province 2009/10 Target Apr-Jun 2008-09 Apr-Jun 2009-10 Provincial Target60% Percent of Cancer Patients who were Screened for Symptom Severity Using ESAS In All Reporting Cancer Centers 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun 2007-08 2008-09 2009-10 Lung Cancer Patients All Other Patients Provincal Target for Lung Cancer Patients Provincial Target for All Other Patients Target for Lung Cancer Patients Target for All Other Patients
    41. 41. Better Cancer Services Every Thoracic Standards Percent of Thoracic Operations Performed at Designated Centers April - January 2008/09 0% 20% 40% 60% 80% 100% 120% Erie St. Clair Central East Central West & Miss. Halton Hamilton NHB Central North East South West Waterloo Wellington Toronto Central PMH Champlain Toronto Central Odette North Simcoe Muskoka North West South East Province Regional and Provincial Target for 2008-09 80% % - Based on CIHI Discharge Abstract Database on May 28, 2009. Data may change. - Erie St. Clair is developing a plan to be compliant with the standards - Regions with 97% and above are given a ranking of number one.
    42. 42. Better Cancer Services Every Multidisciplinary Cancer Conference Percent of Standards Compliant MCCs in place for Incrementally Funded Disease Sites 2008/09 Q4 0% 20% 40% 60% 80% 100% 120% Central East North East South West North West Central West Hamilton NHB Central Waterloo Wellington Toronto Central Champlain South East Mississauga Halton Erie St. Clair North Simcoe Muskoka All Centres Regional and Provincial Target for 2008-09 70% %
    43. 43. Better Cancer Services Every Provincial Summary – September 2009 Performance against the regional target Not meeting target Not meeting target, but improving or meeting provincial target Meeting or within 2% of target. If the region has a stretch target, it is within 5%. Performance against the previous scorecard Improved Decreased No change Note: • Overall Provincial Ranking = Sum of all rankings relative to all other Regions normalized to number of measures available. • Colours = Performance against your regional target. See legend. • Cancer surgery ranking is based on provincial performance, not LHIN targets. • The previous scorecard include the following measures: Radiation Apr-Mar 09, Systemic Apr-Mar 09, Surgery Apr-Mar 09, Colonoscopy WT Jan-Mar 09, Colonoscopy Vol Apr- Mar 09, FOBT Participation 2006-07, Staging Apr-Jul 08, Symptom Management (Lung) Apr-Mar 09, (All Other) Mar 09, Thoracic Apr-Jan 09 and MCC Q4. Note for FOBT Participation, Thoracic and MCC, the data in the current scorecard is the same as the previous one. • There is no trend symbol for data being measured for the first time in the scorecard. STAGE Apr-Oct 2008 WT Ref-Con (%w/in 14 days) WT RTT-Tr (%w/in target) Vol (C1R) WT Ref-Con (% w/in 14 days) WT Con-Tr (% w/in 14 days) Vol (C1S) WT (%w/in target) WT (90th) Vol (cases) WT (FOBT+) WT (Family History) Vol FOBT Participati on Combined Rate Lung All Other PROVINCE ▲ ▲ ▲ ▼ ▼ ▲ ▲ ▲ ▲ ▲ ▼ ▬ ▲ ▲ Waterloo Wellington ▲ ▼ ▼ ▲ ▲ ▲ ▲ ▼ ▲ ▲ ▼ ▲ ▼ ▲ 1 1 North West ▲ ▲ ▼ ▲ ▲ ▲ ▲ ▲ ▲ ▲ ▼ ▼ ▲ ▼ 2 2 Hamilton NHB ▲ ▲ ▼ ▲ ▲ ▼ ▲ ▲ ▲ ▲ ▼ ▼ ▲ ▲ 3 6 North Simcoe Muskoka ▲ ▲ ▲ n/a n/a n/a ▲ ▲ ▲ 3 -2 Central n/a ▲ ▲ ▼ ▲ ▲ ▼ ▲ ▲ ▲ 5 0 Erie St. Clair ▼ ▼ ▼ ▼ ▲ ▲ ▲ ▼ ▲ ▲ ▼ ▲ ▲ ▼ 6 -3 South East ▼ ▼ ▲ ▼ ▲ ▲ ▲ ▼ ▲ ▼ ▼ ▲ ▲ ▲ 7 -1 Toronto Central PMH ▼ ▲ ▲ ▼ ▼ ▲ ▲ ▲ ▲ ▲ ▼ ▼ n/a ▼ 8 2 North East ▲ ▲ ▼ ▲ ▼ ▼ ▲ ▲ ▲ ▲ ▼ ▲ ▲ ▲ 9 4 Toronto Central Odette ▲ ▲ ▼ ▼ ▼ ▲ ▲ ▲ ▼ ▼ ▲ ▼ ▼ ▲ 10 -3 Central West & Miss. Halton ▲ ▲ ▲ ▼ ▲ ▬ ▲ ▼ ▲ ▼ ▼ 11 -3 Central East ▲ ▲ ▲ ▼ ▼ ▲ ▲ ▲ ▲ ▲ ▼ ▼ ▲ ▲ 12 -1 Champlain ▲ ▲ ▼ ▼ ▲ ▲ ▲ ▼ ▲ ▼ ▲ ▲ ▲ ▼ 13 -1 South West ▬ ▼ ▲ ▼ ▼ ▼ ▼ ▲ ▼ ▲ ▼ ▼ ▲ ▲ 14 -1 SYMPTOM MGMT Apr-Jun 2009 COLONOSCOPY WT & Vol = Apr-Jun 2009 Participation = 2006-2007 RADIATION Apr-Jun 2009 Region SYSTEMIC Ref-Con = Apr-Jun 2009 Con-Tr = Jun 2009 SURGERY WT = Apr-Jun 2009 Vol = Apr-Jun 2009 Overall Provincial Rank Change from Previous Rank MCC Q4 08-09 THORACIC Apr 08 - Jan09 n/a ▼ n/a ▼ n/a ▼
    44. 44. Better Cancer Services Every Acronyms • C1R = Number of New Radiation New Cases • C1S = Number of New Systemic New Cases • ESAS = Edmonton Symptom Assessment System • FOBT = Fecal Occult Blood Test • OCSMC = Ontario Cancer Symptom Management Collaborative • Region Names – CE = Central East – CW/MH = Central West and Mississauga Halton – ESC = Erie St. Clair – HNHB = Hamiton Niagara Haldimand Brant – NE = North East – NSM = North Simcoe Muskoka – NW = North West – TC = Toronto Central – WW = Waterloo Wellington
    45. 45. Better Cancer Services Every Ontario Cancer Programs What are the Regional Levers for change? • Implementing provincial programs including Wait Time Strategy; Colon Cancer Check – Rads, Chemo, Surgical Wait time Targets – Colonoscopy* • Implementing quality standards in every LHIN, focusing on a key clinical program areas: – Intensity modulated radiation therapy (IMRT)* – Regional Systemic Therapy Programs* – Multidisciplinary Case Conferences for all cancer patients* – Thoracic Surgery Standards*
    46. 46. Better Cancer Services Every What are the Provincial Levers for change • Aligned and Accountable Cancer leadership • Designated Provincial and Regional Clinical Practice Leaders by specialty • Clinical Indicator Development and Reporting • Clinical Communities of Practice Initiatives • Culture of evidence and performance • Volume and quality linked to $$ funding • Pay for Participation, Pay for volumes, Pay for Quality in Hospital Level Agreements • Quarterly Performance Reviews with each LHIN - Regional Scorecards • ANNUAL Public Reporting on 30+ access and quality measures; Annual Provincial Scorecard • Mandate to advise MOHLTC
    47. 47. Better Cancer Services Every • Greenberg A, Angus H, Sullivan T, Brown A. Development of a set of strategy-based system-level cancer care performance indicators in Ontario, Canada. Int J Qual Health Care 2005;17:107-114. • Sullivan, T. Waiting for the Referee or Refereeing the Wait? CCO’s Role in Hosting and Deploying the Wait Time Information System in Ontario. Health Care Quarterly (12) 2009, 20 -21. • Cowan, D.H. 2004. Closing the circles: A history of governance of cancer control in Ontario. Accessed August 17, 2009. http://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=13708 . • Sullivan, T., Dobrow, M., Thompson, L., and Hudson, A. 2004. Reconstructing cancer services in Ontario. HealthcarePapers 5(1): 69-80. • Sullivan, T., Thompson, L. and Angus, H. 2005. Transforming cancer services in Ontario: A work in progress. HealthcarePapers 5(4): 43-51. • Thompson, L.J. and Martin, M.T. 2004. Integration of cancer services in Ontario: The story of getting it done. HealthcareQuarterly 7(3): 42-48. • Dobrow MJ, Paszat L, Golden B, Brown AD, Holowaty E, Orchard MC, Monga N, Sullivan T. Measuring Integration of Cancer Services to Support Performance Improvement: The CSI Survey. Healthcare Policy (in press) 2009 • Dobrow MJ, Sullivan T, Sawka C. Shifting clinical accountability and the pursuit of quality: aligning clinical and administrative approaches. Healthcare Management Forum, 21(3), 6-19. 2008 • Sullivan T, Dobrow MJ, Schneider E, Newcomer L, Richards M, Wilkinson L, Borella L, Lepage C, Glossmann GP, Walshe R. (2008). Améliorer la responsabilité cliniques et performance en cancérologie [Improving clinical accountability and performance in the cancer field]. Pratiques et Organisation des Soins [Practices and Organization of Care], 39(3), 207-215. DRAFT - Please do not circulate 47 Background Reading

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