Viable	
  and	
  Effec-ve	
  Regional	
  Cancer	
  
Centres:	
  What	
  Does	
  the	
  Future	
  Hold?	
  
Prof	
  Don	
  I...
GENERAL	
  INFORMATION	
  PERTAINING	
  
TO	
  REGIONAL	
  CANCER	
  CENTRES	
  
Burden	
  of	
  Cancer	
  
•  129,000	
  new	
  cancer	
  cases	
  esDmated	
  for	
  2012	
  
–	
  will	
  increase	
  to...
PopulaDon	
  Growth:	
  2007-­‐2012	
  
Australia	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	...
Urban	
  vs	
  Rural	
  Differences	
  
•  Women	
  with	
  breast	
  cancer	
  receiving	
  care	
  in	
  a	
  rural	
  or...
INVESTMENT	
  IN	
  HEALTH	
  CARE	
  –	
  
HOW	
  MUCH	
  IS	
  ENOUGH?	
  
Health	
  Expenditure	
  as	
  a	
  	
  
Percentage	
  of	
  GDP	
  -­‐	
  2011	
  
OECD	
  average	
  
Australia	
  
Cana...
Health	
  Expenditures	
  Per	
  Capita	
  
2011	
  –	
  US$	
  
OECD	
  average	
  
Australia	
  
Canada	
  
France	
  
S...
PharmaceuDcal	
  Expenditures	
  as	
  
%age	
  of	
  GDP	
  
OECD	
  average	
  
Australia	
  
Canada	
  
France	
  
Swed...
EducaDon	
  Expenditure	
  as	
  a	
  
Percentage	
  of	
  GDP	
  -­‐	
  2009	
  
OECD	
  average	
  
Australia	
  
Canada...
INVESTMENT	
  IN	
  CANCER	
  CARE	
  –	
  IS	
  
IT	
  SUSTAINABLE?	
  
Cancer	
  Costs	
  in	
  Australia	
  
•  1993-­‐94	
  costs	
  esDmated	
  at	
  $2	
  bil	
  –	
  6%	
  of	
  
recurrent...
Cancer	
  InpaDent	
  Costs	
  as	
  %age	
  	
  
of	
  Hospital	
  Expenditures	
  -­‐2011	
  
Australia	
  
9%	
  
Canad...
Costs	
  Per	
  Hospital	
  Discharge	
  
for	
  Cancer	
  	
  
Australia	
  
Canada	
  
Germany	
  
Sweden	
  
Netherland...
ProjecDons	
  of	
  Cancer	
  Care	
  Costs	
  	
  
in	
  US:	
  2010-­‐2020	
  
•  Base	
  scenario	
  costs	
  were	
  $...
ECONOMIC	
  IMPACT	
  ON	
  CONSUMERS	
  
WHEN	
  USING	
  HEALTHCARE	
  SERVICES	
  
Out-­‐of-­‐Pocket	
  Expenses	
  as	
  Share	
  of	
  
Final	
  Household	
  ConsumpDon	
  -­‐	
  2011	
  
OECD	
  average...
Unmet	
  Care	
  Due	
  to	
  Costs	
  	
  
by	
  Income	
  -­‐	
  2009	
  
Australia	
  

–  High	
  
–  Low	
  

Canada	...
HEALTHCARE	
  SYSTEM	
  RESOURCES	
  –	
  ARE	
  
WE	
  MAKING	
  THE	
  RIGHT	
  CHOICES?	
  
Hospital	
  Beds	
  	
  
Per	
  1000	
  PopulaDon	
  -­‐	
  2009	
  
OECD	
  average	
  
Australia	
  
Canada	
  
France	
...
MRI	
  and	
  CT	
  Units	
  	
  
per	
  million	
  -­‐	
  2011	
  
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
...
Linacs	
  Required	
  to	
  Meet	
  RadiaDon	
  
Oncology	
  Requirements	
  
2011	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  ...
MEDICAL	
  WORKFORCE	
  –	
  DO	
  WE	
  
HAVE	
  THE	
  RIGHT	
  BALANCE?	
  
PracDsing	
  Doctors	
  	
  
Per	
  1000	
  PopulaDon	
  -­‐	
  2011	
  
OECD	
  average	
  
Australia	
  
Canada	
  
Fran...
Doctor	
  Density	
  in	
  Rural	
  and	
  Urban	
  
Regions	
  Per	
  100,000	
  PopulaDon	
  
Australia	
  (2008)	
  
― ...
Nurse	
  to	
  Doctor	
  RaDo	
  -­‐	
  2011	
  
OECD	
  average	
  
Australia	
  
Canada	
  
France	
  
Great	
  Britain	...
ContribuDons	
  of	
  Mid-­‐Level	
  
PracDDoners	
  in	
  the	
  US	
  
•  In	
  2008-­‐09	
  15%	
  of	
  hospital	
  ou...
CANCER	
  WORKFORCE	
  –	
  CAN	
  WE	
  
MEET	
  THE	
  PROJECTED	
  NEEDS?	
  
RadiaDon	
  Treatment	
  Workforce	
  
Projected	
  shortage	
  assuming	
  52.3%	
  uDlisaDon	
  rate	
  
Profession	
  	...
Medical	
  Oncology	
  Workforce	
  
•  The	
  shorkall	
  of	
  FTE	
  medical	
  oncologists	
  in	
  2009	
  was	
  bet...
Possible	
  SoluDons	
  to	
  Medical	
  
Oncology	
  Workforce	
  Problem	
  
•  Increase	
  fellowship	
  training	
  po...
GP	
  Workforce	
  
•  Only	
  3.9%	
  growth	
  in	
  GPs	
  from	
  2007-­‐11	
  vs	
  7.3%	
  
populaDon	
  growth	
  
...
EssenDal	
  Components	
  to	
  Facilitate	
  
Shared	
  Cancer	
  Care	
  with	
  PCPs	
  
•  Timely	
  and	
  systemaDc	...
 GP	
  Needs	
  Related	
  to	
  ParDcipaDon	
  
	
  in	
  Follow-­‐up	
  Cancer	
  Care	
  
Provision	
  of	
  guidelines...
DOES	
  AUSTRALIA	
  HAVE	
  A	
  HIGH	
  
PERFORMING	
  SYSTEM?	
  
Aoributes	
  of	
  a	
  High	
  Performing	
  
Health	
  Care	
  Delivery	
  System	
  
•  PaDents’	
  clinical	
  informa...
Aoributes	
  of	
  a	
  High	
  Performing	
  
Health	
  Care	
  Delivery	
  System	
  (cont’d)	
  
•  There	
  is	
  clea...
USE	
  OF	
  TECHNOLOGY	
  IN	
  MEDICAL	
  
AND	
  CANCER	
  CARE	
  
The	
  Importance	
  of	
  InformaDon	
  
“Successful	
  21st	
  century	
  cancer	
  care	
  organizaDons	
  will	
  be	
...
Telehealth/Telemedicine	
  
•  Cost	
  per	
  visit	
  for	
  Univ	
  of	
  Kansas	
  Medical	
  Center’s	
  
telemedicine...
2013	
  Canadian	
  Telehealth	
  Report	
  
•  Number	
  of	
  hospital	
  and	
  community-­‐based	
  telehealth	
  
end...
THE	
  CHALLENGE	
  OF	
  CHANGING	
  –	
  IS	
  
MEANINGFUL	
  CHANGE	
  EVEN	
  POSSIBLE?	
  
The	
  Challenge	
  of	
  Changing	
  
“From	
  the	
  perspecDve	
  of	
  systems	
  analysis,	
  the	
  current	
  
heal...
APPROACHES	
  TO	
  ORGANISING	
  CANCER	
  
CARE	
  SERVICES	
  IN	
  REGIONAL	
  AND	
  
RURAL	
  AREAS	
  
Bri-sh	
  Columbia	
  Cancer	
  Agency	
  
Cancer	
  Care	
  Ontario	
  
1	
   Erie	
  St.	
  Clair	
  Cancer	
  Program	
  
2	
   South	
  West	
  Regional	
  Cance...
Alberta’s	
  Cancer	
  Care	
  Centres	
  
Alberta’s	
  Key	
  Strategies	
  for	
  Change	
  
•  Create	
  a	
  comprehensive	
  and	
  coordinated	
  system	
  of	...
RECOMMENDATIONS	
  RELATED	
  TO	
  
REGIONAL	
  CANCER	
  CENTRES	
  
Major	
  Issue	
  for	
  Regional	
  Cancer	
  
Centres	
  
•  DeterminaDon	
  of	
  which	
  cancers	
  can	
  be	
  
tre...
IS	
  IT	
  POSSIBLE	
  TO	
  HAVE	
  AN	
  
INTEGRATED	
  AND	
  COORDINATED	
  
CANCER	
  CARE	
  SYSTEM	
  AT	
  A	
  S...
What	
  Is	
  Needed	
  to	
  Ensure	
  Quality	
  
Cancer	
  Care	
  for	
  Residents	
  in	
  Regional	
  
and	
  Rural	...
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Don Iverson, University of Wollongong: Developing and supporting an integrative system of care in regional areas

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Professor Don Iverson, Executive Dean, Faculty of Science, Medicine and Health, University of Wollongong delivered this presentation at the 2013 Cancer Centres Symposium in Australia. The annual event explores current opportunities and challenges surrounding cancer centre policy, funding, operations, innovations and development. For more information about the annual event, please visit the conference website: http://www.informa.com.au/cancercentressymposium

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Don Iverson, University of Wollongong: Developing and supporting an integrative system of care in regional areas

  1. 1. Viable  and  Effec-ve  Regional  Cancer   Centres:  What  Does  the  Future  Hold?   Prof  Don  Iverson   Exec  Dean,     Faculty  of  Science,  Medicine  &  Health  
  2. 2. GENERAL  INFORMATION  PERTAINING   TO  REGIONAL  CANCER  CENTRES  
  3. 3. Burden  of  Cancer   •  129,000  new  cancer  cases  esDmated  for  2012   –  will  increase  to  150,000  by  2020   •  Five  cancers  account  for  >60%  of  all  cancers:   prostate,  colorectal,  breast,  melanoma  and   lung   •  1  in  2  Australian  men  and  1  in  3  Australian   women  will  develop  cancer  by  age  85  years   Ref:  Cancer  Council  Australia  Factsheet  
  4. 4. PopulaDon  Growth:  2007-­‐2012   Australia                                                    9.0%   Capital  ciDes                                  10.1   Inner  regional                                  7.2   Outer  regional                                5.3   Remote                                                        4.8   Very  remote                                    10.4   Ref:  ABS.  3218.0  Regional  PopulaDon  Growth,  Australia  2012.  
  5. 5. Urban  vs  Rural  Differences   •  Women  with  breast  cancer  receiving  care  in  a  rural  or  regional  public   facility  were  less  likely  to  have  access  to  a  breast  nurse  (70%,  41%)   than  women  being  treated  in  an  urban  public  facility  (84%)   •  WA  study  involved  899  women  with  invasive  breast  cancer  –  rural   women  were  less  likely  to  have  breast-­‐conserving  surgery,  adjuvant   radiotherapy,  hormonal  therapy  and  be  treated  by  high  case-­‐load   breast  cancer  surgeon     •  US  study  found  that  rural  breast  cancer  survivors  had  poorer  MH   funcDoning,  and  more  symptoms  of  anxiety  and  depression  than  urban   breast  cancer  survivors   Ref:  Marsh  C  et  al.  The  Breast  2010;19:142-­‐6;  Mitchell  KJ  et  al.  The  breast  2006;15:769-­‐76;  Burns  JL  &  Andrykowski  M.  Psycho-­‐Oncology  2010;19:637-­‐45  
  6. 6. INVESTMENT  IN  HEALTH  CARE  –   HOW  MUCH  IS  ENOUGH?  
  7. 7. Health  Expenditure  as  a     Percentage  of  GDP  -­‐  2011   OECD  average   Australia   Canada   France   Sweden   United  Kingdom   United  States   Ref:  Health  at  a  Glance  2013:  OECD  Indicators,  2013   9.3%     8.9   11.2   11.6    9.5   9.4   17.7  
  8. 8. Health  Expenditures  Per  Capita   2011  –  US$   OECD  average   Australia   Canada   France   Sweden   United  Kingdom   United  States   Ref:  Health  at  a  Glance  2013:  OECD  Indicators,  2013   $3322     3800   4522   4118   3925      3405        8508  
  9. 9. PharmaceuDcal  Expenditures  as   %age  of  GDP   OECD  average   Australia   Canada   France   Sweden   Germany   United  States   Ref:  Health  at  a  Glance  2013:  OECD  Indicators,  2013   1.5%     1.4   1.9   1.8   1.1      1.6        2.1  
  10. 10. EducaDon  Expenditure  as  a   Percentage  of  GDP  -­‐  2009   OECD  average   Australia   Canada   France   Sweden   United  Kingdom   United  States   Ref:  EducaDon  at  a  Glance  2012:  OECD  Indicators,  2012   6.2%     6.0      6.0   6.4   6.9   6.0   7.1   (9.6)   (8.7)   (11.4)   (11.8)   (10.0)   (9.8)   (17.4)  
  11. 11. INVESTMENT  IN  CANCER  CARE  –  IS   IT  SUSTAINABLE?  
  12. 12. Cancer  Costs  in  Australia   •  1993-­‐94  costs  esDmated  at  $2  bil  –  6%  of   recurrent  health  expenditures   •  2000-­‐01  costs  esDmated  at  $2.9  bil  –  5.8%  of   recurrent  health  expenditures   •  2004-­‐05  costs  esDmated  at  $3.8  bil  –  7.0%  of   recurrent  health  expenditures   •  Increase  of  90%  over  Dme  period   Ref:  AIHW.  HWE  Series  No.4  (1998),  22  (2005)  and  50  (2010)  
  13. 13. Cancer  InpaDent  Costs  as  %age     of  Hospital  Expenditures  -­‐2011   Australia   9%   Canada   9   Germany                                                                      13   Sweden                                                                          11   Ref:  Health  at  a  Glance  2013:  OECD  Indicators,  2013  
  14. 14. Costs  Per  Hospital  Discharge   for  Cancer     Australia   Canada   Germany   Sweden   Netherlands   Ref:  Health  at  a  Glance  2013:  OECD  Indicators,  2013   $10833   8902   5985   7070      11880  
  15. 15. ProjecDons  of  Cancer  Care  Costs     in  US:  2010-­‐2020   •  Base  scenario  costs  were  $124.6  bil  in  2010   •  Using  base  scenario  costs  will  be  $157.8  bil  in   2020  –  27%  increase   •  Assuming  a  2%  annual  increase  in  costs  the  2020   esDmate  is  $172.8  bil  –  39%  increase   •  Assuming  a  5%  annual  increase  in  costs  the  2020   esDmate  is  $207  bil  –  66%  increase   Ref:  J  Nat  Cancer  InsDt.  2011;103:117-­‐29  
  16. 16. ECONOMIC  IMPACT  ON  CONSUMERS   WHEN  USING  HEALTHCARE  SERVICES  
  17. 17. Out-­‐of-­‐Pocket  Expenses  as  Share  of   Final  Household  ConsumpDon  -­‐  2011   OECD  average   Australia   Canada   France   Sweden   United  Kingdom   United  States   Ref:  Health  at  a  Glance  2013:  OECD  Indicators,  2013   2.9%     3.2   2.4   1.5   3.3   1.5    2.9  
  18. 18. Unmet  Care  Due  to  Costs     by  Income  -­‐  2009   Australia   –  High   –  Low   Canada   –  High   –  Low   12%   22         6   18   France         –  High   –  Low   8   17   United  States   –  High   –  Low   Ref:  Health  at  a  Glance  2011:  OECD  Indicators,  2011   20   39  
  19. 19. HEALTHCARE  SYSTEM  RESOURCES  –  ARE   WE  MAKING  THE  RIGHT  CHOICES?  
  20. 20. Hospital  Beds     Per  1000  PopulaDon  -­‐  2009   OECD  average   Australia   Canada   France   Great  Britain   Sweden   United  States   Ref:  Health  at  a  Glance  2011:  OECD  Indicators,  2011   4.9         3.8   3.3   6.6            3.3   2.8   3.1  
  21. 21. MRI  and  CT  Units     per  million  -­‐  2011                                                                                                                    MRI                                      CT                       OECD  average                                                                13.3                                    23.6     Australia                                                                                        5.7                                    44.4   Canada                                                                                              8.5                                    14.6   France                                                                                                7.5                                    12.5   United  Kingdom                                                              5.4                                        8.9   United  States                                                                    31.5                                    40.9           Ref:  Health  at  a  Glance  2013:  OECD  Indicators,  2013  
  22. 22. Linacs  Required  to  Meet  RadiaDon   Oncology  Requirements   2011                                                    168            (exisDng  linacs)   2017                                                    208   2022                                                    267            (59%  increase)   Ref:  TriparDte  NaDonal  Strategic  Plan  for  RadiaDon  Oncology  in  Australia:  2012-­‐2022.  2012.  
  23. 23. MEDICAL  WORKFORCE  –  DO  WE   HAVE  THE  RIGHT  BALANCE?  
  24. 24. PracDsing  Doctors     Per  1000  PopulaDon  -­‐  2011   OECD  average   Australia   Canada   France   Great  Britain   Sweden   United  States   Ref:  Health  at  a  Glance  2013:  OECD  Indicators,  2013   3.2         3.3   2.4   3.3            2.8   3.8   2.5  
  25. 25. Doctor  Density  in  Rural  and  Urban   Regions  Per  100,000  PopulaDon   Australia  (2008)   ―  Urban   ―  Rural   Canada  (2004)   ―  Urban   ―  Rural   France  (2010)   ―  Urban   ―  Rural   USA  (2005)   ―  Urban   ―  Rural   Ref:  Health  at  a  Glance  2011:  OECD  Indicators,  2011   376   187     (1:2.0)   217   84     (1:2.6)   453   120     (1:3.8)   210   113    (1:1.9)  
  26. 26. Nurse  to  Doctor  RaDo  -­‐  2011   OECD  average   Australia   Canada   France   Great  Britain   Sweden   United  States   Ref:  Health  at  a  Glance  2013:  OECD  Indicators,  2013   2.8   3.0   4.3   2.6            3.1   2.9   4.3  
  27. 27. ContribuDons  of  Mid-­‐Level   PracDDoners  in  the  US   •  In  2008-­‐09  15%  of  hospital  outpaDent  visits  involved  NPs  or   PAs   •  The  contribuDons  of  NPs  and  PAs  was  higher  in   nonmetropolitan  hospitals  (36%),  hospitals  with  fewer  than   200  beds  (24%)  and  non-­‐teaching  hospitals  (22%)   •  Primary  reason  for  academic  medical  centres  employing   NPs  and  PAs  is  resident  duty  hour  restricDons  –  other   reasons  include:  increasing  paDent  throughput,  increasing   paDent  access  and  improving  conDnuity  of  care   Ref:  M  Moote  et  al.  Am    J  Med  Quality  2011;26:452-­‐60.Medscape     Medical  News,  Nov  22,  2011    
  28. 28. CANCER  WORKFORCE  –  CAN  WE   MEET  THE  PROJECTED  NEEDS?  
  29. 29. RadiaDon  Treatment  Workforce   Projected  shortage  assuming  52.3%  uDlisaDon  rate   Profession                                                                            2012                      2022   RadiaDon  oncologists                                        156                            36   RadiaDon  therapists                                            626                        538                     RadiaDon  oncology                                                212                        208      medical  physicists   Ref:  TriparDte  NaDonal  Strategic  Plan  for  RadiaDon  Oncology  in  Australia:  2012-­‐2022.  2012.  
  30. 30. Medical  Oncology  Workforce   •  The  shorkall  of  FTE  medical  oncologists  in  2009  was  between   92  and  157  depending  on  projected  uDlisaDon  rates  (was  19%   in  2009  vs  evidence-­‐based  standard  of  51%)   •  Shorkall  in  2014  is  esDmated  to  be  between  84  and  156   •  By  2020  US  esDmates  shortage  of  2550  to  4080  MO   •  Average  number  of  new  paDents  per  MO  is  270  vs   recommended  number  of  150  (recommendaDon  in  Canada  is   between  160-­‐175)   •  Only  6%  of  MOs  pracDced  in  rural  areas  in  2009   Ref:  Blinman  PL  et  al.  MJA  2012;196:58-­‐61  
  31. 31. Possible  SoluDons  to  Medical   Oncology  Workforce  Problem   •  Increase  fellowship  training  posiDons   •  Increase  roles  of  PCPs   •  ProducDvity  gains   •  Increased  use  of  NPs  and  PAs  (54%  already  work   with  PAs  or  NPs)     •  Increased  use  of  hospice  (involves  only  8%  of   oncologist  visits)   Ref:  J  Oncology  PracDce.  2007;3(2):79-­‐86)  
  32. 32. GP  Workforce   •  Only  3.9%  growth  in  GPs  from  2007-­‐11  vs  7.3%   populaDon  growth   •  Number  of  GPs/100,000  populaDon  in  outer  regional   areas  is  99  vs  124  in  major  ciDes  and  106  in  inner   regional  areas   •  ProjecDons  for  2018  range  from  a  surplus  of  2977   GPs  (service  and  workforce  reform  measures)  to  a   shortage  of  2033  GPs  (medium  self-­‐sufficiency)   Health  Workforce  2025  (Vol  3).  2012.  
  33. 33. EssenDal  Components  to  Facilitate   Shared  Cancer  Care  with  PCPs   •  Timely  and  systemaDc  communicaDon,  including  role   clarificaDon,  among  all  members  of  shared  care  team  as  well   as  the  paDent   •  Decision  support  tools  and  governance  systems   •  EducaDon  and  training   •  CredenDaling  for  PCPs   Ref:  GSB  ConsulDng  &  CommunicaDons.  Role  redesign  primary  care  –  shared  care  models  of   cancer  treatment  and  surveillance  post  treatment.  2010  
  34. 34.  GP  Needs  Related  to  ParDcipaDon    in  Follow-­‐up  Cancer  Care   Provision  of  guidelines   Fast  paDent  re-­‐referral   Further  training  and  access  to  resources   Tools  to  stay  connected  to  the  oncologist  (survivorship   care  plan)   •  Defined  role  in  the  delivery  of  care   •  Adequate  compensaDon  for  parDcipaDon   •  •  •  •  Ref:  Chomik  Consult  &  Research.  SupporDng  the  role  of  primary  care  in  cancer  follow-­‐ up.  Canadian  Assoc  Provincial  Cancer  Agencies,  2010  
  35. 35. DOES  AUSTRALIA  HAVE  A  HIGH   PERFORMING  SYSTEM?  
  36. 36. Aoributes  of  a  High  Performing   Health  Care  Delivery  System   •  PaDents’  clinical  informaDon  is  readily  available  to   providers  and  paDents  (ie,  EHR)   •  PaDent  care  is  coordinated  across  providers  and   acDvely  managed  across  seqngs   •  Providers  are  accountable  to  each  other  and   collaborate  reliably  to  deliver  high  quality  care   •  PaDents  have  easy  access  to  appropriate  and  culturally   competent  care  and  informaDon,  when  needed  
  37. 37. Aoributes  of  a  High  Performing   Health  Care  Delivery  System  (cont’d)   •  There  is  clear  accountability  for  the  total  care  of   paDents   •  The  system  is  conDnually  innovaDng  and  learning  how   to  improve  quality,  value  and  the  paDents’  experiences   Ref:  The  Commonwealth  Fund.  Transforming  Health  Care  Delivery:  Why  it  maoers  and  what  it  will   take.  March  2012  
  38. 38. USE  OF  TECHNOLOGY  IN  MEDICAL   AND  CANCER  CARE  
  39. 39. The  Importance  of  InformaDon   “Successful  21st  century  cancer  care  organizaDons  will  be   learning  systems,  able  to  measure  paoerns  of  performance  that   are  criDcal  to  paDent  care  and  organizaDonal  survival.     OrganizaDonal  learning….requires  more  than  IT.    It  requires   availability  of  appropriate  content,  structured  and  standardized   in  ways  that  are  meaningful  to  paDents,  pracDDoners  and   administraDve  staff,  and  accessible  for  monitoring,  decision   support,  and  quality  improvement”.   Ref:  Clauser  ST  et  al.  Am  J  Prev  Med  2011;40(5  Suppl  2):S198-­‐207    (page  203)  
  40. 40. Telehealth/Telemedicine   •  Cost  per  visit  for  Univ  of  Kansas  Medical  Center’s   telemedicine  program  has  decreased  from  $812  in  1995   to  $251  in  2005   •  In  1996  Norway  became  first  country  to  have  an  official   telemedicine  fee  schedule  –  now  have  telepathology,   telepsychiatry,  telegeriatric,  teleemergency  medicine  and   teleoncology  services,  among  others   Ref:  Dooliole  GC  et  al.    J  E  Health  2011;17(9):671-­‐5  Hartvigsen  G  et  al.  Stud  Health  Technol  Inform.   2007;129(Pt  1):82-­‐6  
  41. 41. 2013  Canadian  Telehealth  Report   •  Number  of  hospital  and  community-­‐based  telehealth   endpoints  increased  from  6460  in  2010  to  7297  in  2012  (13%   )   •  Number  of  consultaDons  across  the  13  jurisdicDons  increased   from  187,385  in  2010  to  289,747  in  2012  (54.6%  )  –   increases  occurred  in  all  13  jurisdicDons   •  Number  of  communiDes  served  ranges  from  14  in  the  Yukon   to  120  in  Alberta;  Nunavut  has  25  communiDes   •  Teleoncology  services  occur  in  12  of  the  13  jurisdicDons   Ref:  COACH.  2013  Canadian  Telehealth  Report,  public  version.  2013  
  42. 42. THE  CHALLENGE  OF  CHANGING  –  IS   MEANINGFUL  CHANGE  EVEN  POSSIBLE?  
  43. 43. The  Challenge  of  Changing   “From  the  perspecDve  of  systems  analysis,  the  current   healthcare-­‐delivery  system  is  in  equilibrium;  that  is,   over  Dme,  each  of  its  subsystems  has  found  a  way  to   funcDon  within  the  dysfuncDon  and  irraDonality  of  the   enDre  system.    Thus,  aoempts  to  fix  one  subsystem   inevitably  fail  because  the  change  is  incompaDble  with   other  subsystems”.   Ref:  A  Healthcare-­‐Delivery  System  for  the  Nest  GeneraDon.  A  White  Paper  of  the  Purdue  Healthcare   Summit,  May  2006.  
  44. 44. APPROACHES  TO  ORGANISING  CANCER   CARE  SERVICES  IN  REGIONAL  AND   RURAL  AREAS  
  45. 45. Bri-sh  Columbia  Cancer  Agency  
  46. 46. Cancer  Care  Ontario   1   Erie  St.  Clair  Cancer  Program   2   South  West  Regional  Cancer  Program   3     Waterloo  Wellington  Regional  Cancer     Program   4     Hamilton  Niagra  Haldiman  Brant  Regional     Cancer  Program   5  &  6    Mississauga  Halton/Central  West     Regional  Cancer  Program   7     Toronto  Central  Regional  Cancer  Program   8     Central  Regional  Cancer  Program   9     Central  East  Regional  Cancer  Program   10   South  East  Regional  Cancer  Program   11   Champlain  Regional  Cancer  Program   12   North  Simcoe  Muskoka  Regional  Cancer     Program   13   North  East  Regional  Cancer  Program   14   North  West  Regional  Cancer  Program  
  47. 47. Alberta’s  Cancer  Care  Centres  
  48. 48. Alberta’s  Key  Strategies  for  Change   •  Create  a  comprehensive  and  coordinated  system  of   prevenDon,  screening,  care  and  research     •  Support,  engage  and  integrate  PCPs  in  the  delivery  of  cancer   services  in  the  home  or  community  and  to  underserved   populaDons   •  Beoer  integrate  care  to  deliver  cancer  diagnosis,  treatment   and  support  services   •  Focus  research  efforts     •  Manage  health  system  infrastructure   Ref:  Alberta  Government.  Changing  our  future:  Alberta’s  cancer  plan  to  2030.  2013.  
  49. 49. RECOMMENDATIONS  RELATED  TO   REGIONAL  CANCER  CENTRES  
  50. 50. Major  Issue  for  Regional  Cancer   Centres   •  DeterminaDon  of  which  cancers  can  be   treated  to  standard  seen  in  major  cancer   centres   •  Relevance  of  exisDng  cancer  guidelines   •  Development  and  use  of  cancer  care  pathways   -­‐  CCO  calls  these  Disease  Management   Pathways  
  51. 51. IS  IT  POSSIBLE  TO  HAVE  AN   INTEGRATED  AND  COORDINATED   CANCER  CARE  SYSTEM  AT  A  STATE   LEVEL?  
  52. 52. What  Is  Needed  to  Ensure  Quality   Cancer  Care  for  Residents  in  Regional   and  Rural  Areas?   •  A  single  cancer  agency  that  has  responsibility  for  developing   an  integrated  cancer  system  for  the  state   •  Budgetary  authority  and  responsibility  for  implemenDng   cancer  care  across  the  cancer  conDnuum  in  all  health   authoriDes  in  the  state   •  CreaDon  of  a  cancer  care  ‘learning  system’  based  on  a  robust   IT  plakorm   •  A  commitment  to  paDent  needs  vs  system  preferences  (ie,  the   system  is  paDent-­‐focused)  

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