Improving the Performance of Cancer Services: p g A Framework and - - PowerPoint PPT Presentation

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Improving the Performance of Cancer Services: p g A Framework and - - PowerPoint PPT Presentation

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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

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Improving the Performance of Cancer Services: p g A Framework and Recent Ontario Experience

Terrence Sullivan President and CEO C C O i Cancer Care Ontario Canada

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Planning: Newly diagnosed cancers by LHIN: 2007, 2012, 2017

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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

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y , Source: Ontario Cancer Registry

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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 Appropriate care (reduce under use, over use, misuse) S afe care (minimize errors) Integrated/ coordinated care Patient-centred care Universal coverage Established set of benefits Affordable care Equitable care Minimal appropriate waiting and access

  • 4. SYSTEM CAPACITY TO

IMPROVE

  • 3. EFFICIENT AND

HIGH VALUE CARE IMPROVE

Investment in innovation and research Information infrastructure Educational system for health care providers/ administrators Culture of performance improvement Balance autonomy and accountability

HIGH VALUE CARE

Efficient delivery and administration Care at the right time, in the right setting, with right professional mix Ongoing evaluation of effectiveness and value Balance autonomy and accountability

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Promising Practices to Achieve 4 Core Goals of High Performance Systems

4 Core Goals of High Performance Systems Canada (Ontario) England France Germany USA

  • 1. Appropriateness

and Safety Guideline culture and adherence reporting Th i t d d National Institute for Health and Clinical Excellence (NICE) li i l ti Multidisciplinary approach: Consultation, Diagnosis C N t k Disease Management Program (guideline dh ) Quality Oncology Practice Initiative (QOPI) ( id li dh i Thoracic surgery standards minimum activity &

  • rganizational requirements

(NICE) clinical practice guidance Cancer Networks Minimum activity thresholds and quality criteria adherence) Clinical practice guideline compliance Certification of cancer centres (guideline adherence via voluntary chart abstraction) National Initiative on Cancer Care Quality (guideline adherence)

  • 2. Access and Equity

Wait times monitoring, ti & i t National Cancer Waits P j t l d t Early detection (breast and l t l ) Health insurance coverage f ll iti State and local t i reporting & improvement Colorectal Screening Project led to progress on cancer waits Colorectal Screening colorectal cancer) for all citizens programs to increase insurance coverage and reduce disparities in cancer care

  • 3. Efficiency and Value

Improved data quality for pathology reports and stage capture; Payment link to quality standards Progress review and monitoring (National Audit Office) Specific financing system for innovative drugs incentive for appropriate prescribing Integrated Oncology Centres Payment reform demonstrations that link payment to quality rather than volume standards

  • 4. System Capacity to

Improve Performance reporting through Cancer System Quality Index (CSQI) enrollment in clinical trials Comprehensive cancer plan/strategy Cancer Services Collaborative (service redesign) Access to innovative drugs Quality management programs (analysis and reporting) Upgrading cancer registries

http://www.cancercare.on.ca/documents/UK5_Pre-WorkshopReport.pdf

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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

  • urces
  • f Quality Data
  • f Quality Data

1.3 Performance Reporting

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Common Elements of Performance Improvement : p

  • 2. Active Levers for Performance Improvement

2.1 Institutional and Leadership Alignment on Directions 2 2 C it t / M bili ti f S t k h ld 2.2 Commitment / Mobilization of S takeholders

  • Commitment of clinician and clinician leaders
  • Engaging patients
  • Public engagement
  • Engagement of policy/ administrative decision

makers

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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 ervices S ervices 3.4 Flexible Work Force Initiatives

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A Cancer Improvement Framework Arising from 5 Country Initiative

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Responsabilite et performance en cancerologie Sullivan, Dobrow, Schneider et al, Prat Organ Soins 2008;39(3):207-15

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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 Comments0Recommend6 CBC News

Most hospitals in the U.S. fail to check colon ti t th hl f i th i cancer patients thoroughly for signs their tumour is spreading, say researchers. In the last 10 years, several oncology

  • rganizations 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.

12 Wright, F et al. BMC Health Serv Res. 2006 Jan 16;6:4.

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Performance Reporting p g

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Improving Quality & Program S tandards Program S tandards

(06/07) 4 centres (06/07) 4 centres meet volume standard

Number of self-reported Lung Cancer Surgeries by Hospital, April 1 2007 to March 31 2008 250 300 350 400 C a s e s

(07/08) 7 centres meet volume

50 100 150 200

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Linking Data, Quality, Performance, Participation and Funding

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Congratulations to PMH on 50 Years of Leadership!

Better cancer care every step of the way