better cancer services every step of the way

Better Cancer Services Every Step of the Way

1

Regional Performance Improvement & Quality in Cancer

Services: Aligning Energy, Resources and Metrics

Better cancer services every step of the way

Terrence Sullivan PhDCEO, Cancer Care OntarioSeptember 2009


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




Cancer Quality Council of

Ontario

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


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


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


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


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


Visible System Level Public Reporting On Access and Quality


Focused Yearly Clinical Priorities

2009-10 Priority and Target Setting


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)


Standard Provincial Target Current Performance

Regional Systemic Treatment Program

100% of RSTP programs will have nursing/pharmacy leads identified

New Target


100% of RSTP hospitals will establish a process of identifying & reporting serious systemic treatment adverse events

New Target


100% of RSTP hospitals will have current policies & procedures related to safe handling of cytotoxic agents

New Target

2009/10 Performance Targets



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


MCC Implementation in OntarioOntario Goals:1. Improve the quality of existing MCCs

Bringing them up to standard 2. Improve access/coverage of MCCs

More disease sites and more hospitalsCCO 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


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)


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


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


Screen shots from CSQI


Pay for Participation...


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


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

Hospital (*Designated Centres are highlighted in dark purple)

Nu

mb

er

of

Cases

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.


http://csqi.cancercare.on.ca/cms/One.aspx?portalId=40955&pageId=41185


24

IMRT

• 25% of all radical courses will treated using IMRT by Q4, 2010


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


Draft 2009/10 Performance Targets


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%


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

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

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

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

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

Q1 Performance Summary09/10


Note: Central’s 2009 referral to consult data is excluded due to data issues.

Radiation

C1R VolumesJune 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 2009/10Apr-Jun 2008/09Apr-Jun 2009/10

Scale Refers to Provincial Volumes Only

Note: - PMH volumes are courses.

Radiation Treatment Wait Times in the ProvincePercent of Patients Seen/Treated within Target for All Sites

30%

40%

50%

60%

70%

80%

90%

Apr

May

June

July

Aug

Sep

t

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

t

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: iPortAugust 25, 2009

Radiation Therapy - Ready to Treat to TreatmentPercent 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


Central East

South East


North East

Hamilton NHB

Toronto Central PMH

North West


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



Champlain

North East

Central East


Toronto Central PMH

North West

Hamilton NHB

Waterloo Wellington

PROVINCE

Target for 2009/10

Apr-Jun 2008/09

Apr-Jun 2009/10



SystemicSystemic 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


Erie St. Clair

North East

Toronto Central PMH

Central East

South East

Central



Hamilton NHB

Waterloo Wellington

North West

PROVINCE

Target for 2009/10

Apr-Jun 2008/09

Apr-Jun 2009/10


Systemic Treatment Wait Times in the ProvincePercent of Patients Seen/Treated within Target for All Sites

20%

25%

30%

35%

40%

45%

50%

55%

60%

65%

Apr

May

June

July

Aug

Sep

t

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

t

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


C1S VolumesJune YTD 2008/09 vs 2009/10

0 200 400 600 800 1,000 1,200 1,400 1,600 1,800


Central


North East

Toronto Central PMH

North West

South West

Champlain

South East

Hamilton NHB

Erie St. Clair


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



Systemic Therapy - Consult to TreatmentPercent of Patients Treated Within Target (14 days)May and June 2009

0% 10% 20% 30% 40% 50% 60% 70%

Champlain


Toronto Central PMH

South East

Central East

Central

South West


Waterloo Wellington

Hamilton NHB


North West

Erie St. Clair

North East

PROVINCE

Target for 2009/10

May 2009

June 2009



Notes: Wait times include treatment cases only and exclude lymphoma, skin and priority 1 cases.

SurgeryCancer Surgery Percent of Patients Treated Within Target (14, 28 , 84 days) for All PrioritiesJune YTD 2008/09 vs 2009/10

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

South West

North East

Champlain



Toronto Central PMH

South East

Central East

Hamilton NHB


Erie St. Clair

North West

Waterloo Wellington

Central

PROVINCE

Target for 2009/10

Apr-Jun 2008/09

Apr-Jun 2009/10


Cancer Surgery VolumesJune 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


Erie St. Clair

Toronto Central PMH



Central East

North East

PROVINCE

Volumes

0 2,000 4,000 6,000 8,000 10,000 12,000 14,000



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

Sep

t

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

t

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

2007-08 2008-09 2009-10

Per

cen

t o

f P

atie

nts

20

30

40

50

60

70

80

90

Day

s

% 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


Cancer Surgery90th Percentile Wait TimeJune YTD 2008/09 vs 2009/10

0 10 20 30 40 50 60 70 80 90 100

South West

Toronto Central PMH

Champlain


Central East

Hamilton NHB


South East


Waterloo Wellington

Central

North West

North East

Erie St. Clair

PROVINCE

Days

Target for 2009/10

Apr-Jun 2008/09

Apr-Jun 2009/1048Provincial Target


Colonoscopy

Colonoscopy Wait Times in the ProvincePercent 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


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


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


Hamilton NHB

Central East

Central

Toronto Central PMH

South West

PROVINCE

Target for 2009/10

Apr-Jun 2008/09Apr-Jun 2009/10


Colonoscopy VolumesJune 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


PROVINCE

0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000




Colonoscopy

FOBT Participation in Target Population(men & women ages 50-74)

0% 5% 10% 15% 20% 25% 30% 35% 40%

Toronto Central


North West

North East

South East

HNHB

Erie St. Clair

South West

Central West

Central

Mississauga Halton

Central East

Waterloo Wellington

Champlain

Ontario

Target 2008-092004-20052006-2007

Provincial Target for 2008-0930%

%


Stage Capture

Stage Capture in the ProvinceCombined 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


Stage Capture Rate of All ICP Cancer Cases(RCC and Surgery Only)

0% 20% 40% 60% 80% 100% 120%



South West

Central

Central East

Toronto Central PMH

North West

Erie St. Clair


South East

North East

Champlain

Waterloo Wellington

Hamilton NHB

Province

April - Oct 2007

April - Oct 2008

Regional and Provincial Target

90%%


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


Hamilton NHB

Champlain

South West

North West

South East

Central

North East

Waterloo Wellington


Erie St. Clair


Province

2009/10 Target

Apr-Jun 2008-09

Apr-Jun 2009-10


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


Central East

North East

Champlain

South East

Hamilton NHB

South West

Central


North West

Waterloo Wellington

Erie St. Clair


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 ESASIn 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

Fe

b

Mar

Apr

May

Jun

July

Aug

Sept

Oct

Nov

Dec

Jan

Fe

b

Mar

Apr

May

Jun

2007-08 2008-09 2009-10

Lung Cancer PatientsAll Other PatientsProvincal Target for Lung Cancer PatientsProvincial Target for All Other Patients

Target for Lung Cancer Patients

Target for All Other Patients


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


Hamilton NHB

Central

North East

South West

Waterloo Wellington

Toronto Central PMH

Champlain



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.


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


All Centres

Regional and Provincial Target for 2008-09

70%%


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.

STAGEApr-Oct

2008

WTRef-Con

(% w/in 14 days)

WTRTT-Tr(% w/in target)

Vol(C1R)

WTRef-Con

(% w/in 14 days)

WTCon-Tr

(% w/in 14 days)

Vol(C1S)

WT(% w/in target)

WT(90th)

Vol(cases)

WT(FOBT+)

WT(Family History)

VolFOBT

Participation

Combined Rate

Lung All Other

PROVINCE ▲ ▲ ▲ ▼ ▼ ▲ ▲ ▲ ▲ ▲ ▼ ▬ ▲ ▲

Waterloo Wellington

▲ ▼ ▼ ▲ ▲ ▲ ▲ ▼ ▲ ▲ ▼ ▲ ▼ ▲ 1 1

North West ▲ ▲ ▼ ▲ ▲ ▲ ▲ ▲ ▲ ▲ ▼ ▼ ▲ ▼ 2 2

Hamilton NHB ▲ ▲ ▼ ▲ ▲ ▼ ▲ ▲ ▲ ▲ ▼ ▼ ▲ ▲ 3 6


▲ ▲ ▲ 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


▲ ▲ ▼ ▼ ▼ ▲ ▲ ▲ ▼ ▼ ▲ ▼ ▼ ▲ 10 -3


▲ ▲ ▲ ▼ ▲ ▬ ▲ ▼ ▲ ▼ ▼ 11 -3

Central East ▲ ▲ ▲ ▼ ▼ ▲ ▲ ▲ ▲ ▲ ▼ ▼ ▲ ▲ 12 -1

Champlain ▲ ▲ ▼ ▼ ▲ ▲ ▲ ▼ ▲ ▼ ▲ ▲ ▲ ▼ 13 -1

South West ▬ ▼ ▲ ▼ ▼ ▼ ▼ ▲ ▼ ▲ ▼ ▼ ▲ ▲ 14 -1

SYMPTOM MGMTApr-Jun 2009

COLONOSCOPYWT & Vol = Apr-Jun 2009Participation = 2006-2007

RADIATIONApr-Jun 2009

Region

SYSTEMICRef-Con = Apr-Jun 2009

Con-Tr = Jun 2009

SURGERYWT = Apr-Jun 2009Vol = Apr-Jun 2009 Overall

Provincial Rank

Change from

Previous Rank

MCC Q4 08-09

THORACICApr 08 - Jan09

n/a▼

n/a▼

n/a▼


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


Ontario Cancer ProgramsWhat 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*

STANDARDS

PLANNING

FUNDING


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

STANDARDS

PLANNING

FUNDING


• 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

better cancer services every step of the way

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