BC Cancer Agency`s approach to improving the quality of
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Cette présentation a été effectuée le 23 novembre 2010, au cours de la journée « Les données clinico-administratives et d’enquête essentielles à la qualité des services : l’exemple du cancer » dans le cadre des 14es Journées annuelles de santé publique (JASP 2010). L’ensemble des présentations est disponible sur le site Web des JASP, à l’adresse http://www.inspq.qc.ca/ archives. BC Cancer Agency BC Cancer Agency’ss approach to approach to improving the quality of care in oncology Dr David Levy D D id L President BC Cancer Agency Mandate g y To provide a province‐wide, population‐based cancer control program for BC & the Yukon 14es Journées annuelles de santé publique 1 BCCA mission is to: • To reduce the incidence of cancer • To reduce the mortality rate of people with cancer • To improve the quality of life of people living T i th lit f lif f l li i with cancer Whitehorse, Yukon • Central Agency office •Cancer Research Centre (Vanc. Vict) •Regional Cancer Centres •Community Cancer Centres •Community Cancer Clinics •70 regional pharmacies – chemo •Networks: •hereditary cancer •cervical cytology •colposcopy clinics •screening mammography centres •palliative care •surgical oncology council & network BCCA Cancer Centre and University Cancer Research Centre BCCA Cancer Centre and Research Centre Consultative Clinic Screening Mammography Centres, Cervical Cytology Screening Program Dawson Creek Prince Rupert Terrace Prince George Kitimat Kamloops Vernon Powell River Kelowna Penticton Nelson Vancouver Campbell River Comox Port Alberni Nanaimo Vancouver Island (Victoria) Chilliwack Trail Fraser Valley (Surrey) 14es Journées annuelles de santé publique Cranbrook Creston Abbotsford 2 14es Journées annuelles de santé publique 3 Treatment Referral Prevention Screening Diagnostics Treatment The Patient Screening g data Population data EMR Registry data End of life Care Chemotherapy data Radiology reports Pathology reports Survivorship Surgical data Death data Radiotherapy data Symptom Screening BCCA Clinical Surveillance & Outcomes Data Environment BCCA Clinical, Surveillance & Outcomes Data Environment External Data Sources 14es Journées annuelles de santé publique 4 Ministryy of Health: •DAD - Hospital discharge/admissions data •Diagnoses, surgical procedures, 30 day mortality, •co-morbidity •MSP - Billing data •Surgical information/diagnostic info •SPR - Surgery wait times •Cancer Surgery wait times* Vital Statistics: Death information Challenges (1) • Filling the gaps in the pathway: – Collection of performance status, co‐morbidity and stage – Meaningful surgical data, across the province – Need for synoptic reporting of pathology and radiology 14es Journées annuelles de santé publique 5 Challenges (2) g ( ) Why is BC Why is BC performance better? I do not know 14es Journées annuelles de santé publique 6 I do know • It is only important if you measure it* • Up‐to‐date protocols and their measured adherence, results in consistent high‐quality oncology care across a province • Tumour tissue, linked to outcome data and treatment parameters is a very important research resource 21st century health care 14es Journées annuelles de santé publique 7 Prevention Screening Treatment Referral Diagnostics Survivorship Treatment The Patient What data is important to patients? End of life Care How do we measure recurrence?? Challenge (3) g ( ) • Rising number of cancer cases • Cancer can be a chronic disease • Fiscally challenged healthcare systems • Increasing public and patient expectation 14es Journées annuelles de santé publique 8 Sustainable cancer control systems y • Delivery of Quality care ‐ overtly – Safe, – Effective, – Efficient • Patients expect high‐quality care, outcomes and experience Patient survey 2006 y • 6,000 patients in BC receiving ambulatory cancer treatment • 26,000 patients receiving ambulatory cancer care in Alberta Manitoba Nova Scotia care in Alberta, Manitoba, Nova Scotia, Ontario, and Saskatchewan. 14es Journées annuelles de santé publique 9 Impact in BC p • Further investment in supportive care • Challenge to clinical approach v holistic approach to care • Requires investment in patient‐driven R i i t ti ti t d i priorities rather than clinician‐driven • Q? Who is the healthcare service for? 14es Journées annuelles de santé publique 10 BC – Provincial Breast Health Strategy gy • Low uptake of screening‐ 53% of 50‐69 year olds • Women receive mixed messages • Delays in resolution of abnormal D l i l ti f b l mammograms BC Screening Mammography • 300,000 screens each year • 7.3% are abnormal = 21,737 women • 5 weeks to diagnosis (nowomen biopsy) 94% of with an abnormal b l screen do NOT have cancer • 7 weeks to diagnosis (biopsy) approx 3,600 14es Journées annuelles de santé publique 100% of those women think they may have cancer until diagnostic results 67.9% 39.6% 11 BC Breast Cancer Waits Breast Cancer 300 250 More than half wait more than 2 months # of days 200 150 100 50 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Breast Cancer Cases Reviewed (n=51) In BC healthcare appears • Not patient focussed • Long waits • Difficult to navigate 14es Journées annuelles de santé publique 12 Current pathway Pathway? 14es Journées annuelles de santé publique 13 Pathway design • What Wh t needs d to t happen h • The skills needed • Metrics for quality, timeliness, experience • Funding follows the patient Clinical Pathway: A Highway Roadmap Clinic appointment 7 days 14es Journées annuelles de santé publique Support and Information h here 14 Screening Diagnostics The Patient Screening g data Population data Survivorship Treatment Referral Prevention Radiology reports Treatment End of life Care Chemotherapy data EMR Surgical data Pathology Outcomes and Surveillance Integrated reports Radiotherapy Systems (OaSIS) Registry data Death data data Symptom Screening In conclusion • Sustainable cancer control: – Will be driven by protocolized care – Patient experience of healthcare is now more p , g , important, as good clinical outcomes are assured, and must be measured – Clinicians need to change delivery models of healthcare to focus on improving experience 14es Journées annuelles de santé publique 15 Thank you Hub and Spoke Model for delivery of care SC SC SC SC SC DIC DIC Full Service Screening and Diagnostic (Biopsy) Facility SC Surgery Pathology 14es Journées annuelles de santé publique 16 CANCER CENTRES, CHILDREN’S HOSPITAL Cancer Treatment Data VITAL STATISTICS Sibling Cohort CANCER REGISTRY Survivor Cohort, Patient ID, Diagnosis, Death Follow-up MEDICAL INSURANCE PLAN Health Utilization Data, General Population Sample EDUCATION MINISTRIES Education Data BC CANCER AGENCY Oncology Scheduling, Screening Data CAYACS SURVIVOR RESEARCH RESOURCE STATCAN Income and Employment Info PHARMANET Prescription Drug Info Development of outcome indicators analysis files indicators, I. Health Outcomes II. Health Care Outcomes III. Education Outcomes IV. Income and Employment V. Knowledge Translation BC C/A/YA Cancer Survivors Childhood, Adolescent, and Young Adult (CAYACS) Research Program 70% of childhood survivors are over For all five-year survivors of a cancer or tumour diagnosed under age age of 20 25 years in British Columbia, Canada, from 1970, using population registers and linked databases, the CAYACS Program aims to: • Develop a resource for survivorship research After 25 years, 40% have • Determine risks of long term problems in multiple domains 5.2% have blto these • Examine patterns and d quality l off health h l h care in relation l problems h developed risks a needing second cancer Survivors, hospitalization one third less likely to marry 14es Journées annuelles de santé publique BC C/A/YA Cancer Survivors 17
