Cancer Clinical Pathways in Norway. Kaja Fjell Jørgensen Sissi Espetvedt Bente Bryhn Kjell Magne Tveit

Transcription

1 Cancer Clinical Pathways in Norway Kaja Fjell Jørgensen Sissi Espetvedt Bente Bryhn Kjell Magne Tveit

2 Cancer Clinical Pathways in Norway - status Background Reports from Experiences Challenges Cancer Clinical Pathways home Helsedirektoratet 2

3 Cancer Clinical Pathways in Norway 28 cancer pathways developed by Norwegian Directorate of Health in organ-specific pathways 1 for metastasis with unknown primary 1 diagnostic pathway Build upon official Norwegian guidelines for cancer diagnostics, treatment and follow up Monitoring system - results presented in the national quality indicator system January 1st 2015 the four first cancer pathways were implemented Breast cancer, lung cancer, prostate cancer and colorectal cancer May 1st 2015: 10 more cancer pathways September 1st 2015: 14 more cancer pathways Helsedirektoratet 3

4 Objective for patients and health care system Patients should experience predictability and safety Patients should experience good information and shared decisions Improved collaboration within the specialized health care system Improved collaboration between general practitioners and hospitals Helsedirektoratet 4

5 Monitoring system and establishment of maximum time intervals Dates to be coded and reported Referral received in hospital First admission/consultation in hospital Clinical decision Start initial treatment Different intervals are reported Start Cancer pathway to first consultation (typical 7 days) First consultation to clinical decision (typical 14 days) Clinical decision to start treatment (typical 14 days) Start Cancer pathway to start treatment (typical 35 days, varying from 3 days to 66 days) Helsedirektoratet 5

6 Recording time intervals Start cancer pathway OF1 Start assessment OF2 OF4 Main parameter Sum of time intervals Clinical diagnosis OF3 Start treatment

7 Cancer Clinical Pathway reports NPR (Norwegian Patient Registry) sends reports to the hospitals once a month National system of quality indicators, reported three times a year, for all pathways and hospitals: Helsenorge.no OA1: Proportion of cancer patients included in a Cancer Clinical Pathway OF4: Proportion of patients treated within the accepted time interval Internal reports within the hospitals recording system

8 Proportion of patients with cancer included in cancer pathways - OA Goal: 70% Helsedirektoratet 8

9 Proportion of patients with cancer included in cancer pathways - OA Goal: 70% Helsedirektoratet 9

10 Proportion of patients in cancer pathways without cancer - OA Helsedirektoratet 10

11 OA2 Breast cancer Helsedirektoratet 11

12 Recording of main interval - OF4. Goal: 70% All cancer pathways Helsedirektoratet 12

13 Recording of main interval - OF4. Goal: 70% All cancer pathways Helsedirektoratet 13

14 Experiences in Norway Positivity in hospitals: better logistics and collaboration Positivity among GPs: one door into the hospital Positivity among patients: predictability and safety Hospital pathway coordinators are extremely important

15 Challenges Hospitals may record codes at different times: start code, admission code, clinical decision code (although well defined) Real time registration of included patients (not afterwards) Should patients with recurrences be included? Inclusion of cancer patients treated in an acute situation? Private specialists may be involved in the pathway, but do not report Patients who want to postpone treatment (eg. prostate cancer) Two hospitals involved in same pathway transfer of patients Workshop October 24 discussed these issues: some specifications and changes have to be made

16 «Cancer Clinical Pathways Home» From hospital to home The Norwegian Directorate of Health have started to develop «Cancer Clinical Pathways Home» Goal: to create a pathway describing the transition from the spesialized health care in hospitals to the primary health care system Criteria Describe the role of the Hospital pathway coordinators and the Cancer coordinators in primary health care Include psychosocial follow-up of patients Include rehabilitation Should build upon existing Norwegian treatment guidelines Should be monitored and reported

17 Cancer clinical pathways in Norway status Overall most hospitals and regions meet the goal of 70% inclusion of patients and most patients are treated within the normative time standards We are still facing challenges with coding and registration. The cancer clinical pathways are still considered a success in Norway, and more pathways in other areas of medicine are beening implemented. Cancer clinical pathway home Helsedirektoratet 17

18 Thank you