CSQI BACKGROUNDER What is The Cancer Quality Council of Ontario (CQCO)? What does CQCO do? What is the Cancer System Quality Index?

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1 CSQI BACKGROUNDER What is The Cancer Quality Council of Ontario (CQCO)? Established in 2002 by the Ministry of Health and Long-Term Care (MOHLTC), the Cancer Quality Council of Ontario (CQCO) is an arm s length advisory group that provides guidance to Cancer Care Ontario and the MOHLTC in order to improve the quality of cancer care in the province. The CQCO is a multidisciplinary group of healthcare providers, cancer survivors, family members and experts in the areas of oncology, health system policy, performance measurement, health services research and healthcare governance. What does CQCO do? The CQCO has a mandate to monitor and report publicly on the performance and quality of the Ontario cancer system and to motivate improvement through national and international benchmarking. The CQCO s mission is to improve the quality of cancer services in Ontario. The organization works in partnership with Cancer Care Ontario to identify and assess gaps in cancer system performance and to provide recommendations on planning and strategic priorities. For more information, visit: What is the Cancer System Quality Index? Now in its 13th year, the Cancer System Quality Index (CSQI) is a quality improvement index that highlights where cancer service providers can advance the quality and performance of care. The interactive web-based public reporting tool includes 35 indicators spanning the continuum of cancer care, along with several measures related to cancer prevention. The CSQI is used by health professionals and cancer organizations, planners and policy-makers to identify cancer trends and to plan and make improvements in all areas of cancer prevention, care and survivorship. The CSQI evolves year-over-year and informs Cancer Care Ontario s overall action plan, helping to determine priorities and allocation of resources. In addition, the CSQI allows Cancer Care Ontario and the MOHLTC to track and assess the quality and consistency of the cancer system across the province, enabling them to identify areas where they can make improvements. The CSQI is one of the most comprehensive tools of its kind worldwide in terms of its breadth of measurement, jurisdictional comparisons and international benchmarks. The first of its kind in North America, CSQI was launched in 2005 by CQCO. CSQI 2017 Highlights: Overall, Ontario s cancer system as a whole is performing well when compared with other jurisdictions nationally and internationally.

2 Each indicator used to measure performance is a specific measurement of progress against one of seven dimensions of quality - each established to help us focus our efforts in improving the cancer system: Enhancing patient and provider safety this year s rating is good Ensuring cancer services are effective this year s rating is good Improved access for Ontarians - this year s rating is fair Providing care that is responsive to patient needs - this year s rating is fair Ensuring equity - this year s rating is fair Improved integration - this year s rating is fair Greater efficiency - this year s rating is fair Rating scale: HIGH LOW Very Good Good Fair Poor Incomplete Data This year there was a decline in the Access rating from Good to Fair. Ontarians continue to access many specialist services they need within appropriate timeframes. However, wait times for other services including testing, and supportive care require improvements for timely access to these resources. As well, there was a decline in the Responsive rating from Good to Fair. Opportunities for improvement still exist with respect to real-time measures of patient experience and outcomes. More emphasis is needed on patient quality of life during and after treatment. First Nations, Inuit and Métis Information: The CQCO collaborated with the Aboriginal Cancer Control Unit at Cancer Care Ontario and their First Nations, Inuit and Métis partners to present findings related to modifiable risk factors for this specific group of Ontarians, and also to formalize relationship-building and cancer control planning with this group. Retired Indicators: Three indicators have been retired from CSQI since Measures are retired only when they achieve sustainable results that reach or surpass their target or it has been determined that there is a more accurate way to explore an issue. The retired measures include: Cervical cancer screening quality - Negative-predictive value: Although this was a new indicator in 2016, the data shows that it is performing very well. There is little variation

3 between age groups and it has remained stable over time. Pap test positive-predictive value, is being brought on as a new measure of cervical cancer screening quality. Treating Non-Small Cell Lung Cancer (NSCLC) according to guidelines: For inoperable NSCLC patients: this measure is performing well. The vast majority of patients had appropriate consultations with a medical and/or radiation oncologist. We therefore can assume that the available treatment options were explored and that patients with inoperable lung cancer are receiving appropriate care. For operable NSCLC patients: the rationale is similar to inoperable patients, however with the resected population only a consult with medical oncologist (not radiation oncologist) is needed. Data showed that the vast majority of patients had appropriate consultations with a medical oncologist, from which we can infer that patients with resectable lung cancer are receiving appropriate care. Symptom Screening in Survivorship: This measure was replaced by a question from the Ambulatory Oncology Patient Satisfaction Survey on patients being informed of their plan of care in CSQI New Indicators: Engagement with First Nations, Inuit and Métis communities: developing and sustaining relationships within the cancer system Tobacco use screening in ambulatory care Cervical cancer screening quality and efficiency: o Positive predictive value o Pap test history in cases of invasive cervical cancer Access to PET/CT scans before surgery for patients with esophageal cancers Reporting of cancer stage at diagnosis by income and urban/rural Unplanned hospital visits after surgery for patients diagnosed with thyroid and breast cancer Reoperation rates after surgery for patients diagnosed with thoracic, prostate and colorectal cancer

4 Unplanned hospital visits for patients who received oral-chemotherapy: stage III colon cancer Access to psychosocial oncology services: cancer patients referred to social work services Number of electronic Patient Reported Experience Measures (PREM) sites in Ontario regional cancer centres Wait time for cancer surgery for thyroid cancer patients Patient knowledge of next steps of care after treatment Special Focus: Thyroid Cancer in Ontario This year, the CSQI presents a special focus story on thyroid cancer in Ontario. In addition to providing surveillance statistics of thyroid cancer, the story includes an overview of the thyroid cancer patient journey, including diagnosis, treatment, survivorship/follow-up and end-of-life care. Previous special focus stories have included cervical, lymphoma, breast, prostate, lung and colorectal cancers. Regional Comparisons: Local Health Integration Network (LHIN) Based Analysis the Index also presents cancer system performance within each of Ontario s 14 LHINs and presents a snapshot view of how each LHIN is doing in terms all indicators across CSQI. International Comparisons: The CSQI includes international comparators as we move towards regular benchmarking against international best practice. In addition to the CSQI, the CQCO also helps benchmark the quality of Ontario s cancer system performance against international leaders by bringing in international expertise to review quality gaps and issues related to performance and by providing policy advice based on an assessment of lessons learned in international experience. Those annual initiatives include: An annual Signature Event that brings practice leaders, policy makers, providers, patient and family representatives together with international and national experts to provide practical solutions to address a quality gap and identify areas of opportunity to improve the quality of health services delivery within the Ontario context.

5 The annual Quality and Innovation Awards, sponsored by CQCO, Cancer Care Ontario and the Canadian Cancer Society Ontario Division, which recognizes significant contributions to quality or innovation in the delivery of cancer care across the province of Ontario. The annual Programmatic Review that brings Ontario clinical leads together with international experts to review an existing cancer system program, analyze their effectiveness and make recommendations regarding strategic directions and improvements.