Cancer Services Performance Indicators. Round Report

Transcription

1 Cancer Services Performance Indicators Round Report

2 To receive this publication in an accessible format phone (03) , using the National Relay Service if required, or Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. State of Victoria, Department of Health and Human Services, March 2016.

3 Contents Introduction... 4 Key recommendations... 5 Performance against policy:... 5 Data quality assurance:... 5 Dissemination of findings:... 5 Overview of results Documented evidence of multidisciplinary team recommendations Documented evidence of disease staging in the multidisciplinary team recommendations Documented evidence of communication of initial treatment plan to GP Documented evidence of supportive care screening Findings Performance against policy Improvement strategies to consider: Method... 16

4 Introduction As we enter into a new phase of Victorian Government policy around cancer with the next Cancer Plan due for release October 2016, it is to be expected that improved patient outcomes can be demonstrated by a range of indicators. The cancer service performance indicators described in this report have been established to measure and monitor progress with the implementation of Victorian Government policy in the areas of multidisciplinary care (MDC), supportive care and coordination of care. These indicators are just one component of a broader number of program evaluation strategies taking place in the health environment including MDC survey evaluation, patient experience survey, indicator/activity benchmarking and local evaluation conducted by the Integrated Cancer Services (ICS). Together, these quality monitoring and evaluation initiatives underpin the model for safety and quality in Victorian cancer services as outlined in Clinical Excellence in Cancer Care (DHS, 2007). The collection of data by ICS secretariats via a medical record audit is used to inform four cancer service performance indicators, related to targets outlined in Victoria s Cancer Action Plan (VCAP) and other relevant policies. The Victorian Cancer Service Performance Indicators, Data Collection Method 2015 document describes the four cancer performance indicators including rationale, definitions and targets. The indicators include: 1. Documented evidence of multidisciplinary team recommendations. 2. Documented evidence of disease staging in the multidisciplinary team recommendations. 3. Documented evidence of communication of initial treatment plan to GP. 4. Documented evidence of supportive care screening. Indicators provide a flag rather than a definitive answer to practice issues; they can suggest potential opportunities to address identified gaps in a service. They support monitoring and evaluation to inform the continuous quality improvement cycle at the ICS level. These performance indicators have now been tracked continuously for several years providing a record of progress. This report, the findings and recommendations are intended for use at the health service level. Integrated Cancer Services as supported by their governing bodies, and Department of Health & Human Services levels to focus future cancer service improvement activities. To support this, these reports have regularly been presented at a range of departmental committees including the Cancer Quality and Outcome Committee, the Victorian ICS Governance and Network Groups meetings, and are provided de-identified to other states for benchmarking purposes. Results of the audits will continue to be presented at high level committees by the department. The Cancer Service Performance Indicator data are collected in accordance with the departmental Data Reform Program and approval for this data collection has been received. It is a requirement of all ICS to collect and report accurate data and ensure appropriate data storage as per the Financial Management Act Page 4 Cancer Services Performance Indicators Round Report

5 Key recommendations The cancer service performance indicators allow for monitoring and evaluation of relevant policy implementation and progress. The ICS secretariats are well placed to facilitate activities aimed at improving their community s experience of cancer within these four areas of focus. Performance against policy: 1. The ICS should encourage good multidisciplinary team meeting (MDM) practices including: adequate clinical governance, processes and protocols to promote recognised international best practice of prospective treatment planning for cancer patients at an MDM. 2. the inclusion of documented treatment recommendations and communication to referring doctor and/or GP in the patient s central medical record 3. The ICS should continue to promote inclusion of staging information where appropriate in case discussions and documentation of stage as part of the meeting documentation. Staging information underpins treatment decision making, risk adjustment of health outcomes and is a mandatory reporting requirement for Victorian hospitals from 1 July 2013 as defined in the Cancer (Reporting) Regulations The ICS should promote the communication of the initial treatment plan to the patient s referring doctor and/or GP as a key component of coordinated care. The increasing use of software to support MDMs provides an opportunity to streamline this process in a timely fashion. 5. The ICS should continue with effective strategies to implement systematic and sustainable screening processes to identify and manage supportive care needs and review implementation and change management processes. Persistent and significant variation between ICS suggests that collaboration between ICS to extend effective implementation strategies may improve achievement in this area. Data quality assurance: 6. Data and information submitted under this performance reporting program must be reviewed locally and be approved by the ICS program manager or director prior to submission on the provided template to eliminate ongoing data quality issues. Should the department have any queries regarding a submission they will contact the program manager. 7. All ICS should ensure the audit methods are followed as defined. For regional ICS, this requirement includes the over-sampling of patients within the main host site (at least 50% of the sample) or on relative caseloads the top two cancer service providers should account for at least 70% of the sample. Any changes from current arrangement will be discussed initially at the ICS Information Management Group and recommendations forwarded to the department. Dissemination of findings: 8. The department expects the cancer performance indicators to be a standing agenda item at each ICS governance and clinical advisory committees. Where relevant findings should be regularly presented to tumour groups and/or MDMs and to other stakeholders involved in local quality improvement activities, including health service quality units. 9. ICS secretariats are expected to provide local analyses and results directly to individual health services and MDMs to improve performance over time. Cancer Services Performance Indicators Round Report Page 5

6 10. While awaiting the final Cancer Services Performance Indicators (CSPI) state wide report to be circulated after an audit round, the department would encourage each ICS to use local data to initiate discussions with relevant parties to commence targeted strategies addressing areas of concern. Overview of Results The data presented in this report are derived from Round 1 for 2015, for indicators 1 to 4. The number of patients included in the data collection for Round is 1752 state-wide (1126 MICS, 581 RICS, 45 PICS). Table 1 provides a high-level summary of the state-wide results against the 2015 target (unchanged from the 2014 target) and against prior period results. Indicators 1 and 4 had progressive targets until 2012 and performance over time should be compared against the applicable target. Table 1: State-wide summary of results Indicators Result 2011 Result 2012 Result 2013 Result 2014 Result Rd Target Documented evidence of multidisciplinary team recommendations 2. Documented evidence of disease staging in the multidisciplinary team recommendations 3. Documented evidence of communication of initial treatment plan to GP 4. Documented evidence of supportive care screening 49% 62% 64% 70% 72% 72%# 75%# 79%# 79%# 78% N/A N/A N/A 71% 67% 18%* 31%* 36%* 37% 39% 50% Number of medical records audited Notes Indicator 3 was last collected in 2010 (result 68%) before being reintroduced again in 2014 # the state-wide results excluded Haematology and CNS data * the state-wide results to 2013 excluded PICS data. The following sections of this report present data by ICS and by tumour stream against the 2015 targets. Whilst direct comparison of results at the individual ICS level may be problematic (due to the variation in population size, geography and cancer services available) it is noted that comparison of broad trends can assist ICS for the purpose of sharing knowledge about what works well locally. Page 6 Cancer Services Performance Indicators Round Report

7 1. Documented evidence of multidisciplinary team recommendations Target: 80 per cent Performance: 72 per cent (state-wide) Definition: Numerator Denominator Total number of new cancer patients with documented evidence of multidisciplinary team recommendations Total number of new cancer patients audited per tumour stream Results: Figure 1a shows the documented evidence of multidisciplinary team recommendations for Round by ICS. Figure 1b presents pooled data showing the proportion of patient records audited which show documented evidence of multidisciplinary team recommendations by metropolitan and regional ICS groupings. Figure 1c shows the documented evidence of multidisciplinary team recommendations for 2015 by tumour stream. Figure 1a: Documented evidence of multidisciplinary team (MDT) recommendations Documented evidence of MDT recommendations Round (n=1752) 77% 82% 72% 58% 53% 51% 40% 41% 0% BSWRICS (120) GICS (122) GRICS (120) HRICS (81) LMICS (138) NEMICS (452) SMICS (327) WCMICS (347) PICS (45) Statewide (1752) Cancer Services Performance Indicators Round Report Page 7

8 Figure 1b: Documented evidence of MDT recommendations by metropolitan and regional ICS RICS: Evidence of MDT discussion, R MICS: Evidence of MDT discussion, R % 54% MDT No MDT MDT No MDT Figure 1b shows differences in achievement against this target between regional and metropolitan health services, based on pooled data. This difference persists with the gap wider than the Round results. Although this result will reflect differences in the cancer services available within each region it does flag the potential opportunity for creating MDT meeting linkages across regions. Figure 1c: Documented evidence of MDT recommendations by tumour stream 90% 70% 50% 40% 30% 10% 0% 84% 82% Documented evidence of MDT recommendations by tumour stream - Round % 62% 83% 57% 85% 72% 50% 76% Note: ` PST Paediatric Solid Tumours. Paediatric, Central Nervous System (CNS) and Haematological cancers are included within the relevant tumour streams. Page 8 Cancer Services Performance Indicators Round Report

9 2. Documented evidence of disease staging in the multidisciplinary team recommendations Target: 100 per cent Performance: 78 per cent (state-wide) Definition: Numerator Denominator Total number of new cancer patients with documented evidence of cancer staging* in the MDT recommendations Total number of new cancer patients with documented MDT recommendations per tumour stream * Staging should be recorded as per AJCC staging (TNM), SEER or other accepted staging system for the disease type as endorsed by local tumour groups or MDTs. Results: Figure 2a shows the documented evidence of disease staging in the multidisciplinary team recommendations for Round by ICS. Figure 2b shows the results by tumour stream. It should be noted that these results only include patients who have documented team meeting recommendations inclusive now of CNS and haematology (n=1270) in response to the 2014 State-wide MDM Survey. This survey identified that 87% of haematology MDMs use a staging system which is discussed as part of the treatment planning process. Consideration of results for each ICS should be within the context of their respective sample numbers. Figure 2a: Documented evidence of disease staging in the MDT recommendations by ICS Documented evidence of disease staging in the MDT recommendations by ICS - Round % 86% 96% 89% 70% 76% 87% 78% 40% 0% Cancer Services Performance Indicators Round Report Page 9

10 Figure 2b: Total numbers of new cancer patients with documented evidence of cancer staging in the MDT recommendations by tumour stream Documented evidence of disease staging in the MDT recommendations by tumour stream - Round % 70% 87% 67% 94% 61% 64% 63% 74% 78% 76% 59% 50% 40% 30% 10% 0% Note: ` PST Paediatric Solid Tumours. UGI Upper Gastrointestinal Paediatric CNS and haematological cancers are included within the relevant tumour streams. Page 10 Cancer Services Performance Indicators Round Report

11 3. Documented evidence of communication of initial treatment plan to General Practitioner (GP) Target: 100 per cent Performance: 67 per cent (state-wide) Definition: Numerator Denominator Total number of new cancer patients with evidence of communication of the treatment plan to the General Practitioner (or paediatrician) Total number of new cancer patients audited per tumour stream Results: Figure 3a shows the documented evidence of communication of the initial treatment plan to the GP for Round by ICS. Figure 3b shows the documented evidence of communication of the initial treatment plan to the GP for Round by tumour stream. Figure 3a: Evidence of communication of initial treatment plan to GP by ICS Evidence of communication of initial treatment plan to GP - Round % 95% 74% 75% 86% 84% 89% 67% 40% 54% 43% 0% Cancer Services Performance Indicators Round Report Page 11

12 Figure 3b: Evidence of communication of initial treatment plan to GP by tumour stream Evidence of communication of initial treatment plan to GP by tumour stream - Round % 75% 74% 53% 63% 89% 75% 87% 67% 78% 40% 0% Note: PST Paediatric Solid Tumours. UGI Upper Gatrointestinal Paediatric CNS and haematological cancers are included with the tumour streams. Figure 3c: Evidence of communication of initial treatment plan to GP by metropolitan and regional ICS RICS MICS No communication 55% 45% No communication Communication 81% 19% Communication This indicator was last collected in 2010 and reintroduced in In 2010 a breakdown between metropolitan and regional ICS was not provided. In percentage terms 81% of metropolitan services communicate an initial treatment plan to GPs while in regional sites it is 55% for this round 1 period. Page 12 Cancer Services Performance Indicators Round Report

13 4. Documented evidence of supportive care screening Target: 50 per cent Performance: 39 per cent (state-wide) Definition: Numerator Denominator Total number of new cancer patients with documented evidence of supportive care screening Total number of new cancer patients audited per tumour stream Results: Figure 4a shows the evidence of supportive care screening by ICS for Round Figure 4b shows the results by tumour stream. Although the overall target has not yet been achieved, some ICS have demonstrated steady progress from (see CSPI 2014 full year report). Figure 4a: Documented evidence of supportive care screening by ICS Documented evidence of supportive care screening - Round % 61% 73% 36% 39% 58% 67% 39% 50% 15% 24% 0% Note: The state-wide result includes PICS data for the first time reflecting the availability and implementation of a paediatric validated screening tool in the Australian setting. Cancer Services Performance Indicators Round Report Page 13

14 Figure 4b: Documented evidence of supportive care screening by tumour stream Documented evidence of supportive care screening by tumour stream - Round % 40% 24% 31% 24% 44% 47% 23% 43% 37% 31% 50% 6% 0% Note: PST Paediatric Solid Tumours. UGI Upper Gastrointestinal Paediatric CNS and haematological cancer results are included with the relevant tumour streams. Page 14 Cancer Services Performance Indicators Round Report

15 Overview of Findings Performance against policy Indicator 1: Documented evidence of multidisciplinary team recommendations For a number of ICS, achievement of the target has been reached with a considerable gain being made state-wide since Indicator 2: Documented evidence of disease staging in the multidisciplinary team recommendations For the majority of ICS (and at the state-wide level) achievement against this indicator is being maintained but still at levels below the target. Indicator 3: Documented evidence of communication of initial treatment plan to GP Since its reintroduction in Round there has been some meaningful improvement in this indicator for a number of ICS. Indicator 4: Documented evidence of supportive care screening The results for the Round audit round continues to suggest a general slowing of progress however some ICS have continued to exceed the 50% target. Improvement strategies to consider: In order to bridge the widening gap between regional and metropolitan services in the documentation of MDT discussions, new or different approaches may need to be employed To improve the Genitourinary stream s documentation of disease stage (when compared with other high volume tumour streams such as Breast and Colorectal), better understanding of their processes may determine improvement strategies Given the disparity between metropolitan and regional areas for communicating initial treatment plans to GPs, further investment in automated technology by regional ICS where appropriate is to be encouraged Supportive care screening data (while it represents activity undertaken more than 12 months ago) strongly suggests that some ICS will need to re-evaluate their current implementation strategies and consider alternative initiatives that have proven successful elsewhere. Cancer Services Performance Indicators Round Report Page 15

16 Method The ICS secretariats undertake the collection of data for the cancer service performance indicators, which are obtained from the patient central medical record. The method for the audit is outlined in the Victorian Cancer Service Performance Indicators, Data Collection Method Inclusion criteria: patients who are newly diagnosed and have undergone active treatment locally. All ICS conduct data collection and reporting twice a year. There is a two month minimum lag time between patient cancer diagnosis and inclusion in the audit. The audit rounds include cancer patients from all tumour streams. Adult patients are identified for audit using the Victorian Admitted Episode Dataset (VAED) and the Victorian Cancer Registry (VCR) dataset. Patients must have received their primary treatment in the ICS in which they are reported. Random sampling processes are applied to identify the sample for data collection from all treated cancer patients. Paediatric patients are identified for audit using the paediatric haematology/oncology database which contains data for most paediatric oncology patients. Table 2 outlines the audit numbers required. Table 2: 2015 Audit Requirements - record numbers by round and due dates Audit ICS Minimum Records Tumour Streams Date Due Round 1 Metro 320 All* Regional 120 All* Paediatrics 45 Paediatrics 19 Dec 2015 Round 2 Metro 320 All* Regional 120 All* Paediatrics 45 Paediatrics 30 June 2016 Notes: All* = whilst the selection of cases may aim to ensure representative data capture across the ICS and/or tumour streams it is important to avoid any obvious and/or systematic bias which would skew results. ICS may be asked to explain their case selection strategy. Record numbers are a minimum and ICS are encouraged to capture data above these numbers if considered important locally. The data collection process captures information recorded in the central medical record (or equivalent) and it is acknowledged that results may reflect inadequate documentation or filing rather than failure to deliver quality care. Documentation is however a key requirement for clinical communication, quality cancer services, and to ensure patient safety. Page 16 Cancer Services Performance Indicators Round Report