Cancer System Quality Index 2017 13 th Annual Launch Event MODERATOR: Ruthe Anne Conyngham Member of the Wednesday, May 17, 2017
CSQI 2017 THE RESULTS PRESENTER: Virginia McLaughlin Chair of the Wednesday May 17, 2017
CQCO s Relationship with Cancer Care Ontario Established in 2002, the CQCO is: an arm s length advisory group to Cancer Care Ontario, set up to provide advice to CCO and the Ministry of Health and Long-Term Care in their efforts to improve the quality of cancer care in the province. The CQCO is composed of: cancer survivors and family members, and experts in the areas of oncology, health system policy, performance measurement, health services research and health care governance. Regional Cancer Programs led by Regional Vice Presidents Provincial Clinical Programs with Clinical Leads The CQCO s mandates are: to monitor and report publicly and annually on the performance of the Ontario cancer system through the Cancer System Quality Index (CSQI); and, to motivate quality improvement through national and international benchmarking. CQCO is supported by a Secretariat housed at Cancer Care Ontario 3
CQCO s tools to improve the system CQCO MISSION: Our website: www.cqco.ca Improve the quality of cancer services in Ontario CQCO TOOLS: Cancer System Quality Index (CSQI) www.csqi.ca Quality and Innovation Awards Annual programmatic reviews Signature Events and international advice OUTCOMES: Reduce prevalence of cancer Improve cancer treatment and survival Improve cancer patient satisfaction Evolve / develop new quality indicators : contributes to improving the cancer system 4
The role of CSQI in driving change The CSQI is a quality improvement tool that strives to identify gaps and highlight where cancer service providers can advance the quality and performance of care. It is meant to motivate improvement through regional, provincial, national and international benchmarking. It is the unique relationship with Cancer Care Ontario that has enabled the CSQI to drive change over the last 13 years. The CSQI is used as an important tool in partnership with clinicians/health professionals, cancer organizations in every region, planners, and policy makers to identify cancer trends and to plan and make improvements. By co-owning the development and results of the data, Cancer Care Ontario understands the results and drives the quality improvement work by making changes at the hospital level, regional level, and the system level. 5
CSQI 2017: The Burden of Cancer in Ontario As of January 1, 2014, there were over 370,000 people living in Ontario who had been diagnosed with cancer in the previous 10 years. Ontario s cancer survival rate has improved for most cancers in the past 10 years. The annual number of new cancer cases diagnosed in Ontario has more than doubled since 1984, with roughly 88,045 new cancer cases estimated to be diagnosed in 2017. Cancer remains the leading cause of death in Ontario, however Ontario has lower mortality rates than the Canadian rate for colorectal and lung cancer for both males and females, as well as female breast cancer. The mortality rate for prostate cancer in Ontario is similar to the Canadian rate. 6
How CQCO Measures Quality Through CSQI 7
Quality Dimensions since 2010: Each indicator is a specific measurement of progress against one of seven dimensions of quality Safe Effective Accessible Responsive (Patient-Centred) Equitable Integrated Efficient Avoiding, preventing, and ameliorating adverse outcomes or injuries caused by health care management (Source: OECD, Baker). Providing services based on scientific knowledge to all who could benefit (Source: IOM) Making health services available in the most suitable setting in a reasonable time and distance (Source: Alberta, HQC). Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions (Source: IOM). Providing care and ensuring health status does not vary in quality because of personal characteristics (gender, ethnicity, geographic location, SES, age) (Source: IOM). Coordinating health services across the various functions, activities and operating units of a system (Source: Gillies et al). Optimally using resources to achieve desired outcomes (Source: Alberta, HQC). 8
The Cancer Journey 9
CSQI 2017 an overview Distinct CQCO website www.cqco.ca Link 2017 Special Focus Story on Thyroid Cancer in Ontario Ontario Surveillance data International comparisons Indicators by Type of Cancer Indicators by Quality Dimension/Patient Journey Direct link to CSQI www.csqi.on.ca GOES LIVE WITH 2017 DATA on Wednesday May 17, 2017 LHIN (14 regions) analysis Webcast Link Personal reflections 10
CSQI INDICATOR RESULTS 11
CSQI 2017 Ratings and Messaging Good. Many processes for a safe cancer system are in place. However, there is room for improvement in deepening the understanding of complications of care and supporting patients needs, during active treatment phase. Good. More cancer patients are receiving care based on the best available evidence across the care continuum. Guidelines selected for CSQI are systemfocused and continue to require efforts to achieve targets and consistency across regions. 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. 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. Fair. Inequity exists, however, for some measures in the cancer system, equitable care is being realized. Coordinated efforts using a holistic approach across the system are needed to ensure equal health status across Ontario. Fair. More efforts are required to measure the level of coordination across the various functions and services within Ontario s cancer system. The goal is to support seamless and effective patient transitions regardless of location or provider. Fair. There are examples of efficient use of services in cancer screening. However, more meaningful measures identifying ways of optimizing system resources are needed without compromising health outcomes. 12 please treat as confidential
Safety: Appropriate Peer Review for Radiation Therapy KEY FINDINGS Peer review is a valuable tool that is central to quality management or quality assurance programs in health care. While some peer review is being done among radiation oncologists across Ontario, there is significant variation in the rates of peer review reported by Regional Cancer Programs. The overall Ontario average of curative cases being peerreviewed is 77%, which exceeds the Cancer Care Ontario program target of 75%. 13
Effective: Tobacco Screening in Regional Cancer Programs KEY FINDINGS Cancer Care Ontario s Smoking Cessation program was implemented in 2013 and is a provincial effort to ensure that new cancer patients seen in Regional Cancer Centres (RCCs) are screened for tobacco use and, if appropriate, are referred to smoking cessation services available at or through the Regional Cancer Programs (RCPs). The number of new ambulatory cancer patients reported as having been screened for tobacco use in regional cancer centres across Ontario has increased. Screening rates have increased from 42% in April 2015 to 62% in December 2016, which represents approximately 1,000 more new patients screened in December 2016 than in April 2015. 14
Accessible: Wait Times for Breast Cancer Screening for High Risk Women KEY FINDINGS Breast cancer screening with mammography and breast MRI is recommended every year for women aged 30 to 69 identified as being at high risk for breast cancer The proportion of women at high risk for breast cancer who were screened in the OBSP with mammography, plus magnetic resonance imaging (MRI) or ultrasound, within 90 days of confirmation of their high risk status was 47% in 2015, which is down from 65% in 2011 2012. The OBSP has set a provincial target of 90% or greater for this indicator, meaning that about 9 in 10 women should be screened within 90 days of confirmation of their high risk status. 15
Responsive: Symptom Assessment and Management KEY FINDINGS Cancer Care Ontario collects data on patient symptom screening using Your Symptoms Matter General Symptoms (formerly known as the Edmonton Symptom Assessment System, or ESAS). The percentage of patients who are screened for symptoms using Your Symptoms Matter General Symptoms (YSM-General) has increased from 50% in 2011 to 61% in 2016. In total, 383,023 unique patients were screened using YSM-General in 2016. Fifty-three percent (53%) of patients surveyed in 2016 said that their health care team always discussed their YSM-General scores with them. 16
Equity: Engagement with First Nations, Inuit and Métis Communities KEY FINDINGS Number of regions where all core First nation, Inuit & Métis Health Tables are engaged Number of regions with a sustainable structure A sustainability structure has been developed when all Core First Nations, Inuit and Métis Health Tables have been engaged in the development of a Regional Aboriginal Cancer Plan, and have agreed to an established process which ensures the opportunity to provide ongoing guidance to the cancer system at the local level. Since the launch of the Aboriginal Cancer Strategy III in September 2015, sustainability structures have been established in 7 regions in Ontario (Northeast, Erie St. Clair, Champlain, North Simcoe Muskoka, Central East, Southwest and Southeast). 17
Equity: Unplanned Hospital Visits During Chemotherapy (age) KEY FINDINGS Percentage of patients who receive chemotherapy visit the emergency department (ED) or are admitted to hospital at least once within 4 weeks of receiving chemotherapy: 44% of breast cancer patients, 47% of colon cancer patients who received IV, 37% of patients who received oral-chemotherapy, 51% of lymphoma patients Aged 18 to 29, breast cancer patients who received IV-chemotherapy had the highest unplanned hospital visits, while lymphoma patients and colon cancer patients who received IV chemotherapy had the highest unplanned hospital visits for patients aged 65 and older. Side effects do occur and patient education resources are needed for patients to self-manage complications where appropriate, while also having a place where they can call or go when they require evaluation or a prescription. 18
Integration: Wait Times from Diagnosis to Radiation KEY FINDINGS *time trend data not available The median wait time of 49 days from diagnosis to start of radiation treatment for oropharynx cancer patients diagnosed from 2014 to 2015 is consistent with findings from last year (patients diagnosed from 2013 to 2014). The diagnosis-to-referral median is 14 days, which indicates that 50% of patients are not referred more than 2 weeks after being diagnosed. *time trend data not available The median wait time from diagnosis to referral for patients diagnosed with cervical cancer in Ontario from 2014 to 2015 was 25 days. The referral-to-consult median wait time was 6 days and consult-to-treatment median wait time was 21 days. 19
Efficiency: Colorectal Cancer Screening Quality and Efficiency KEY FINDINGS A minority of Ontarians had a second colonoscopy within 36 months of a normal and complete outpatient colonoscopy, although there was notable regional variation. In 2015, 3.6% of Ontarians had a second colonoscopy within 36 months of a normal and complete outpatient colonoscopy, compared to 4.4% in 2013. 20
MODERATOR: Ruthe Anne Conyngham Member, CSQI 2017 LAUNCH EVENT Panel Discussion: Measuring What Matters PANELISTS: Camille Gray, Patient and Family Member Representative Virginia McLaughlin, Chair, Dr. Calvin Law, Regional Vice President, Odette Cancer Centre Dr. Robin McLeod, Vice-President, Clinical Programs & Quality Initiatives, Cancer Care Ontario
MODERATOR: Ruthe Anne Conyngham Member, CSQI 2017 LAUNCH EVENT Q&A with Audience and Webcast Sites Measuring What Matters PANELISTS: Camille Gray, Patient and Family Member Representative Virginia McLaughlin, Chair, Dr. Calvin Law, Regional Vice President, Odette Cancer Centre Dr. Robin McLeod, Vice-President, Clinical Programs & Quality Initiatives, Cancer Care Ontario
Now accessible: CSQI 2017 INTERACTIVE SITE www.csqi.on.ca Brought to you by the