The Disease Site Program
This past year, the Disease Site Program, the cornerstone of the RCN, gained significant scope. There are now seven Disease Site Teams, most with co-leaders from two partner hospitals, and a representative membership from across the network. This model for harmonizing care across centres is in line with best practices in the top cancer centres in the world.
Taken together, the seven Disease Site Teams represent over 100 multi-disciplinary health care professionals who now communicate regularly and have identified the crucial disease-site specific indicators required to benchmark care and outcomes across the network.
Under their aegis, a reinvigorated clinical trials program is now in place in the partner hospitals. There are over 85 active clinical trials ongoing in an RCN hospital. A new RCN-hosted website lists all clinical trials across institutions allowing physicians to refer patients for the most appropriate care, regardless of treating hospital.
The Disease Site Teams lead a coordinated approach and facilitate a network culture between RCN hospitals to promote and advance the diagnosis, treatment, and continuing care of cancer patients through:
Promoting Highest Quality of Care
• Identifying clinical quality performance indicators (QPIs) pertinent to the disease site
• Aiding in the defining the QPIs, reviewing data, requesting sub-analyses from the data and communicating results with DS group
• Making recommendations for targeted quality improvements
• Initiating quality improvement projects
Providing Patients with Access to Emerging Treatments
• Obtaining the most promising drugs for patients
• Having a repository for all available active trials accessible to patients and clinicians
• Working together to recruit patients effectively
• Finding solutions so that clinical trials are available to patients across the Network (ex. satellite sites)
Coordinating Care and Quality Initiatives
• From measurement to action: identifying quality improvement initiatives
• Engaging disease site members and coordinating resources
• Prioritizing initiatives that will have the greatest impact on improve patient care
The RCN was conceived as a network built on clinical evidence to drive improvement initiatives. A process for continuous performance improvement is necessary to ensure and maintain a track record of high quality of care for our cancer patients.
Clinical Data – Scorecard
Thanks to the development of the Disease Site Program, we now have 69 tumor-site specific clinical quality indicators defined for the RCN Scorecard. Aligned with the Institute of Medicine (IOM), the scorecard addresses six dimensions of quality, along the patient care trajectory, from diagnosis to end-of-life. The scorecard initiative supports the overall RCN mandate to provide each cancer patient with an integrated and increasingly higher standard of care that is consistent throughout the network.
Surgical Data – NSQIP
Beginning in 2016, a new source of data will allow us to further enhance the work being undertaken in the network: The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons will be expanded in the partner hospitals, providing risk-adjusted surgical outcome measures that can be used for performance improvement.
Patient Feedback – AOPSS
We now have three years of data from over 2000 patients collected through the Ambulatory Outpatient Satisfaction Survey, a national standard, which covers six dimensions of patient satisfaction in over 100 questions:
- emotional support
- continuity and coordination of care
- respect for their preferences
- physical comfort
- quality of information, education and communication
The data shows a need on the part of patients to have increased emotional support and additional information about their treatment and cancer journey. After a further review of recent data, new projects will be developed to address key areas for improvement in the coming year.
A network-wide IT infrastructure has been a key priority since the inception of the RCN. The scope and details of the IT architecture plan have been refined as the network has matured, but remains focussed on 3 core components:
- an electronic health record for oncology (e-HR)
- a data management system
- an electronic patient portal
In the last year, significant effort was invested to prepare to bring this plan to market. A request for Information (RFI), a Request for Proposal (RFP) and a detailed 5-year plan were developed. Discussions with the Ministère de la Santé et des Services Sociaux are planned to resume shortly, and the guidance the RCN will receive from the ministry will inform the next steps in the development of a network IT Infrastructure.
Research & Education
The RCN’s Cancer Quality & Innovation Program was established to support advancements in quality of care for patients in the network. This initiative helps to promote continuous improvement projects, the sharing of best practices and the development of research and training platforms for the rapid generation of scientific knowledge related to cancer care quality.
With two years of Education and Research Grants already awarded, the CQI program has over 20 active projects in the network addressing cancer care quality issues from a variety of angles.
There are 110 health professionals, including physicians, nurses, nutritionists, psychosocial oncologists and rehabilitation professionals who are directly addressing areas of improvement in their field.
The CQI Program consists of 3 granting streams, each of which is open to all health professionals directly involved in the provision of cancer care in the network.
New skills, new ways of solving problems and new approaches are brought to existing teams through the Education Grants. To date, four grants have been attributed to key team members in nursing, radiation oncology and nutrition. Read more about how we're expanding skills in the newtork (see bottom of page).
This year's edition will focus on building nursing-specific oncology skills.
Since 2014, the RCN Research Grants have invested close to $1 million to enable the completion of 12 projects targeting various aspects of the cancer care trajectory. In addition to contributing to the science of health services research, the projects will generate data enabling the RCN hospitals to implement quality improvement initiatives that have a demonstrated impact.
An external peer review process is used to assess proposals, relying on internationally recognized experts to ensure the highest quality of scientific advancement.
There are currently 12 funded research projects being carried out (from both the 2014 and 2015 editions). Among the initiatives are research projects examining how new targeted molecular therapy and personalized medicine can advance the delivery of care and allow McGill to be a leader in cancer care quality.
In addition, several Research Grants projects are already impacting patient care through a pilot project component — whether it be pre-habilitation before surgery, enhanced recovery protocols, coordinated care to improve access to treatment or compression therapy post-surgery. Read more about active projects.
Inaugurated in 2015, the Quality Improvement Initiatives Fund (QI2) grew out of a demonstrated need to provide project support to health care professionals who were committed to implementing cancer care quality improvements in their department.
This new initiative will offer both financing and the support of an RCN project manager, data analyst, cancer registrar or others, with the goal of implementing the proposed project in a short time frame and impacting patients in the coming year. Read more about this year's active projects.
Improving the Patient Experience
To determine how we could best address patient satisfaction and quality of life, we commissioned NRC Picker Canada to deploy the industry standard Ambulatory Outpatient Satisfaction Survey (AOPSS).
The survey is sent out every three months, and in the past two years over 2000 patients in the network have responded. Their answers led us to create initiatives that address their most pressing concerns.
Instituting symptom screening
Untreated emotional distress in cancer patients has been shown to impact quality of life and adherence to treatment. The Canadian Partnership Against Cancer (CPAC) refers to distress as the 6th vital sign and recommends that cancer patients be routinely screened for distress.
The RCN and Cancer Care Ontario (CCO) have joined forces with a $1 million grant from CPAC for a pan-Canadian project titled Improving Patient Experience and Health Outcomes Collaborative (iPEHOC). The project involves implementing specialized assessments of patients’ levels of anxiety, depression, pain and fatigue, so that those who need help can be referred for psychosocial care. The project team will also assess whether the program leads to a reduction in symptoms.
This three-year initiative also addresses the challenges of integrating patient-reported measures into clinical practice by developing a standardized and translatable process for implementing the measurement of patient-reported symptoms of cancer and patient experience of care. Ultimately, the goal is to contribute to the development of a patient experience measurement system that will become the Canadian standard. Learn how this new screening is impacting patient care.
Engaging primary care physicians
When cancer patients re-enter the primary health care network, information concerning their treatment and follow-up needs are rarely communicated in a complete fashion. Yet providing primary care providers with this information has been shown to be key in preventing new or reoccurring cancer, assessing physical and psychosocial effects, and reducing late complications.
To address this need, the RCN’s Finding Common Ground project team has developed a three-pronged approach: they developed a MAINPRO-accredited workshop which was delivered to over 125 family physicians, informing them of the potential physical and psychosocial complications of cancer survivors. The team is also developing a Standardize Treatment Plan to provide regular updates to physicians during a patient’s cancer treatment, as well as a pilot Survivorship Care Plan to summarize the treatment the patient received and to provide guidance on late effects and surveillance. Find out how we're supporting survivors by educating physicians.
Providing information to demystify radiotherapy treatments
To help reduce the anxiety of patients prescribed radiotherapy, an RCN team created a communications kit to demystify the treatment journey and alleviate patients’ concerns. The tools were created after surveying almost 100 patients and 65 health care professionals in radiotherapy and oncology at all three hospitals about their most frequently asked questions.
A 20-page booklet describes how patients can prepare for treatment and the steps involved in radiotherapy. An accompanying video gives patients a virtual tour of the JGH and MUHC radiotherapy clinics, explaining what to expect. The material has been accessed by 2500 patients in the project’s first six months, helping to prepare patients from the JGH, MUHC as well as those from SMHC, who are transferred to one of the other sites for radiation oncology. Take a look at the booklets and videos on our site.
Reducing wait times with self-check-in kiosks
A new self-check-in system being piloted has reduced wait times from over 10 minutes at peak times to about 20 seconds. Patients now scan their medicare card at a kiosk, and the entire health care team knows immediately that they have arrived. In addition to reduced wait times and increased patient comfort, patients are able to get questions answered more quickly by registration clerks who are now freed up to help with forms or appointments.
The project also involved installing a screen in the doctors’ team room to display the wait times of individual patients; this has helped physicians monitor and manage their patient’s experience. The project is being piloted in radiation oncology at the MUHC, and lessons learned will inform similar self-check-in systems at the JGH and SMHC. Find out what patients are saying about the changes.
Reducing chemotherapy wait times
For cancer patients, wait times for appointments add up. One of the RCN’s key projects has been identifying inefficiencies in the system. Focus groups, time mapping and benchmarking at the JGH, MUHC and SMHC allowed us to identify areas for improvement.
Simple changes such as booking less complex cases earlier in the day, separating check-in and check-out tasks and streamlining the review of patient files before they reach the pharmacy, among others, were found to have an important impact. Read more about the changes that are reducing waits in the network.