Access to Care for Prostate Cancer Patients in Northeastern Ontario

1
Access to Care for Prostate Cancer Patients in
Northeastern Ontario

• Surgical Oncology Program/Regional Cancer Program
  of the Hôpital régional de Sudbury Regional
  Hospital
• Nov 2006

2
Overall Purpose

• To evaluate and improve access to care for
  prostate cancer patients in Northeastern Ontario

3
Problem/Issue

• Do prostate cancer patients in Northeastern
  Ontario currently have the access to the care
  they need along the continuum, and with the
  projected increase in incidence and prevalence
  can we meet their needs in the future?

4
Alignment with RCP Objectives 2006/07

• Patients with a confirmed diagnosis of cancer
  have access to a full range of multidisciplinary
  cancer services in the Northeastern Region.
• Phase 1 analysis will examine access and
  identify issues. Phase 2 will involve the
  development of strategies policies around this.
• Expand services for consistency with the cancer
  control continuum for the Northeast region.
• Phase 1 will identify the services available and
  accessible Phase 2 could recommend expansion of
  services, technology and /or human resources.
• Implement electronic solutions to support
  clinical/patient information management
  requirements.
• Data requirements for this project will shed
  light on strengths and weaknesses in the
  informatics system and capacity, and this
  learning will help form recommendations.

5
Work Plan

• Phase 1. April 1, 2006-March 31, 2007
• Utilize the ICES framework for assessing health
  system performance1
• Build the information matrix
• Analyze data and information
• Report findings to Regional Cancer Program and
  CCO Surgical Oncology Program
• Staffing Resources Regional Head of Surgical
  Oncology Program, Health Planner in consultation
  with staff, regional and provincial partners and
  stakeholders
• Source ICES, Moving Toward a Better Health
  Data System for Ontario, April 2006.

6
Work Plan

• Phase 2. Post April 1, 2007
• RCP to collaborate regionally to develop
  strategies to meet local needs for service
  integration, coordination and quality improvement
  (as per Ontario Cancer Plan Update, 2005)
• Optimize access to care for prostate patients of
  LHIN 13
• Membership/Resources needed Form Regional
  Steering Committee with Task Groups

7
Building Information Matrix

• 1. Retrieve and organize available aggregate data
  and information
• 2005 cancer surveillance figures (CCO iPort)
• Environmental scan of system characteristics and
  structure, including available providers
• 2005 treatment utilization breakdown and numbers,
  inclusive of supportive care and clinical trials
• Description of patterns of patient flow through
  diagnosis, staging and treatment
• Reporting on existing quality indicators

8
Building Information Matrix

• 2. Individual Patient Tracking
• Utilize prospective tracking available through
  the Cancer Surgery Agreement for intervals of
  prostate patient from time of referral to
  specialist to consult consult to
  decision-to-treat decision-to-treat to date of
  operation (HRSRH and North Bay)
• Undertake retrospective data collection through
  Meditech. Map encounters in the portion of
  journey from referral to specialist through to
  initiation of treatment. Project Charter for
  HRSRH.

9
Building Information Matrix

• 2. Individual Patient Tracking (contd)
• Approach selected NEON Hospitals to undertake
  retrospective audit, as above. Explore
  feasibility and other issues
• Request retrospective OPIS chart audits to track
  key intervals from the date of referral to the
  RCP to the initiation of treatment.

10
Building Information Matrix

• 3. Patient Perspective
• Agreement made with NRCPicker to generate a
  report that extracts responses from patients who
  cited prostate as their cancer disease site, from
  March-August 2005 survey.
• Meet with focus groups, both existing support
  groups and group assembled for this project.
  (Ethics approval)

11
Building Information Matrix

• 4. Survey and interview health care providers
• Family physicians, specialists, oncologists,
  nurses, supportive care and other RCP staff, and
  community allied health professionals

12
Tools for Phase 1 Analysis

• Utilize
• existing benchmarks (eg. health human
  resources ratios)
• existing indicators
• comparisons with provincial average and with
  other regions
• qualitative analysis (focus groups findings)
• Consult the literature and expert opinion

13
Identification of Gaps, Issues

• Identify issues with availability of data and
  access to data

14
Identification of Gaps, Issues

• Identify issues of access to
• appropriate providers
• testing
• facilities
• procedures
• information and support

15
Identification of Gaps, Issues

• Quality of care questions
• Are patients able to receive a full range of
  multidisciplinary cancer services?
• Is access to care coordinated?
• Is access timely?

16
Identification of Gaps, Issues

• Equity of care
• Determine the variability within the region

17
Phase 2 Potential Outcomes and Strategies

• Development or enhancement of networks and/or
  communities of practice to facilitate
  communication, improve services, foster uptake of
  guidelines
• Increasing capacity of facilities, services
  and/or human resources
• Continuation of monitoring and measuring access
  to care
• Improvement of identified services through system
  redesign, coordination or integration integrated
  care pathway
• Improve identified services through process
  redesign (development of clinical pathways for
  specific portions forms bookings )