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Cancer Services Performance Indicators

Round 1 2015 Report

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Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.

© State of Victoria, Department of Health and Human Services, March 2016.

Contents

Introduction ................................................................................................................................................. 4

Key recommendations ............................................................................................................................... 5

Performance against policy: ......................................................................................................................... 5

Data quality assurance: ................................................................................................................................ 5

Dissemination of findings: ............................................................................................................................. 5

Overview of results .................................................................................................................................... 6

1. Documented evidence of multidisciplinary team recommendations .................................................. 7

2. Documented evidence of disease staging in the multidisciplinary team recommendations .............. 9

3. Documented evidence of communication of initial treatment plan to GP ........................................ 11

4. Documented evidence of supportive care screening ....................................................................... 13

Findings ..................................................................................................................................................... 15

Performance against policy ........................................................................................................................ 15

Improvement strategies to consider: .......................................................................................................... 15

Method ....................................................................................................................................................... 16

Cancer Services Performance Indicators – Round 1 2015 Report

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) 2008-2011

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 1994.


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 2013.

4. 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.


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 1 2015 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 1 2015

Target 2015

1. Documented evidence of multidisciplinary team recommendations

49% 62% 64% 70% 72% 80%

2. Documented evidence of disease staging in the multidisciplinary team recommendations

72%# 75%# 79%# 79%# 78% 100%

3. Documented evidence of communication of initial treatment plan to GP

N/A N/A N/A 71% 67% 100%

4. Documented evidence of supportive care screening

18%* 31%* 36%* 37% 39% 50%

Number of medical records audited 3420 3333 3401 3591 1752

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.


1. Documented evidence of multidisciplinary team recommendations

Target: 80 per cent

Performance: 72 per cent (state-wide)

Definition:

Numerator Total number of new cancer patients with documented evidence of multidisciplinary team recommendations

Denominator Total number of new cancer patients audited per tumour stream

Results:

Figure 1a shows the documented evidence of multidisciplinary team recommendations for Round 1 2015

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

58%

41%

53%

77%

51%

82% 80% 80%

100%

72%

0%

20%

40%

60%

80%

100%

BSWRICS(120)

GICS(122)

GRICS(120)

HRICS(81)

LMICS(138)

NEMICS(452)

SMICS(327)

WCMICS(347)

PICS (45) Statewide(1752)

Documented evidence of MDT recommendations Round 1 2015 - (n=1752)

80%


Figure 1b: Documented evidence of MDT recommendations by metropolitan and regional ICS

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 1 2014

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

Note: PST – Paediatric Solid Tumours.

` Paediatric, Central Nervous System (CNS) and Haematological cancers are included within the relevant tumour streams.

54%

46%

RICS: Evidence of MDT discussion, R1 2015

MDT

No MDT 80%

20%

MICS: Evidence of MDT discussion, R1 2015

MDT

No MDT

84% 82% 80%

43%

62%

83%

57%

85%

72%

50%

76%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Documented evidence of MDT recommendations by tumour stream - Round 1 2015

80%


2. Documented evidence of disease staging in the multidisciplinary team recommendations

Target: 100 per cent


Definition:

Numerator Total number of new cancer patients with documented evidence of cancer staging* in the MDT recommendations

Denominator 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 1 2015 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

85% 86% 96%

89%

80%

70%

80% 76%

87%

78%

0%

20%

40%

60%

80%

100%

Documented evidence of disease staging in the MDT recommendations by ICS - Round 1 2015

100%


Figure 2b: Total numbers of new cancer patients with documented evidence of cancer staging in

the MDT recommendations by tumour stream


UGI – Upper Gastrointestinal

` Paediatric CNS and haematological cancers are included within the relevant tumour streams.

87%

67%

94%

61% 64% 63%

74%

80% 78%

76%

59%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Documented evidence of disease staging in the MDT recommendations by tumour stream - Round 1 2015

100%


3. Documented evidence of communication of initial treatment plan to General Practitioner (GP)

Target: 100 per cent


Definition:

Numerator Total number of new cancer patients with evidence of communication of the treatment plan to the General Practitioner (or paediatrician)


Results:

Figure 3a shows the documented evidence of communication of the initial treatment plan to the GP for

Round 1 2015 by ICS.

Figure 3b shows the documented evidence of communication of the initial treatment plan to the GP for

Round 1 2015 by tumour stream.

Figure 3a: Evidence of communication of initial treatment plan to GP by ICS

54%

43%

83%

95%

74% 75%

86% 84% 89%

67%

0%

20%

40%

60%

80%

100%

Evidence of communication of initial treatment plan to GP - Round 1 2015

100%


19%

81%

MICS Nocommunication

Communication

Figure 3b: Evidence of communication of initial treatment plan to GP by tumour stream


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

This indicator was last collected in 2010 and reintroduced in 2014. 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.

75% 75% 74%

53%

63%

89%

60%

75%

87%

67%

78%

100%

0%

20%

40%

60%

80%

100%

Evidence of communication of initial treatment plan to GP by tumour stream - Round 1 2015

100%

45%

55%

RICS

Nocommunication

Communication


4. Documented evidence of supportive care screening

Target: 50 per cent


Definition:

Numerator Total number of new cancer patients with documented evidence of supportive care screening


Results:

Figure 4a shows the evidence of supportive care screening by ICS for Round 1 2015.

Figure 4b shows the results by tumour stream. Although the overall target has not yet been achieved,

some ICS have demonstrated steady progress from 2010-14 (see CSPI 2014 full year report).

Figure 4a: Documented evidence of supportive care screening by ICS

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.

15%

24%

61%

73%

36%

39%

58%

20%

67%

39%

0%

20%

40%

60%

80%

100%

Documented evidence of supportive care screening - Round 1 2015

50%


Figure 4b: Documented evidence of supportive care screening by tumour stream


UGI – Upper Gastrointestinal

Paediatric CNS and haematological cancer results are included with the relevant tumour streams.

64%

24% 31%

6%

24%

44% 47%

23%

43%

20%

37% 31%

0%

20%

40%

60%

80%

100%

Documented evidence of supportive care screening by tumour stream - Round 1 2015

50%


Overview of Findings

Performance against policy

Indicator 1: Documented evidence of multidisciplinary team recommendations

For a number of ICS, achievement of the 80% target has been reached with a considerable gain being

made state-wide since 2011.

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 100% target.

Indicator 3: Documented evidence of communication of initial treatment plan to GP

Since its reintroduction in Round 1 2014 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 1 2015 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.


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 2014.

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*

19 Dec 2015 Regional 120 All*

Paediatrics 45 Paediatrics

Round 2 Metro 320 All*

30 June 2016 Regional 120 All*

Paediatrics 45 Paediatrics

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.

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