ontario cancer plan 4 (2015-2019) pre-reading for regional ... · ontario cancer plan 4 (2015-2019)...
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Ontario Cancer Plan 4 (2015-2019)
Pre-reading for regional engagement
September, 2013
Table of contents • Background/refresh
• OCP III overview
• Rationale for OCP 4
• Lessons learned from OCP III
• Updated approach & timeline
•Current state assessment
• Cancer related statistics/data (CSQI & Canadian Cancer Statistics, 2013)
• Cancer System Quality Index results (CQCO)
•Environmental scan
• Cancer system stakeholders’ areas of focus
• Areas of focus of Canadian and international cancer plans
• Findings from a systematic review of European national cancer plans
• Emerging trends/ opportunities related to CCO’s program areas
•Questions related to SWOT
2
OCP III OVERVIEW &
OCP 4 APPROACH
Background/Refresh
OCP III – 2011-2015
4
OCP III: 6 strategic priorities and 30 initiatives
1: Develop and implement a
focused approach to cancer risk
reduction
Cancer prevention performance measurement
framework
Online cancer risk assessment tool
Cancer risk reduction initiative in each RCC
Renewed Smoke-Free Ontario Strategy & the Provincial Training & Consultation Centre
Second Aboriginal Cancer Strategy
2: Implement integrated cancer
screening
ICS strategy for breast, cervical & colorectal
cancers.
Expand InScreen
ICS support services at RCCs & accountability
for screening
Centralized administration support for all cancer screening
Integrated screening reports for primary
care providers
3: Continue to improve patient
outcomes through accessible, safe, high quality care
Disease pathway maps, quality improvement
targets
Provincial plans for delivery of surgery,
radiation treatment & palliative care
Strengthen quality assurance & best
practice at provider level
Develop measures & manage performance on patient outcomes
Recommendations on new technology that
improves patient outcomes
Oversight of stem cell transplant,
neuroendocrine tumours & sarcoma
4: Continue to assess and improve
the patient experience
Access to information, coordination of care &
Electronic Pathway Solution (diagnostic)
Improved survey instruments to measure
patient experience during treatment
ISAAC adoption & use increased use of tale-
ISAAC
Better response to elevated symptom
scores using notification alerts
Measure patient-reported outcomes
(post-treatment)
RCP accountability for improving the patient
experience
Expand regional psychosocial oncology
& patient education programs
5: Develop and implement
innovative models of care delivery
Develop new models of care delivery
Implement models & address necessary
changes
Evaluation, modification &
improvement of models
6: Expand our efforts in
personalized medicine
Process to integrate new knowledge into
clinical practice
Implement recommendations of
CCO’s Molecular Oncology Task Force
Mechanism to evaluate &integrate new
knowledge for doctors & patients
(effectiveness & cost-effectiveness of
targeted therapies)
Access to & quality of clinical & laboratory
services
Using different tools and processes to improve
the cancer system performance
6
Cancer Care Ontario (CCO) Regional Cancer Programs
Regional Cancer Programs Regional Cancer Programs Regional Cancer Programs
Regional Cancer Programs
Work collaboratively to implement OCP, improve system performance & reach goals
CSQI informs
OCP progress reporting Internal
performance management tool – overall progress
against OCP
Regional performance
management tool - areas requiring
improvement
Quarterly Regional
Performance Scorecard
guides
Shared priorities /initiatives
7
Updates/Evolutions
Since OCP III
CCO Corporate Strategy 2012-2018
Why OCP 4?
8
OCP III ends in 2015. Progress has been made in the past few years. Need to evaluate goals and strategic priorities.
Cancer system and health system changing and progressing and we have learned more about the cancer journey.
Organizational changes – new Corporate Strategy (vision, mission, areas of focus)
Previous OCPs have been successfully accepted, adopted and used. A well articulated plan has facilitated change and progress in the cancer system .
OCP III – Lessons learned
9
- Overall approach
- Comprehensive and consultative
- Expected outcomes more clearly articulated (compared to OCP II)
- More time for plan development
- PLC & CC – more oversight and accountability for plan development
- More patient engagement
- More regional engagement
- Engage additional key stakeholders
- Embed measures of success expected by end of strategy
- Earlier engagement with communications
- Build on previous plans; core work will continue to support goals
What worked well? Future approach
Ph
ase
0
Phase I:
Conduct Environment
al Scan, Current state assessment & develop
OCP framework.
Phase II:
Identify strategic
priorities, desired
outcomes, and options
for initiatives.
Phase III:
Validate strategic
priorities & prioritize
initiatives.
Phase IV:
Finalize strategic
priorities, initiatives
and develop implementation roadmap
(inc. funding).
Phase V:
Develop launch plan. Write plan, translate,
develop final product.
Obtain final sign-off. Launch.
Alignment with other CCO activities
10
Stakeholder Consultation & Engagement; Ongoing Environmental Scanning
CCO business planning 2015/16
Systemic Treatment Provincial Planning
DAP strategic planning
OC
P 4
C
on
curr
ent
acti
viti
es
Board Retreat
Exec Team, PLC & CC, Board & SPPRM, PFAC, CQCO
Joint CEO, RVP, PLC
Spring Planning Day
Joint CEO, RVP, PLC
Feb-Apr 2013
May-Sep 2013 Feb-May 2014 Jun-Aug 2014 Sep2014-Jan 2015 Oct-Jan 2014
Board Input
Release - January 2015
CCO organizational PM framework
CCO business planning 2015/16
Phase VI:
Develop detailed
implementation plan, and launch measurem
ent of progress
(scorecard)
Aboriginal Cancer Strategy III – June 2015 release
TBC-CIO Strategic Planning
ET Retreat (Tentative)
Feb 2015 onwards
Board sign-off
Board Input & international
validation Board Input
Spring Planning Day
CANCER RELATED STATISTICS/DATA
(CSQI & CCS)
Current state
Report date: February 2013
Data source: Ontario Cancer Registry, Collaborative Staging Database
Prepared by: Cancer Care Ontario, Informatics Centre of Excllence
Population-based distribution of cancer stage, breast cancer, Ontario, 2007-2011
Reporting of Cancer Stage
Year
2007
2008
2009
2010
2011
Pe
rce
nta
ge
(%
)
0
10
20
30
40
50
60
70
80
90
100
Stage I
Stage II
Stage III
Stage IV
CSQI 2013
Report date: February, 2013
Data source: Ontario Cancer Registry, Collaborative Staging Database
Prepared by: Cancer Care Ontario, Informatics Centre of Excellence
Population-based stage distribution of cancer stage, colorectal cancer,patients diagnosed from 2007-2011, Ontario
Reporting of Cancer Stage
Year20
07
2008
2009
2010
2011
Pe
rce
nta
ge
(%
)
0
10
20
30
40
50
60
70
80
90
100
Stage I
Stage II
Stage III
Stage IV
CSQI 2013
Report date: February, 2013
Data source: Ontario Cancer Registry, Collaborative Staging Database
Prepared by: Cancer Care Ontario, Informatics Centre of Excellence
Population-based stage distribution of cancer stage, lung cancer,patients diagnosed from 2007-2011, Ontario
Reporting of Cancer Stage
Year
2007
2008
2009
2010
2011
Pe
rce
nta
ge
(%
)
0
10
20
30
40
50
60
70
80
90
100
Stage I
Stage II
Stage III
Stage IV
CSQI 2013
Report date: February, 2013
Data source: Ontario Cancer Registry, Collaborative Staging Database
Prepared by: Cancer Care Ontario, Informatics Centre of Excellence
Population-based stage distribution of cancer stage, cervical cancer,patients diagnosed from 2007-2011, Ontario
Reporting of Cancer Stage
Year
2007
2008
2009
2010
2011
Pe
rce
nta
ge
(%
)
0
10
20
30
40
50
60
70
80
90
100
Stage I
Stage II
Stage III
Stage IV
CSQI 2013
CANCER SYSTEM QUALITY INDEX
RESULTS
Current state
CSQI 2012 & 2013
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*New or updated areas or indicators
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CQCO 2012 & 2013 summary Good news (* as well in 2012) Areas for improvement 2013 (*as well as in 2012)
Safe • HPB surgeries stds; post-surgical death rate declined for pancreatic & liver resection
• CPOE increasing across cancer treatment facilities
• Neutropenia, fever or infection are common & should be considered in overall treatment plan
• Unplanned visits to the hospital after chemotherapy *
Effective • Increase in breast cancer screening • Synoptic pathology reporting* • MCC • Positive Margins after Rectal Surgery • Pts. consultation with Med Onc after surgery • Radiation & IMRT pts. treated according gdles • Reporting cancer staging at diagnosis • More cancer survivors receiving treatment
based on best available evidence
• Treating lung & colon cancer according to gdls * • Follow up of abnormal screening results *cervical
Accessible • WT for cancer • WT for radiation • WT for systemic
• CRC screening * • WT between consult to treatment for
chemotherapy *
Responsive • Pt. experience with DAPs & nurse navigators • Pt. satisfaction in ambulatory care (outpatient)
settings * • Symptom mgmt via ESAS tool & more providers
are using tool
• Emotional support satisfaction remains low compared to other aspects measured
• Pt. satisfaction outpatient by type of cancer • Pts need more info about impact of cancer
(beyond treatment) on their life • More measures to determine patients’ &
survivors’ quality of life • Coordination & continuity *of care
CQCO 2012 & 2013 summary Good news Areas for improvement 2013 (*as well as in 2012)
Equitable • Cancer burden still higher among lower SES * • Some variation exists in the use of gdls for patients 70+ • All screening programs continue to indicate that
individuals with lower SES less likely to be screened than those with higher-SES.
• Improve screening rates among under/never screened • Other socio demographic factors such as age, sex,
geography and ethnicity also have a significant impact on risk factors for cancer, cancer screening rates, as well as treatment.
• More work needs to be done, using a whole-of-society approach to ensure equity.
Integrated • Primary Care & Screening indicator suggest that retention, participation & follow-up rates are higher among individuals enrolled with a physician in a PEM practice
• Wait times from Surgery to Chemotherapy * • No target for Cancer Screening Integrated Participation • Integrated WT from diagnosis to treatment
Efficient • Chemotherapy in last 2 wks of life • Radiation equipment utilization (no
target) • New measures for cost-effectiveness
of IMRT vs non-IMRT
• Start palliative care discussion & referrals sooner, variation across province
• Use of acute care too high * • Death in acute care hospital remains high * • Alternatives need to be initiated so last minute visits to
ER and hospital can be avoided
Overall summary (2012/2013) • As of today, we’re best at treating people once they are in the system.
• Cancer services provided are generally effective and evidence-based; in 2013 strongest dimensions are
effectiveness and accessible
• Ontario is relatively strong, by world standards, in providing effective diagnosis and high-quality
cancer treatment services.
Areas for improvement/focus
• Lung Cancer treatment
• Prevention (risk factors)
• More ‘safety’ measures, across all aspects of cancer treatment and from the patients’ perspective.
• More focus required on the patients’ & survivors’ quality of life and consideration of the whole person
and family during and after active treatment.
• Cancer burden among those with lower socioeconomic status. A whole-of-society approach is required
to ensure equity.
• Better measures to determine value for money for all services, while maintaining good health
outcomes and seamless patient care. Resources and supports at the end-of-life.
• Services across the system need to be coordinated and integrated to support seamless and effective
patient transitions regardless of location or provider.
• Patient-centred integrated wait times show that although individual service-specific waits are
achieving their targets, it’s a long wait from diagnosis to treatment from the patients’ perspective.
The vision for the system is that it will be fully integrated if patient transitions are seamless and
effective regardless of location or provider.
CANCER SYSTEM STAKEHOLDERS’
AREAS OF FOCUS
Environmental Scan
Summary of system stakeholder strategic areas of focus -
National Other points to note
Can Partnership Against Cancer (CPAC) 2012-17
Research – understand cancer & related chronic dis.
Population based prevention
Population based screening
High quality early detection
High quality clinical care
Cancer control for First Nations Inuit Metis
Person-centred perspective (cancer journey)
-Public & pt. engagement & awareness -Perf. Reporting
Canadian Cancer Society (CCS) 2010-15
Research for prevention
Influence public policy for quality cancer care (screening, early detection)
Support programs on needs of pts. & caregivers (supportive care, survivorship, end-of-life care)
Engage more Canadians in the fight against cancer
-Programs are available & accessible -Improve quality of life
Can Assoc of Prov Cancer Agencies (CAPCA) 2009-14
Alignment & role clarity or agency
Safe care - share & promote best practice, tools, processes, knowledge sharing
Enhanced cancer care across the continuum – community setting (identify gaps, shared oncology care, education curriculum for GPOs)
Access to cancer drugs & mitigate costs (utilization mgmt, purchasing)
CIHI (2012-17)
Improve the comprehensiveness, quality & availability of data
Support population health & health system decision-making
Deliver Organizational Excellence
GPOs = General Practitioners of Oncology
Summary of system stakeholder strategic plan areas of
focus - Provincial
Other points to note
MOHLTC – public health 2013 (3-5 yrs)
Optimize healthy human development – early childhood development
Improve the prevention and control of infectious diseases - immunization
Improve health by reducing preventable diseases and injuries – physical activity & healthy eating, tobacco & alcohol
Promote healthy environ – natural & built – focus on built environ(?)
Strengthen the public health sector’s capacity, infrastructure and emergency preparedness – workforce, collaboration, info & knowledge sharing
Note: MOHLTC has separate strategies for seniors & mental health & addictions
Health Quality Ontario (HQO) 2012-?
Focus the system on a common quality agenda (quality plans)
Build evidence & knowledge (health tech assessment)
Broker improvement (training, best practice implementation)
Catalyze speed (process & tools, system recommendations on accreditation, infrastructure)
Evaluate progress (indicators, reporting)
Ontario Institute for Cancer Research (OICR) 2010-15 (Translation priorities)
Adoption of more personalized medicine for cancer
Solutions to clinical issues that could benefit patients in the next 5 yrs. – pancreatic, prostate, breast, colon, children and youth
Digitization and interpretation of cancer data.
Acceleration of patents to products program (commercialization)
Additional innovation & technology program priorities available in plan
AREAS OF FOCUS OF CANADIAN AND
INTERNATIONAL CANCER PLANS
Environmental Scan
Provincial Cancer Plan Priorities/Areas of Focus* (Please note : terminology used in plans related to goals/priorities/activities varied)
AB 2013-30
Prevention-Reduce risk through coordinated & integrated strategies; Increase awareness
Screening – use robust data and appropriate activities
Integrated diagnosis, treatment & support services
Psychosocial, physical, supportive care & palliative care throughout journey for patients & families
Research (primary care, prevention, cancer care, policy)
Develop strong workforce (needs, gaps in data, roles/skills definition, models)
Manage infrastructure (information, equipment, IT, knowledge)
Surveillance-Develop strong monitoring system
Integrated care (evidence, care models)
SK 2011-14
Improve the client, patient & family Experience throughout cancer journey
Improve the coordination & timely access of safe, high quality care for clients, patients and their families
Development of quality measures, accountability and transparency that enhance evaluation
Enhance & maximize the benefits of integrated primary prevention & early detection programs to reduce risk
MB 2012-17
Primary Prevention & health promotion (work with partners)
Early detection through screening &diagnosis – improve access, reduce anxiety
Access to quality patient-focused cancer treatment & care
Follow-up care & survivorship (optimal pathways, symptom management)
Cross Cutting Objectives
Establish vulnerable populations Program
Provide professional education; Share patient communication guidelines
Promoting & supporting cancer research
Implement cancer patient tracking information system …
Consult patients in design of physical space
NL 2010-?
Prevention through promoting a healthy population (collaborate with stakeholders)
Identifying individuals at risk
Coordinating care along cancer continuum (primary health, navigation, best practice)
Supportive & palliative care (increase access)
Clinical practice guidelines & standards
Access and advocacy (social policy, location of service, drug issues)
Surveillance & information systems & technology- comprehensive programs supported by research agenda
Education & training for public and professionals; accountability & measuring success
PEI 2004-15
Prevention-Identify individuals at risk; decrease # preventable cancers
Screening & diagnosis- improve access to timely & accurate diagnosis
Treatment & supportive care (access, symptom management, rehab, palliative care throughout treatment)
Survivorship (enhance quality of life for survivors & families)
Palliative & end of life care (continuity, access in different settings, throughout treatment)
*Publicly available plans included. BC cancer plan is currently under development, and not available publicly. An interview will be set up with BC for input.
Summary of high-level provincial findings
• Many provincial plans highlight areas of focus which align at least in
part with CCO’s ‘Cancer Journey’
• One plan included ‘Cross-cutting Objectives’ as additional areas of
focus, spanning multiple areas, or the entire cancer journey
• Coordination of care, integration, education and training, and health
promotion were each called out separate as areas of focus in multiple
provinces.
• Developing the cancer workforce has been identified as an area of
focus for Alberta
International Cancer Plan Priorities/Areas of Focus (Please note : terminology used in plans related to goals/priorities/activities varied)
New South Wales 2011-15
To reduce the incidence of cancer (through improving modifiable risk factors)
Improving the survival of people with cancer
Improving the quality of life of people with cancer & their caregivers
Cross-Cutting Issues
Monitoring and evaluating cancer control activities
Strategic research investment
Improve cancer outcomes for Aboriginal people
Improve cancer outcomes for rural and remote populations
Improve cancer outcomes for people who are socio-economically disadvantaged
Enhance the role of primary and community care in cancer control
SUI 2011-15
Epidemiology & monitoring (more comprehensive & precise data)
Prevention & Screening (measurement, study risk factors, manage interfaces between primary/secondary/tertiary prevention.
Research (translation, expand outcome research, public KTE)
Therapy (self management/determination, guidelines, quality assurance, training, cost-effectiveness)
Nursing (expand evidence base, innovative models, self management)
Psychosocial Support (info on resources, guidelines, coordination, research)
Psycho-oncology (standards/guidelines, funding, integrate into multidisciplinary care)
Rehabilitation (coordinate inpatient/outpatient, patient pathways, quality, funding, interdisciplinary training)
Palliative Care (capacity, access, communicate benefits, education, research)
FRA 2009-13
Monitoring & evaluation (smoking, physical activity, environ, immunization)
Research (transfer of outcomes for benefit of all patients)
Observation (better understanding of cancer burden)
Prevention & Screening – preventive actions to avoid cancers or seriousness
Patient care – guarantee each patient individualized and effective care management
Life during & after cancer (improve quality of life and fight any form of exclusion)
Cross-cutting Themes
Take more effective account of health inequalities
Encourage analysis & taking account of individual & environmental factors
Strengthen the role of the referring doctor
International Cancer Plan Priorities/Areas of Focus (Please note : terminology used in plans related to goals/priorities/activities varied)
Malta 2011-15
Policies for prevention (preventing preventable cancers)
Policies for early diagnosis
Ensuring quality in the diagnosis & treatment of cancer
Improving the quality of life of persons living with cancer
The patient’s perspective
Human resources
Surveillance and research
Implementation of the plan
UK 2011
Putting patients & public first: information and choice
Improving outcomes for cancer patients: prevention and early diagnosis
Improving outcomes for cancer patients: quality of life and patient experience
Improving outcomes for cancer patients: better treatment
Improving outcomes for cancer patients: reducing inequalities
Autonomy, accountability and democratic legitimacy: commissioning and levers
Wales 2012-2016
Preventing cancer (healthy lifestyle/choices & minimize risk)
Detecting cancer quickly where does occur or recur.
Delivering fast, effective treatment & care so they have best chance of cure
Meeting people’s needs (feel well supported and informed, able to manage the effects of cancer)
Caring at the end of Life (feel well cared for & pain & symptom free)
Cross-cutting Areas
Improving information
Targeting research
Summary of high-level international findings
• Many of the international areas of focus align in part with CCO’s
‘Cancer Journey’
• Cross-cutting issues/themes/areas are evident in a number of
jurisdictions, aimed at multiple phases of the ‘Cancer Journey’
• Quality of life is a recurring area of focus across a number of
countries
• Other areas of interest include: nursing, psychosocial support,
psycho-oncology, human resources, epidemiology/monitoring
FINDINGS FROM A SYSTEMATIC
REVIEW OF EUROPEAN NATIONAL
CANCER PLANS
Environmental Scan
Recommendations from report analyzing national
cancer control plans (NCCPs) in Europe
Critical health system functions
Need to understand the health system context
Intermediate goals
Ultimate goals
Source: Imperial College London. 2009. Analysis of National Cancer Control Programmes in Europe
Key components of a NCCP and
analytical framework used in study–
Areas to consider
Source: Imperial College London. 2009. Analysis of National Cancer Control Programmes in Europe
Additional activities related to service delivery: Health Education Health Promotion Screening Primary health care Inpatient care National Drug Policy Improvement of quality of medical services Care Networks Multidisciplinary Diagnosis Multidisciplinary Care
EMERGING TRENDS/ OPPORTUNITIES
RELATED TO CCO’S PROGRAM
AREAS
Environmental Scan
Emerging trends/ opportunities related to CCO’s
program areas (common themes)
• Quality based procedures/patient based funding
• Resource efficiency - innovative models of care (ex. alignment of clinical & organizational best practices)
• Physician level quality/performance reporting
• Implementation/adoption of new technologies (ex. cancer surgery, oral chemo, protons, minimally invasive)
• Care in the community
• Personalized medicine (science & technology)
• Patient specific pathways (for education, as foundation for EMR)
• Self-care/management enabled by education, information and technology
• Decision-support tools (for clinicians and patients)
• Standardization (ex. process, protocols, and regional level programs)
• ‘Systems thinking’ (ex. impact of implementing one program/guideline on other programs/area both upstream and downstream)
SWOT Questions (Strengths, Weaknesses, Opportunities, Threats)
From an “internal perspective” (i.e. CCO + RCPs)
1. What are the strengths of CCO and the RCPs?
a) What makes each of these a strength/ allowed these strengths to be sustained?
2. What do you feel are areas for improvement, or limitations of CCO and the RCPs?
a) Where are we vulnerable?
From an “external perspective” (i.e. environment external to CCO + RCPs)
3. Please describe any emerging trends in healthcare/cancer care that you feel CCO should take note
of in developing the next OCP.
a) Which of these areas would require innovative solutions that CCO could lead?
4. What do you see as the cancer system’s top 3 to 5 priorities over the next 3-5 years? These can
include either internal or external drivers (e.g. Social/demographic factors, Political factors,
Environmental factors, Technological factors, Legal factors etc.) .
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SWOT Questions continued
5. What do we know about our external environment that we have not yet addressed?
6. What are the pressure points or points of vulnerability for the current cancer system?
a) What factors in the broader external environment contribute or add to areas of vulnerability?
7. What do you see as the cancer system’s top 3 to 5 challenges over the next 3-5 years. These can
include either internal or external drivers (e.g. Social/demographic factors, Political factors,
Environmental factors, Technological factors, Legal factors etc.)
Additional Questions:
8. If you were a patient requiring care and/or a family member interacting with Ontario’s cancer
system, what would you expect the system to deliver?
9. What would make us the best cancer system in the world?
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