In early 2013, a Request for Proposals (RFP) process was initiated relating to the accelerated diffusion of strategic quality initiatives for the diagnosis and treatment of cancer. Specifically, this call for proposals sought to identify and support projects with a coordinated strategy to accelerate the multijurisdictional (preferably pan-Canadian) implementation of an existing, effective quality initiative that will greatly impact Canadians.
Successful projects will be supported from 2014 to 2017. A sustainability plan has been developed for each project to ensure that the initiative continues to provide a benefit to Canadians after the funding period has ended.
Projects supported through this initiative
The Partnership is excited to work with four groups on various quality initiatives that aim to improve the diagnosis and treatment of cancer patients across Canada. The four projects funded as part of this initiative include:
The Canadian Immunohistochemistry Quality Control (cIQc) program provides proficiency testing of immunohistochemistry (IHC) and in situ hybridization tests for breast cancer for more than 100 laboratories in Canada. The project will expand the range of diagnostic tests and provide support to help laboratories optimize and validate new biomarker tests, thereby facilitating their introduction into practice. For more established predictive biomarkers, such as estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2, the researchers further proposed to develop and launch a website based on a German model that allows all pathology laboratories in Canada to individually report positivity rates of more common diagnostic IHC biomarkers on a monthly basis. Positivity rates differing significantly from a benchmark or literature expectations may be indicative that additional optimization of biomarker performance in a specific laboratory is required. This can facilitate simple and immediate identification of potential systematic testing errors.
Optimal performance of IHC testing for cancer biomarkers will translate into improved cancer patient management and save lives. The group has previously demonstrated improved performance of breast cancer biomarkers through the program such that performance of these tests by Canadian laboratories is the best reported, worldwide. Through funding of an expansion of the cIQc program, excellent quality of biomarker testing for a range of cancers will be achieved and documented, and introduction of new biomarker tests hastened, thus making these important tests available to all patients in Canada.
This project will accelerate implementation of established quality initiatives for rectal cancer including Total Mesorectal Excision (TME) surgery and assessment, multidisciplinary cancer conferences, and Magnetic Resonance Imaging (MRI) using a multi-faceted knowledge translation (KT) strategy. While all have proven to improve clinical outcomes, there is significant variation in uptake and use of these quality initiatives across the country, with no centre having implemented all three initiatives. This project will involve eight high volume centres across Canada and will include surgeons, radiologists, radiation oncologists, medical oncologists and pathologists involved in the care of rectal cancer patients, as well as patient and family advisors.
Successful implementation of these quality initiatives will lead to improved rectal cancer care and clinical outcomes for rectal cancer patients, and set a national standard for these quality initiatives across Canada.
The National Rectal Cancer Quality Initiative: A Novel Approach to System Improvement was presented at the ARCC 2015 Annual Conference.
This project is a strategy to accelerate the uptake of peer review (PR) for radiation treatment (RT) planning. The value of PR is well supported and extends well beyond the concept of simply catching medical errors. Other values include reducing variability, improving departmental policy and treatment planning processes, and continuous medical education. While the uptake of PR in Ontario is growing, this project maps out a strategy to accelerate the uptake of PR across all centres in Ontario, British Columbia, Alberta, and ideally across Canada. The project lead comes from a centre with a long history of RT PR, and more recently Cancer Care Ontario has identified the proportion of RT PR cases to be an indicator of quality care. Furthermore, the proposal identifies local facilitators that will lead the PR process, both to improve the rates in lagging centres in Ontario and in the new centres within Alberta and BC. Rates of peer review and outcomes of the process will also be collected. Ongoing support from national organizations with strong quality mandates (CPQR, CARO and, potentially, Accreditation Canada) will facilitate the development of a Canada-wide culture in which peer review practices form a critical component of quality improvement activities in radiation oncology.
More information and frequently asked questions about the initiative are available through the Cancer Care and Epidemiology Cancer Research Institute at Queen’s University.
This quality initiative will take an existing tool called the Diagnostic Assessment Program – Electronic Pathway Solution (DAP-EPS), and expand its use from eleven DAPs in five current regional cancer centres to five new DAP sites. This well-developed tool allows both patients and providers in the DAP to review the patient’s care plan, directly access results and scheduling relevant to the patient’s diagnostic phase of their cancer journey. This project will incite system change by improving the quality and timeliness of the diagnostic phase of care, and also enable improved data collection.