Embedding evidence to improve quality of cancer diagnosis and
Over the past decade, the Partnership has worked with pathologists, surgeons and provincial and national agencies to implement national standards (see Resources) in electronic information systems, known as synoptic reporting systems.
With synoptic reporting, the information is captured systematically in discrete data fields, which provides comprehensive documentation that can be used by clinicians to diagnose, treat and coordinate care for patients with cancer. These data can also support clinical, program and health system management, quality improvement initiatives and population-based research.
The transition from narrative to synoptic reporting is well underway in Canada: about 850 pathologists in six provinces and 250 surgeons in five provinces now generate electronic synoptic reports for 60% of the prominent types of cancer.
- capture essential information including cancer stage, tumor size, prognosis, recurrence, and inter-operative complications
- enhance communication between multidisciplinary clinician groups to direct patient care and coordinate health services
- increase access to discrete data that can be used to measure process, clinical, prognostic, survival and outcomes indicators:
In 2016-2017, multiple provincial partners and clinicians used synoptic data to generate:
- 48 clinical-diagnostic indicator analyses for breast, colorectal, lung, prostate and endometrial cancers based on the College of American Pathologists (CAP) national standards for pathology
- 80 surgical-indicator analyses for breast, lung, colon, rectal, endometrial, ovarian, prostate and thyroid cancers based on data collected by surgeons using pan-Canadian surgical synoptic reporting standards. These pan-Canadian standards have been developed by Canadian surgeons in collaboration with the Partnership, and are endorsed by eight medical societies. (Pan-Canadian Standards for Eight Types of Cancer)
Decisions made by cancer specialists to diagnose, stage and treat cancer cases can vary across Canada. To promote high quality cancer diagnosis and care, cancer clinicians, as well as regional, provincial and national organizations, are focusing on the following over the next three years (2017-2020):
- implementing technical solutions to produce and disseminate comparative feedback reports that enable clinicians to review prognostic and treatment data, and use evidence to improve cancer diagnosis and patient care
- using key indicator analysis as the basis to connect with peers through communities of practice to gain a better understanding of practice variation among patient cohorts — why they exist, their extent, the clinical significance, and the possible options to reduce variation across institutions, regions and provinces
- convening clinician forums to mobilize evidence, identify best practices to address and reduce practice variation and inform clinical guidelines/policies
Read about pathology and surgical implementation lessons learned from these Partnership publications:
- Synoptic surgery reporting initiative benefits evaluation: final report
- Readiness assessment-electronic synoptic surgical quality initiative (March 2017)
- Electronic synoptic pathology reporting initiative evaluation (April 2017)
- Infographic: Improving patient care in Canada with pan-Canadian synoptic surgery reporting standards
- A coordinated approach to improve consistency in surgical care across Canada: Pan-Canadian standards for 8 types of cancer
- CAP standards webinar videos, 2010-2018
Data-driven quality improvement
This webinar series is for clinicians, project implementation teams, sponsors of synoptic systems, and others who are interested in leveraging data to support the deliverables of optimal quality of care and quality improvement.
Webinar 1: Evidence-based strategies to turn data into actionable information
In November 2017, this webinar focused on applying best practices to convert the wealth of synoptic data into reports that will be actually viewed and clearly understood. It explored the role of measurement as the foundation for change, provided tips on how to create effective clinical performance feedback reports and examined the factors that can get in the way of this process. Watch a recording of the webinar.
Delivered by Dr. Noah Ivers, MD, PhD, CCFP
Webinar 2: Facilitating discussions about clinical performance data that lead to change
In January 2018, this webinar focused on best practices and approaches to start conversations with clinical peers around what the data are signaling and their significance in clinical practice for improving quality. The presentation explored circumstances when provision of data is not enough to enable desired changes, and discussed evidence-based approaches and skills needed to effectively facilitate action-oriented feedback meetings with clinicians. Specific examples were used to highlight common barriers and useful techniques to consider when facilitating responses to clinical performance data. Watch a recording of the webinar.
Delivered by Dr. Noah Ivers, MD, PhD, CCFP and Dr. Andrew Seely, MD, FRCSC
2018 National Forum: Leveraging Synoptic Data to Lead Change
A national forum on data-driven quality improvement was hosted by the Partnership in Toronto. Lee Fairclough, Dr. Michael Fung-Kee-Fung, and Dr. Chris Hayes—three dynamic keynote speakers—shared advice on how to foster a culture of quality in one’s own institution and how to influence health systems to make them more adaptable and sustainable. Lessons highlighted by a myriad of speakers inspired and empowered attendees to be leaders of change in their own jurisdictions using data, fostering collaboration, and engaging with a variety of individuals across the health system.
Thirty-seven partners (including pathologists, surgeons, project managers, and executives) from 10 provinces reported that they intend to use the knowledge gained from this forum to implement mechanisms that increase the uptake and use of data to drive patient-centered quality improvement. Presentations and slides from the March 8 meeting can be viewed below.
Overall, the national forum was successful in facilitating a dialogue between partners and experts, and inspiring partners to use tools to lead change on the ground. Better has no limits and we are excited to see the change that our partners will lead.
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