BC Cancer Agency Mandate

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1 BC Cancer Agency s approach to improving the quality of care in oncology Dr David idlevy President BC Cancer Agency Mandate To provide a province wide, population based cancer control program for BC & the Yukon 14es Journées annuelles de santé publique 1

2 BCCA mission is to: To reduce the incidence of cancer To reduce the mortality rate of people with cancer To improve the quality of life of people living i with cancer Whitehorse, Yukon BCCA Cancer Centre and University Cancer Research Centre BCCA Cancer Centre and Research Centre Consultative Clinic Screening Mammography Centres, Cervical Cytology Screening Program Prince Rupert Kitimat Terrace Prince George Dawson Creek Central Agency office Cancer Research Centre (Vanc. Vict) Regional Cancer Centres Community Cancer Centres Community Cancer Clinics 70 regional pharmacies chemo Networks: hereditary cancer cervical cytology colposcopy clinics screening mammography centres palliative care surgical oncology council & network Kamloops Powell River Vancouver Vernon Kelowna Penticton Nelson Campbell River Comox Port Alberni Nanaimo Vancouver Island (Victoria) Fraser Valley (Surrey) Chilliwack Trail Abbotsford Cranbrook Creston 14es Journées annuelles de santé publique 2

3 14es Journées annuelles de santé publique 3

4 Referral Treatment Survivorship Prevention Population Screening Screening Radiology reports Pathology reports Diagnostics The Patient Registry EMR Treatment Chemotherapy Surgical Radiotherapy Symptom Screening End of life Care Death BCCA Clinical, Surveillance & Outcomes Data Environment External Data Sources 14es Journées annuelles de santé publique 4

5 Ministry of Health: DAD - Hospital discharge/admissions Diagnoses, surgical procedures, 30 day mortality, co-morbidity MSP - Billing Surgical information/diagnostic info SPR - Surgery wait times Cancer Surgery wait times* Vital Statistics: Death information Challenges (1) Filling the gaps in the pathway: Collection of performance status, co morbidity and stage Meaningful surgical, across the province Need for synoptic reporting of pathology and radiology 14es Journées annuelles de santé publique 5

6 Challenges (2) Why is BC performance better? I do not know 14es Journées annuelles de santé publique 6

7 I do know It is only important if you measure it* Up to date protocols and their measured adherence, results in consistent high quality oncology care across a province Tumour tissue, linked to outcome and treatment parameters is a very important research resource 21 st century health care 14es Journées annuelles de santé publique 7

8 Referral Treatment Survivorship Prevention Screening Diagnostics The Patient What is important to patients? Treatment End of life Care How do we measure recurrence? Challenge (3) Rising number of cancer cases Cancer can be a chronic disease Fiscally challenged healthcare systems Increasing public and patient expectation 14es Journées annuelles de santé publique 8

9 Sustainable cancer control systems Delivery of Quality care overtly Safe, Effective, Efficient Patients expect high quality care, outcomes and experience Patient survey ,000 patients in BC receiving ambulatory cancer treatment 26,000 patients receiving ambulatory cancer care in Alberta, Manitoba, Nova Scotia, Ontario, and Saskatchewan. 14es Journées annuelles de santé publique 9

10 Impact in BC Further investment in supportive care Challenge to clinical approach v holistic approach to care Requires investment tin patient driven t di priorities rather than clinician driven Q? Who is the healthcare service for? 14es Journées annuelles de santé publique 10

11 BC Provincial Breast Health Strategy Low uptake of screening 53% of year olds Women receive mixed messages Dl Delays in resolution of abnormal mammograms BC Screening Mammography 300,000 screens each year 7.3% are abnormal = 21,737 women 100% of those women think they may have cancer until diagnostic results 5 weeks to diagnosis (no biopsy) 67.9% 94% of women with an abnormal screen do NOT have cancer 7 weeks to diagnosis (biopsy) 39.6% approx 3,600 14es Journées annuelles de santé publique 11

12 BC Breast Cancer Waits Breast Cancer 300 # of days More than half wait more than 2 months Breast Cancer Cases Reviewed (n=51) In BC healthcare appears Not patient focussed Long waits Difficult to navigate 14es Journées annuelles de santé publique 12

13 Current pathway Pathway? 14es Journées annuelles de santé publique 13

14 Pathway design What needs to happen The skills needed Metrics for quality, timeliness, experience Funding follows the patient Clinical Pathway: A Highway Roadmap Clinic appointment 7 days Support and Information here 14es Journées annuelles de santé publique 14

15 Referral Treatment Survivorship Prevention Population Screening Screening Radiology reports Pathology reports Diagnostics The Patient Registry EMR Treatment Chemotherapy Surgical Outcomes and Surveillance Integrated Systems (OaSIS) Radiotherapy Symptom Screening End of life Care Death In conclusion Sustainable cancer control: Will be driven by protocolized care Patient experience of healthcare is now more important, as good clinical outcomes are assured, and must be measured Clinicians need to change delivery models of healthcare to focus on improving experience 14es Journées annuelles de santé publique 15

16 Thank you Hub and Spoke Model for delivery of care SC SC SC SC SC DIC DIC SC Full Service Screening and Diagnostic (Biopsy) Facility Pathology Surgery 14es Journées annuelles de santé publique 16

17 CANCER CENTRES, CHILDREN S HOSPITAL Cancer Treatment Data VITAL STATISTICS Sibling Cohort CANCER REGISTRY Survivor Cohort, Patient ID, Diagnosis, Death Follow-up EDUCATION MINISTRIES Education Data MEDICAL INSURANCE PLAN Health Utilization Data, General Population Sample STATCAN Income and Employment Info CAYACS SURVIVOR RESEARCH RESOURCE Development of outcome indicators, analysis files PHARMANET Prescription Drug Info BC CANCER AGENCY Oncology Scheduling, Screening Data I. Health Outcomes II. Health Care Outcomes III. Education Outcomes IV. Income and Employment V. Knowledge Translation BC C/A/YA Cancer Survivors Childhood, Adolescent, and Young Adult (CAYACS) Research Program 70% of childhood survivors are over For all five-year survivors of a cancer or tumour diagnosed under age age of years in British Columbia, Canada, from 1970, using population registers and linked bases, the CAYACS Program aims to: Develop a resource for survivorship research After 25 years, Determine risks of long term problems in multiple domains 40% have 5.2% have Examine patterns and quality of health h care in relation problems to these developed risks a needing second cancer Survivors, hospitalization one third less likely to marry BC C/A/YA Cancer Survivors 14es Journées annuelles de santé publique 17

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