1. Disease Pathway Management: Cancer Care Ontario’s Approach
Canadian Foundation for Healthcare Improvement’s
CEO Forum
Dr. Carol Sawka MD, FRCPC
VP, Clinical Programs and Quality Initiatives Cancer Care Ontario Professor of Medicine, University of Toronto
February 6, 2013

2. The Cancer Journey: connected but still siloed
Surgery
Survivorship
Diagnostic Imaging
Prevention & Screening
Radiation Oncology
Pathology
End of Life
Medical Oncology
Primary Care
Palliative Care + Psychosocial Oncology
Patient Education

3. The patient’s view: comprehensive
Not: “I’m a suspected case” “I’m a confirmed diagnosis” “I’m a referral to the cancer centre” “I’m a radiation patient” “I’m a chemo patient”
But instead: “I’m a lung patient” “I’m a colorectal patient” “I’m on a journey” “What lies ahead?” 3

4. Disease Pathway Management is an innovative approach to quality improvement at CCO
Inherently patient centered
Recognizes that the patient journey differs for each type of cancer
Identifies improvement opportunities at regional and system levels

5. DPM applies a phased approach to identifying areas for improvement and acting on them
Step 1: Understand the Journey Map the disease-site specific journey Step 2: Evaluate System Performance Use data and front-line experience Identify areas for improvement Step 3: Identify and Share Priorities for Action Prioritize areas for improvement Share them with community Step 4: Support Action Against Priorities Offer expert opinion, people, financial support Provincial and Regional Step 5: Measure Results Regional: quarterly reporting, CSQI
Maps patient journey
Evaluates system performance
Develops integrated improvement program

6. Step 1: Develop Pathway Maps
Pathway development is evidence-based and informed by expert opinion
Evidence-based
Ontario
National
International
Multidisciplinary involvement
Disease site teams
External review teams
Patient/caregiver advisory group
Iterative process
Internal: DPM co-chairs, DPM teams, Clinical Council
Wide provincial consultative review
Pathway Drafted
Expert Panel Review
Clinical Council Review
External Consultative Review
Final Expert Panel Review
Clinical Council Review
Pathway Finalized
Pathway Published to CCO Website
Regular updates

9. Clinical Pathway Depicting Ideal State Set Provincial Priorities
Clinical pathways serve as an analytical framework for quality improvement
Clinical Pathway Depicting Ideal State
Gap Analysis:
Quality of Care
Processes
Patient Experience
Setting Expectations for Regional Performance
Modeling
Set Provincial Priorities
Regions: act and organize care
MoHLTC 9

10. Provincial Investigation Project:
Step 2: Gap Analysis Use the pathways to identify priorities for action
Provincial Investigation Project:
ID underlying causes and address them
Lead by: Lung DPM team 10

11. Step 3: Identify and Share Priorities for Action
Provincially and Regionally

12. Setting Expectations: using the pathways as a means to support regional improvement
Regions provided with:
Priorities for Action
Cross-journey data and targets
Funding
Expectations:
Determine disease-specific areas of focus
Use funds to improve measurably 12

13. Diagnostic Assessment Programs
Setting Expectations: using the pathways as a means to support regional improvement
Diagnostic Assessment Programs
and DAP-EPS
Guidance for 13

14. Step 4: Support Action
Multiple options: Centrally-driven pilot projects (e.g. Dyspnea Management) Support for provincial clinical guidelines Provincial support to a specialty (people, expertise, funding) Regional support for local priorities (e.g. 10/11 funding to RCPs)

15. Step 5: Measure Results
In development, but will include: Regional quarterly reporting CSQI Others

16. In summary: Good experience so far Work in progress Great potential
Ongoing evaluation of effort/impact of various approaches to development and maintenance of disease pathways
Maps patient journey
Evaluates system performance
Develops integrated improvement program

17. www.cancercare.on.ca www.csqi.on.ca17