Department of Surgery, University of Ottawa, Ottawa, ON. ; Surgical Oncology Program, Cancer Care Ontario, Toronto, ON.
Department of Surgery, University of Ottawa, Ottawa, ON.
Curr Oncol. 2014 Feb;21(1):27-34. doi: 10.3747/co.21.1663.
Patients requiring assessment for cancer surgery encounter a complex series of steps in their cancer journey. Further complicating the process is the fact that care is often delivered in a fragmented, silo-based system. Isolated strategies to improve cancer outcomes within those systems have had inconsistent results.
A regional quality improvement collaborative was developed based on a community of practice (cop) platform, a hub-and-spoke infrastructure, and a regional steering committee linking cop improvement projects with affiliated hospitals and their strategic priorities. The cop provided an avenue for multidisciplinary teams to collect and compare their performance data and to institute regional standards through literature review, discussion, and consensus. Regional interdisciplinary teams developed a set of quality indicators linked to mutually agreed-upon care standards. A limited regional database supported feedback about performance against both provincial and regional standards.
The cop approach helped to develop a multihospital collaboration that facilitated care quality improvements on a regional scale, with clinical outcomes of the improvements able to be measured. The 9 participating hospitals delivered cancer surgery in the specific disease sites according to practitioner-developed and provincially- or regionally-generated care standards and clinical pathways. Compliance with provincial evidence-based clinical guidelines improved (20% increase in 2010-2011 compared with 2006-2007). Other significant improvements included standardization and implementation of regional perioperative pathways in breast, colorectal, and prostate cancer disease sites; rectal cancer surgery centralization; increased use of sentinel lymph node biopsies in breast cancer surgery; and decreased positive surgical margin rates in prostate cancer.
Improved quality is likely a result of diverse confounding factors. The deliberately cultivated multihospital multidisciplinary cops have contributed to positive structural and functional change in cancer surgery in the region. This regional cop model has the potential to play an important role in the development of successful collaborations in care quality improvement.
需要评估癌症手术的患者在癌症治疗过程中会经历一系列复杂的步骤。更复杂的是，护理往往是在分散的、孤立的系统中进行的。在这些系统中，孤立地采取措施来改善癌症治疗结果的策略效果并不一致。
基于实践社区（cop）平台、枢纽和辐条基础设施以及一个区域指导委员会，该委员会将 cop 改进项目与附属医院及其战略重点联系起来，开发了一个区域质量改进合作组织。cop 为多学科团队提供了一个收集和比较其绩效数据的途径，并通过文献回顾、讨论和共识来制定区域标准。区域多学科团队制定了一套与共同商定的护理标准相关的质量指标。一个有限的区域数据库支持对省级和区域标准的绩效反馈。
cop 方法有助于建立一个多医院合作组织，在区域范围内促进护理质量改进，并且能够衡量改进的临床效果。9 家参与医院根据从业者制定的和省级或区域生成的护理标准和临床路径，在特定的疾病部位开展癌症手术。对省级循证临床指南的依从性提高（2010-2011 年与 2006-2007 年相比增加了 20%）。其他显著的改进包括在乳腺癌、结直肠癌和前列腺癌疾病部位标准化和实施区域围手术期路径；直肠肿瘤手术集中化；增加在乳腺癌手术中使用前哨淋巴结活检；以及降低前列腺癌的阳性手术切缘率。
质量的提高可能是多种混杂因素的结果。经过精心培养的多医院多学科 cop 为该地区癌症手术的积极结构和功能变化做出了贡献。这种区域 cop 模式有可能在改善护理质量的成功合作发展中发挥重要作用。
