Download Indicator 1 - Central Cancer Network

Tumour Streams
Eleanor Whitehead
CCN Project Manager
Topics
• National tumour stream standards project
status
• Regional/local implementation considerations
• Progress against lung standards
• Other regional tumour stream work – skin,
bowel
• Gynae pathway – presentation from Dr. Cecile
Bergzoll CCDHB
• Proposed activities 2013/2014
National standards of service
provision
Background
• Ensure that patients receive timely and good quality
care
• Enable the development of efficient and sustainable
best practice management of specific tumour types
• Promote a nationally co-ordinated and consistent
approach to service provision for the tumour type
• Required to help mitigate the risk of patients receiving
poor quality care including the provision of services
which meet the timeliness measures assciated with the
FCT indicators
National tumour stream standards project
status
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Aligned cancer standards agreed 30th May 2013
CCN - Haematology stream – lymphoma and myeloma
MCN – Breast
SCN - Gynaecological
SCN - Bowel
NCN - Head and Neck
NCN - Upper Gastrointestinal
NCN- Melanoma
NCN – Sarcoma
Submitted end June 2013
To be published November 2013 as provisional documents
National tumour stream standards – future
development plans
• Ongoing role of the working groups - the Chairs Group
recommended a two-tier process for consideration by
the MoH –
– A smaller tumour specific group to give mandate to chair.
– A national pan-tumour group including all the Chairs
• Additional tumour stream standards to be developed –
prostate 2013-2014, urology and CNS TBA
National Aligned Cancer Standards
Agreed clusters
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Prevention and early detection – optional
Timely access to services
Referral and communication
Investigation, diagnosis and staging
Multidisciplinary care
Care co-ordination
Treatment
Follow-up and surveillance
Clinical performance, monitoring and research
Examples of national activity in specific
clusters
Cluster
Existing / planned activity in 2013 - 2014
Timely access to services

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Communication and
referral

Investigations, staging and 
diagnosis
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Multidisciplinary care

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DHB quarterly reporting on FCT indicators
RCN regional FCT implementation plans aimed at improving data quality
MOH currently seeking feedback from DHBs re additional initiatives to
improve reporting
DHB e-referral developments
Suspected Cancer in Primary Guideline
CCNZ implementation of structured reporting from labs
DHBs reporting on colonoscopy, CT/MRI wait time indicators
PET-CT Indicators
Fast track clinics
MOH MDM Guidelines
RCN MDM development plans
Examples of national activity in specific
clusters
Cluster
Existing/planned activity 2013-2014
Care co-ordination and
supportive care
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MOH Supportive Care Guidance and implementation plan
DHB implementation of Cancer Nurse Coordinator initiative
MOH establishment of National Patient Information Network
Treatment

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
Medical Oncology Models of Care Plan
National Radiation Oncology Plan
Palliative Care – Resource and Capability Framework completed, finalise
Specialist Palliative Care Service Specifications
Bone Marrow Transplant Services in New Zealand for Adults – service
improvement plan

Follow up and surveillance
Clinical Performance
Monitoring and Research
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
CCNZ improvements to the NZ Cancer Registry (Staging, structured lab
reporting)
Regional data repositories
RCN MDM development plans – data capture and reporting
MOSAIQ / METRIQ Pilot (SCN)
National View of Cancer
Example of national activity specific to
individual tumour streams
Tumour Stream
Existing / planned activity in 2013-2014
Breast
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Bowel
Myeloma
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

Lymphoma

Management of Early Breast Cancer Guideline (MOH, 2009)
Breast Cancer Registry
BSA Digital Mammography project
NCN Breast Cancer Follow-up Guideline
Management of Early Colorectal Cancer Guidelines (MOH, 2011)
National Bowel Screening Pilot
Endoscopy Quality Improvement Programme – implement Global
Rating Scale in all DHBs,
Colonoscopy – direct access guidelines and wait time indicator
National Bowel Cancer Working Group Plan
Bone Marrow Transplant Services in NZ for Adults – Service
Improvement Plan
Bone Marrow Transplant Services in NZ for Adults – Service
Improvement Plan
Example of national activity specific to
individual tumour streams
Tumour Stream
Existing / planned activity in 2013-2014
Head and Neck
Melanoma
Upper GI
Sarcoma
Gynae


Lung

Draft National Gynae-oncology Service Plan
Consultation re 2,3 or 4 hub model to be undertaken by Gynae
Standards Group
Cervical screening - implementation of Parliamentary Review
Committee Recommendations
National Lung Cancer Working Group Plan
Prostate
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
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Prostate Quality Improvement Programme (Phase 1):
Developing and distributing prostate cancer information resources
Developing prostate cancer standards and draft guidelines

FCT reporting
• Top four tumour streams account for 64% of all FCT
data - breast (20%), lower GI (17%), urological (14%), lung (13%)
100%
Other
90%
Gynaecological
80%
Head and neck
Percentage
70%
Haematological
60%
Upper GI
50%
Skin
40%
Lung
30%
Urological
20%
Lower GI
10%
Breast
0%
C&C
HB
HV
MC
TK
DHB of domicile
Wai
Wha
CCN
total
FCT reporting – waiting times
• Haematological tumour stream consistently had the
best waiting time compliance across all three
indicators, while urological consistently had the least
favourable.
Graph indicator 1 (referral to first treatment)
Q3 2012/13
Q4 2012/13
YTD
100%
80%
70%
60%
50%
40%
30%
20%
CCN total
Other
Gynaecolo
gical
Head and
neck
Haematolo
gical
Tumour stream
Upper GI
Skin
Lung
Urological
0%
Lower GI
10%
Breast
Percentage <=62 days
90%
0%
Tumour stream
CCN total
Other
Gynaecolo
gical
Q4 2012/13
Head and
neck
Haematolo
gical
Q3 2012/13
Upper GI
Skin
Lung
Urological
Lower GI
Breast
Percentage <=14 days
FCT indicators
• Indicator 2
YTD
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Tumour stream
CCN total
Other
Gynaecolo
gical
Q4 2012/13
Head and
neck
Haematolo
gical
Q3 2012/13
Upper GI
Skin
Lung
Urological
Lower GI
Breast
Percentage <=31 days
FCT indicators
• Indicator 3
YTD
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
Some FCT data by tumour stream
• Indicator 1 –best practice 62 days – results:
overall 62%, haem 76%, breast 73%, skin 71%
gynae 70% urology 40%
• Indicator 2 –best practice 14 days - results :
overall 55% haem 77%, lung 73%, gynae 73%,
urology 32%
• Indicator 3 –best practice 31days- results:
overall 88% all above 75% except urological at
48%
CCN Region – current tumour stream based
activities
• CNCs tumour specific focus – lung, gynae,
sarcoma, bowel, skin, lymphoma
• Skin in primary care – WhaDHB skin lesion
project, MDHB Map of Medicine
• Bowel – NEQIP, colonoscopy indicators
• Lung progress against lung standards
• Gynae pathway
Lung standards – national
Key Actions
Responsibility Progress
National Lung Cancer Work Group (NLCWG)
The following areas for action were identified for consideration at a
national level:
 Abnormal CXR – discussion re variable processes in place from
when a patient has an abnormal CXR and subsequent access to
CT. Suggested that an audit is done of current practices through
the College of Radiologists, including both private and public
services
 Special Interest Group - support for an email comms group to be
established to support the spread of innovation and new
approaches
 Follow-up – potential guidance re F/U requirements. Helen to send
Breast F/U package to Loryn
 Lung cancer conference – support for an annual clinical forum
attached the national conference. Consider networks hosting these
on rotation
NLCWG
Recent communications from NLCWG:
 19/12 - Release of updated Australian clinical
practice guidelines for lung cancer
 21/12 - Revised Lung Cancer Core Dataset Form
for consultation
The next NLCWG is on the 22nd March 2013. The following
current members on the group are from the CCN region;

Dr James Entwisle, Clinical Leader, Radiology
Department, CCDHB

Dr David Hamilton, Radiation Oncologist, CCDHB

Mr Glen McKay, Cardiothoracic Surgeon, CCDHB

Dr Helen Winter, Medical Oncologist and Intern
Supervisor, MDHB

Professor Richard Edwards, Professor of Public
Health and Head of Department, University of
Otago, Wellington School of Medicine and Health
Services
Lung standards - regional
• Regional lung steering group – proposed
that function sits with lung MDMs
• Data – enabling clinical audit
• EBUS – C&CDHB implementation currently
• Lung MDMs – TORs referral criteria
• Care coordination – CNCs with lung focus
in C&CDHB, MDHB, HBDHB
Lung standard indicators
Indicators
and year
DHBs
Capital and
Coast
Midcentral
Indicator 1 %
2010
Indicator 2 %
2011
Q3/4 2012
2010
2011
Q3/4 2012
Indicator 3
%
Q3/4 2012
46
77
50
52
65
67
94
NA
NA
96
NA
NA
91
96
76
NA
55
61
NA
66
96
33
50
NR
67
57
NR
NR
69
53
42
75
71
82
94
40
67
57
33
56
83
100
47
64
55
40
46
73
82
Hawke’s Bay
Wairarapa
Hutt Valley
Whanganui
Taranaki
Gynaecological Oncology
Patient Pathway
Cecile Bergzoll
Gynaecological Oncologist
Wellington
Regional/local implementation
considerations
Audit
• Previous regional mapping work done in lung, gynae and
bowel can be used as baseline data
• Faster Cancer Treatment data will be utilised
• Audit can be performed either within a tumour stream
as well as across the aligned standards
• RCNs developing agreed audit tools
• Need to work out an audit plan with the DHBs to ensure
we obtain the greatest value for each DHB and for the
region as a whole to inform their FCT work
Bowel 2013-2014 proposed activities
3.3 Support implementation of the National Endoscopy
Quality Improvement Programme (NEQIP) plan in each
DHB (led by NEQIP team, Bay of Plenty DHB)
• Proposed Activities:
• All DHBs completing the roll out of the Global Rating Scale
• Ministry visits to DHBs to discuss implementation of direct access
to colonoscopy criteria in Aug/Sep 2013
• Develop and implement a subregional approach to colonoscopy
referral and wait list – C&CDHB, HVDHB, WaiDHB (3D)
• Participate in nationally led endoscopy workforce developments as
appropriate
Prostate 2013-2014 proposed activities
2.7 Identify and establish plan to address regional
priorities arising from the National Prostate Cancer
Quality Improvement Plan
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Proposed Activities:
Contribute to the national development and distribution of prostate
cancer information resources by June 2014.
Contribute to the development of national standards and draft guidelines
by June 2014.
Suggest that the following two activities identified in the RSP are delayed
until next year when the standards are available:
Regional Prostate Cancer Steering Group established by end September
2013.
Regional Prostate Cancer Improvement Plan approved by DHBs by end
December 2013.
Overall tumour steam proposed activities
2013-2014
2.5 Begin implementing the National Tumour Standards
of Service Provision – annual priorities identified and
actions planned to address gaps
• Proposed Activities:
• CCN stakeholders to continue to participate on national tumour
stream groups as able (Ministry currently identifying roles and
support for these groups).
• Confirm regional clinical leadership processes – proposed that this
sits with MDM groups via 6 monthly meetings.
• Work with other RCNs to develop a tool for auditing the tumour
standards by December 13 and undertake an audit against a
tumour standard by March 13. (standard yet to be decided)