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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 • • • • • • • • • • • 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 • • • • • • • • • 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 Communication and referral Investigations, staging and diagnosis Multidisciplinary care 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 MOH Supportive Care Guidance and implementation plan DHB implementation of Cancer Nurse Coordinator initiative MOH establishment of National Patient Information Network Treatment 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 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 Bowel Myeloma 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 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 • • • • • • 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)