Closing the quality loop: facilitating improvement in oncology practice through timely access to clinical performance indicators.
OBJECTIVE
Health care organizations and professionals are being called on to develop clear and transparent measures of quality and to demonstrate the application of the data to performance improvement at the system and provider levels.


METHODS
Cancer Care Ontario (CCO) initiated a pathology reporting project aimed at improving the quality of cancer pathology by standardizing the content, format, and transmission of reports to a central registry and enabling the information to be available for planning, quality measurement, and quality improvement. This population-based quality-improvement project involved more than 400 Ontario pathologists and more than 100 hospitals. Clinically relevant quality indicators that used the newly available data were developed and shared. Synoptic pathology data were electronically captured at the point of report development and used to automate the timely generation of clinical performance indicators that support quality improvement in surgical oncology. These reports provided comparison data at the organizational, regional, and population levels.


RESULTS
Monthly quality indicator reports are generated and distributed to each cancer center and are used to generate dialogue at the professional, organizational, and regional levels regarding evidence-informed quality-improvement opportunities. Since the launch of the project, colorectal lymph node retrieval rates have increased from 76% to 87%, and pT2 prostatectomy margin positivity rates have decreased from 37% to 21%.


CONCLUSIONS
High-quality, complete cancer pathology reports are important not only for contemporary oncological practice, but also for secondary users of pathology information including tumor registries, health planners, epidemiologists, and others involved in quality-improvement activities and research.
Cancer Care Ontario; University Health Network; Mount Sinai Hosptial; University of Toronto, Toronto; Trillium Health Partners, Mississauga; Grand River Hospital, Kitchener; and McMaster University, Hamilton, Ontario, Canada.
John
J
Srigley
Sara
S
Lankshear
James
J
Brierley
Thomas
T
McGowan
Dimitrios
D
Divaris
Marta
M
Yurcan
Robin
R
Rossi
Tim
T
Yardley
Mary Jane
MJ
King
Jillian
J
Ross
Jonathan
J
Irish
Robin
R
McLeod
Carol
C
Sawka
D006801:Humans; D008495:Medical Oncology / Q000379:methods / Q000592:standards*; D009369:Neoplasms / Q000473:pathology*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012107:Research Design / Q000592:standards*