title: Quality improvement in colorectal cancer in local health integration network 4 (LHIN 4) project (QICC-L4): integrated knowledge translation in a large geographic region.
abstract: BACKGROUND
  Stakeholders suggest that integrating end users into the planning and execution of quality improvement interventions may more effectively close quality gaps. We tested if such an approach could improve the quality of colorectal cancer surgery in a large geographic region (i.e., LHIN4) in Ontario, Canada.
  
  
  METHODS
  All LHIN4 surgeons who provide colorectal cancer surgery were invited to an October 2006 inaugural QICC-L4 workshop and subsequent workshops in 2008, 2010, and 2012. At workshops, surgeons selected clinically relevant quality markers for targeted improvement and interventions to achieve improvements. Selected markers included rates of colon and rectal radiology imaging, rate of pathology reporting of rectal radial margin distance, and rate of positive rectal radial margins. To date, implemented interventions have included audit and feedback, tailoring interviews to identify barriers and facilitators to optimal quality, and preoperative internet-based patient reviews. Hospital and regional cancer centre charts provide audit data for annual feedback reports to surgeons.
  
  
  RESULTS
  Participating surgeons at workshops and surgeon participants in preoperative reviews treated approximately 70 % of all LHIN4 patients undergoing colorectal surgery. For years 2006-2012, the rate of radiology imaging for colon and rectal cases increased from 70 to 91 % and from 71 to 91 %, respectively. For rectal cases, the rate of reporting radial margins increased (55-93 %), and the rate of positive radial margins decreased (14-6 %).
  
  
  CONCLUSIONS
  Initiation of the integrated knowledge translation QICC-L4 project in a large geographic region was associated with marked improvements in relevant colorectal cancer surgery quality markers.
authors: Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, marko.simunovic@jcc.hhsc.ca.
authors: Marko
authors: M
authors: Simunovic
authors: Wesley
authors: W
authors: Stephen
authors: Stephen
authors: S
authors: Kelly
authors: Shawn
authors: S
authors: Forbes
authors: Margherita
authors: M
authors: Cadeddu
authors: Lehana
authors: L
authors: Thabane
authors: Vanja
authors: V
authors: Grubac
authors: Peter
authors: P
authors: Lovrics
authors: Franco
authors: F
authors: DeNardi
authors: Dwight
authors: D
authors: Prodger
authors: Scott
authors: S
authors: Tsai
authors: Angela
authors: A
authors: Coates
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D002170:Canada; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery; D005500:Follow-Up Studies; D006801:Humans; D009367:Neoplasm Staging; D010819:Physician's Role; D011379:Prognosis; D058996:Quality Improvement; D011787:Quality of Health Care; D057170:Translational Research, Biomedical
chemical_list: D014408:Biomarkers, Tumor