title: Using Data From Ontario's Episode-Based Funding Model to Assess Quality of Chemotherapy.
abstract: A new episode-based funding model for ambulatory systemic therapy was implemented in Ontario, Canada on April 1, 2014, after a comprehensive knowledge transfer and exchange strategy with providers and administrators. An analysis of the data from the first year of the new funding model provided an opportunity to assess the quality of chemotherapy, which was not possible under the old funding model.
  
  
  
  Options for chemotherapy regimens given with adjuvant/curative intent or palliative intent were informed by input from disease site groups. Bundles were developed and priced to enable evidence-informed best practice. Analysis of systemic therapy utilization after model implementation was performed to assess the concordance rate of the treatments chosen with recommended practice. The actual number of cycles of treatment delivered was also compared with expert recommendations.
  
  
  
  Significant improvement compared with baseline was seen in the proportion of adjuvant/curative regimens that aligned with disease site group-recommended options (98% v 90%). Similar improvement was seen for palliative regimens (94% v 89%). However, overall, the number of cycles of adjuvant/curative therapy delivered was lower than recommended best practice in 57.5% of patients. There was significant variation by disease site and between facilities.
  
  
  
  Linking funding to quality, supported by knowledge transfer and exchange, resulted in a rapid improvement in the quality of systemic treatment in Ontario. This analysis has also identified further opportunities for improvement and the need for model refinement.
authors.affiliation: Cancer Care Ontario, Toronto and Trillium Health Partners, Mississauga, Ontario, Canada.
authors.forename: Leonard
authors.initials: L
authors.lastname: Kaizer
authors.affiliation: Cancer Care Ontario, Toronto and Trillium Health Partners, Mississauga, Ontario, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Simanovski
authors.affiliation: Cancer Care Ontario, Toronto and Trillium Health Partners, Mississauga, Ontario, Canada.
authors.forename: Carlin
authors.initials: C
authors.lastname: Lalonde
authors.affiliation: Cancer Care Ontario, Toronto and Trillium Health Partners, Mississauga, Ontario, Canada.
authors.forename: Huma
authors.initials: H
authors.lastname: Tariq
authors.affiliation: Cancer Care Ontario, Toronto and Trillium Health Partners, Mississauga, Ontario, Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Blais
authors.affiliation: Cancer Care Ontario, Toronto and Trillium Health Partners, Mississauga, Ontario, Canada.
authors.forename: William K
authors.initials: WK
authors.lastname: Evans
mesh_terms: D000553:Ambulatory Care; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D008962:Models, Theoretical; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics; D009864:Ontario; D011787:Quality of Health Care
chemical_list: D000970:Antineoplastic Agents