Development of ovarian cancer surgery quality indicators using a modified Delphi approach

Background Cancer quality indicators have previously been described for a single tumour site or a single treatment modality, or according to distinct data sources. Our objective was to identify cancer quality indicators across all treatment modalities specific to breast, prostate, colorectal, and lung cancer.Methods Candidate indicators for each tumour site were extracted from the relevant literature and rated in a modified Delphi approach by multidisciplinary groups of expert clinicians from 3 clinical cancer programs. All rating rounds were conducted by e-mail, except for one that was conducted as a face-to-face expert panel meeting, thus modifying the original Delphi technique. Four high-level indicators were chosen for immediate data collection. A list of confounding variables was also constructed in a separate literature review.Results A total of 156 candidate indicators were identified for breast cancer, 68 for colorectal cancer, 40 for lung cancer, and 43 for prostate cancer. Iterative rounds of ratings led to a final list of 20 evidence- and consensus-based indicators each for colorectal and lung cancer, and 19 each for breast and prostate cancer. Approximately 30 clinicians participated in the selection of the breast, lung, and prostate indicators; approximately 50 clinicians participated in the selection of the colorectal indicators.Conclusions The modified Delphi approach that incorporates an in-person meeting of expert clinicians is an effective and efficient method for performance indicator selection and offers the added benefit of optimal clinician engagement. The finalized indicator lists for each tumour site, together with salient confounding variables, can be directly adopted (or adapted) for deployment within a performance improvement program.

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Cohort profile: the TrueNTH Global Registry - an international registry to monitor and improve localised prostate cancer health outcomes

BMJ Open ◽

10.1136/bmjopen-2017-017006 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017006 ◽

Cited By ~ 19

Author(s):

Sue M Evans ◽

Jeremy L Millar ◽

Caroline M Moore ◽

John D Lewis ◽

Hartwig Huland ◽

...

Keyword(s):

Prostate Cancer ◽

Quality Indicators ◽

Steering Committee ◽

Ethical Review ◽

Local Data ◽

Modified Delphi ◽

Delphi Approach ◽

International Registry ◽

Project Coordination ◽

Global Registry

PurposeGlobally, prostate cancer treatment and outcomes for men vary according to where they live, their race and the care they receive. The TrueNTH Global Registry project was established as an international registry monitoring care provided to men with localised prostate cancer (CaP).ParticipantsSites with existing CaP databases in Movember fundraising countries were invited to participate in the international registry. In total, 25 Local Data Centres (LDCs) representing 113 participating sites across 13 countries have nominated to contribute to the project. It will collect a dataset based on the International Consortium for Health Outcome Measures (ICHOM) standardised dataset for localised CaP.Findings to dateA governance strategy has been developed to oversee registry operation, including transmission of reversibly anonymised data. LDCs are represented on the Project Steering Committee, reporting to an Executive Committee. A Project Coordination Centre and Data Coordination Centre (DCC) have been established. A project was undertaken to compare existing datasets, understand capacity at project commencement (baseline) to collect the ICHOM dataset and assist in determining the final data dictionary. 21/25 LDCs provided data dictionaries for review. Some ICHOM data fields were well collected (diagnosis, treatment start dates) and others poorly collected (complications, comorbidities). 17/94 (18%) ICHOM data fields were relegated to non-mandatory fields due to poor capture by most existing registries. Participating sites will transmit data through a web interface biannually to the DCC.Future plansRecruitment to the TrueNTH Global Registry-PCOR project will commence in late 2017 with sites progressively contributing reversibly anonymised data following ethical review in local regions. Researchers will have capacity to source deidentified data after the establishment phase. Quality indicators are to be established through a modified Delphi approach in later 2017, and it is anticipated that reports on performance against quality indicators will be provided to LDCs.

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A method to audit and score implementation of knowledge translation (KT) interventions in large health regions – an observational pilot study using rectal cancer surgery in Ontario

10.21203/rs.2.22559/v4 ◽

2020 ◽

Author(s):

Marko Simunovic ◽

Christine Fahim ◽

Angela Coates ◽

David Urbach ◽

Craig Earle ◽

...

Keyword(s):

Rectal Cancer ◽

Knowledge Translation ◽

Assessment Tool ◽

Cancer Surgery ◽

Average Score ◽

Rectal Cancer Surgery ◽

Modified Delphi ◽

Delphi Approach ◽

Cancer Agency

Abstract Background: Across Ontario, since the year 2006 various knowledge translation (KT) interventions designed to improve the quality of rectal cancer surgery have been implemented by the provincial cancer agency or by individual researchers. Ontario is divided administratively into 14 health regions. We piloted a method to audit and score for each region of the province the KT interventions implemented to improve the quality of rectal cancer surgery. Methods: We interviewed stakeholders to audit KT interventions used in respective regions over years 2006 to 2014. Results were summarized into narrative and visual forms. Using a modified Delphi approach, KT experts reviewed these data and then, for each region, scored implementation of KT interventions using a 20-item KT Signature Assessment Tool. Scores could range from 20-100 with higher scores commensurate with greater KT intervention implementation. Results: There were thirty interviews. KT experts produced scores for each region that were bimodally distributed, with an average score for 2 regions of 78 (range 73-83) and for 12 regions of 30.5 (range 22-38). Conclusion: Our methods efficiently identified two groups with similar KT Signature scores. Two regions had relatively high scores reflecting numerous KT interventions and the use of sustained iterative approaches in addition to those encouraged by the provincial cancer agency, while 12 regions had relatively low scores reflecting minimal activities outside of those encouraged by the provincial cancer agency. These groupings will be used for future comparative quantitative analyses to help determine if higher KT signature scores correlate with improved measures for quality of rectal cancer surgery.

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Quality of advanced ovarian cancer surgery: A French assessment of ESGO quality indicators

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2020.08.003 ◽

2020 ◽

Author(s):

Marie-Mélanie Gac ◽

Cécile Loaec ◽

Johanna Silve ◽

Edouard Vaucel ◽

Paule Augereau ◽

...

Keyword(s):

Ovarian Cancer ◽

Quality Indicators ◽

Advanced Ovarian Cancer ◽

Cancer Surgery

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An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120975314 ◽

2020 ◽

Vol 7 ◽

pp. 205435812097531

Author(s):

Daniel Blum ◽

Alison Thomas ◽

Claire Harris ◽

Jay Hingwala ◽

William Beaubien-Souligny ◽

...

Keyword(s):

Health Care ◽

Quality Improvement ◽

Quality Indicators ◽

Quality Metrics ◽

Care Quality ◽

Environmental Scan ◽

Modified Delphi ◽

Delphi Approach ◽

Effective Care ◽

Starting Point

Background: Quality metrics or indicators help guide quality improvement work by reporting on measurable aspects of health care upon which improvement efforts can focus. For recipients of in-center hemodialysis (ICHD) in Canada, it is unclear what ICHD quality indicators exist and whether they adequately cover different domains of health care quality. Objectives: To identify and evaluate current Canadian ICHD quality metrics to document a starting point for future collaborations and standardization of quality improvement in Canada. Design: Environmental scan of quality metrics in ICHD, and subsequent indicator evaluation using a modified Delphi approach. Setting: Canadian ICHD units. Participants: Sixteen-member pan-Canadian working group with expertise in ICHD and quality improvement. Measurements: We classified the existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods: Each metric was rated by a 5-person subcommittee using a modified Delphi approach based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for additional comments. Results: We identified 27 metrics that are tracked across 8 provinces, with only 9 (33%) tracked by multiple provinces (ie, more than 1 province). We rated 9 metrics (33%) as “necessary” to distinguish high-quality from low-quality care, of which only 2 were tracked by multiple provinces (proportion of patients by primary access and rate of vascular access-related bloodstream infections). Most (16/27, 59%) indicators assessed the IOM domains of safe or effective care, and none of the “necessary” indicators measured the IOM domains of timely, patient-centered, or equitable care. Limitations: The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals, with more representation from academic sites. Conclusions: Quality indicators in Canada mainly focus on safe and effective care, with little provincial overlap. These results highlight current gaps in quality of care measurement for ICHD, and this initial work should provide programs with a starting point to combine highly rated indicators with newly developed indicators into a concise balanced scorecard that supports quality improvement initiatives across all aspects of ICHD care. Trial Registration: not applicable.

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