Standarized Synoptic Cancer Pathology Reporting: Implementation Strategies for a Population-Based Change Management Initiaitve Involving 400 Pathologists across 86 Hospitals.
John Srigley, Demo Divaris, Tom McGowan, Marta Yurcan, Carol Sawka, Jill Ross, Mary Jane King, Tim Yardley, Kamini Milnes, Josh Mazuryk, Jon Irish, Robin McLeod. Cancer Care Ontario, Toronto, Canada; McMaster Univ, Hamilton, ON, Canada; Univ. of Toronto, ON, Canada
Background: Standardized (synoptic) cancer pathology reports (SCPRs) facilitate clinical management and data collection by cancer registries (CR), accrediting bodies and planning agencies. This project led by the provincial cancer agency in partnership with 400 pathologists within 86 hospitals, aimed to implement electronic, discrete data field (DDF) synoptic reporting of cancer resection specimens based on the College of American Pathologists (CAP) checklists (2005) to the provincial CR. Change management and knowledge transfer (KT) strategies were employed to optimize physician, vendor and organizational engagement.
Design: Strategies utilized to enable population based implementation of SCPRs in DDF format by all cancer treating hospitals to the CR included: establishing clinical leadership at provincial and local hospital levels to lead the adoption of the CAP standard; enabling interoperability between CR and hospitals with common data and messaging standards; providing hospital funding for synoptic reporting eTools in lab systems; leading KT education and outreach to pathologists; facilitating community of practice groups with synoptic tool vendors and hospitals; and monthly reporting of clinical indicator results to hospital leads on SCPR completeness and surgical quality i (e.g. % of colorectal resections with more than 12 lymph nodes examined and % positive margins in pT2 prostate carcinomas).
Results: The success of the change management strategies utilized is evident in the extent of hospital implementation and population level reporting of pathology and surgical indicators. All 86 hospitals have implemented synoptic reporting e-Tools, and are reporting against CAP standards. Of the five most common anatomic sites, which account for over 50% of all resections, 94 % were submitted in DDF synoptic format and 94% were found to be complete against the CAP standard. With respect to surgical pathology quality indicators, 87% (1812/2093) colon and 79% (637/807) rectal and rectosigmoid resections had 12 or more lymph nodes examined. The overall rates of margin positivity for pT2 prostate cancer based on radical prostatectomy reports was 22% (254/1140).
Conclusions: Adoption of a common reporting standard by pathologists is unprecedented for a jurisdiction of this size and complexity, therefore the utilization of a multi-faceted approach to the implementation of a population level practice change was a key enabler.
Category: Quality Assurance
Monday, February 28, 2011 1:00 PM
Poster Session II # 224, Monday Afternoon