Improving Margin Status in Radical Prostatectomies through Performance Measurement and Multidisciplinary Knowledge Transfer (KT) Activities: A Population Level Approach to Quality Improvement
John Srigley, Andrew Evans, Marta Yurcan, Amber Hunter, Jennifer Hart, Joshua Mazuryk, Leigh McKnight, Marilyn Raby, Jonathan Irish, Joseph Chin, Tom McGowan, Robin McLeod, Neil Fleshner. Cancer Care Ontario, Toronto, Canada; McMaster University, Hamilton, Canada; University Health Network, Toronto, Canada; University Health Network and Mount Sinai Hospital, Toronto, Canada; University of Toronto, Toronto, Canada; London Health Sciences Centre, London, Canada; University of Western Ontario, London, Canada; Credit Valley Hospital, Mississauga, Canada; Mount Sinai Hospital, Toronto, Canada; Princess Margaret Hospital, Toronto, Canada
Background: About 3,000 radical prostatectomies (RP) are performed annually in Ontario (male population = ∼6.5M). As part of a 2007 RP guideline development process, a manual audit based on 2005/06 data (n=2,074) revealed a margin positivity rate (MPR) of 33% for organ confined (pT2) disease (n=1,577). Quality improvement (QI) strategies were developed to reduce this rate.
Design: A target of <25% MPR for pT2 was set by consensus. QI strategies included creation of pathology, surgery and radiation oncology champions in 14 regions, hosting provincial champion workshops, implementing a prostate cancer case based listserve, providing regional funding to support multi-disciplinary communities of practice (CoPs), providing hospital-level data and a performance measurement process that reports quarterly to regions and publicly on an annual basis. Starting in 2008, the RP margin positivity rates were monitored using the discrete data field synoptic reporting system developed in Ontario.
Results: The provincial pT2 MPR declined from 33.3% (2008-09 Q3) to 20% in 2010/11 (n=1,772). The reduction in MPR was seen in all regions of the province. However, significant variation between regions (13% to 35% in FY2010/11) and between hospitals within individual regions still exists.
Conclusions: Margin positivity rates are related to patient selection, pathological interpretation and surgical factors. Through a multi-faceted approach, we have successfully engaged the clinicians and pathologists and have achieved a significant improvement in overall pT2 MPR in Ontario. The clinical engagement with creation of CoPs and the regular monitoring and reporting of quality indicators were key factors in this population-level QI program. We are currently working with regions and hospitals to reduce both inter- and intra-regional variations in performance.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 8:45 AM
Platform Session: Section A, Monday Morning