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Development of communities of practice to facilitate quality improvement initiatives in surgical oncology.

https://arctichealth.org/en/permalink/ahliterature157643
Source
Qual Manag Health Care. 2008 Apr-Jun;17(2):174-85
Publication Type
Article
Author
Michael Fung-Kee-Fung
Elena Goubanova
Karen Sequeira
Arifa Abdulla
Rose Cook
Claire Crossley
Bernard Langer
Andrew J Smith
Hartley Stern
Author Affiliation
Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada. MFUNG@Ottawahospital.on.ca
Source
Qual Manag Health Care. 2008 Apr-Jun;17(2):174-85
Language
English
Publication Type
Article
Keywords
Humans
Models, organizational
Oncology Service, Hospital - standards
Ontario
Organizational Case Studies
Quality Assurance, Health Care - organization & administration
Surgery Department, Hospital - standards
Abstract
The process of developing clinical guidelines and standards for cancer treatment and screening is well established in the Ontario health care system; however, the dissemination and implementation of such guidelines and standards are more recent undertakings. Traditional implementation strategies to improve surgical practice and the delivery of cancer care have not been consistently effective. There is a recognized need to develop integrated models that offer direct support for implementation strategies. Such a model should be feasible, adaptable, and open to evaluation across diverse surgical settings.
Research suggests that successful implementation should consider tools and expertise from other disciplines. This article considers a community of practice (COP) model to provide a supportive infrastructure for quality improvements in cancer surgery. The COP model was adapted for cancer surgeons. It is supported by 5 enablers referred to as tools: communication system, project development support, access to data, access to evidence review, and accreditation with continued medical education and continued professional development. These tools need to be part of an infrastructure that is both provided and supported by a team of administrators and health care professionals, who have active roles and responsibilities. Therefore, the primary objective of this article is to describe our COP model in cancer surgery including the key success factors necessary for providing the infrastructure and tools. The secondary objective is to offer the integrated COP model as a basis for future research and the evaluation of various collaborative improvement projects.
Building on knowledge management concepts, we identified the 4 essential processes that should be targeted by implementation strategies. A common COP evaluation framework uses the outcomes of 4 knowledge conversion modes-organizational memory, social capital, innovation, and knowledge transfer-as proxies for actual provider and organizational behavior. Insights from different collaborative improvement projects described in a consistent way could inform future research and assist in the collation of systematic reviews on this topic.
PubMed ID
18425031 View in PubMed
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Development of quality indicators for colorectal cancer surgery, using a 3-step modified Delphi approach.

https://arctichealth.org/en/permalink/ahliterature171146
Source
Can J Surg. 2005 Dec;48(6):441-52
Publication Type
Article
Date
Dec-2005
Author
Anna R Gagliardi
Marko Simunovic
Bernard Langer
Hartley Stern
Adalsteinn D Brown
Author Affiliation
Sunnybrook and Women's College Health Sciences Centre, Toronto.
Source
Can J Surg. 2005 Dec;48(6):441-52
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Benchmarking
Colorectal Neoplasms - surgery
Colorectal Surgery - standards
Consensus
Delphi Technique
Female
Health Care Surveys
Humans
Male
Ontario
Quality Indicators, Health Care
Sensitivity and specificity
Abstract
Little performance measurement has been undertaken in the area of oncology, particularly for surgery, which is a pivotal event in the continuum of cancer care. This work was conducted to develop indicators of quality for colorectal cancer surgery, using a 3-step modified Delphi approach.
A multidisciplinary panel, comprising surgical and methodological co-chairs, 9 surgeons, a medical oncologist, a radiation oncologist, a nurse and a pathologist, reviewed potential indicators extracted from the medical literature through 2 consecutive rounds of rating followed by consensus discussion. The panel then prioritized the indicators selected in the previous 2 rounds.
Of 45 possible indicators that emerged from 30 selected articles, 15 were prioritized by the panel as benchmarks for assessing the quality of surgical care. The 15 indicators represent 3 levels of measurement (provincial/regional, hospital, individual provider) across several phases of care (diagnosis, surgery, adjuvant therapy, pathology and follow-up), as well as broad measures of access and outcome. The indicators selected by the panel were more often supported by evidence than those that were discarded.
This project represents a unique initiative, and the results may be applicable to colorectal cancer surgery in any jurisdiction.
Notes
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PubMed ID
16417050 View in PubMed
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Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario.

https://arctichealth.org/en/permalink/ahliterature167652
Source
Can J Surg. 2006 Aug;49(4):251-8
Publication Type
Article
Date
Aug-2006
Author
Marko Simunovic
Eddy Rempel
Marc-Erick Thériault
Angela Coates
Timothy Whelan
Eric Holowaty
Bernard Langer
Mark Levine
Author Affiliation
Department of Surgery, Faculty of Health Sciences, McMaster University, the Juravinski Cancer Centre, Hamilton, ON. marko.simunovic@hrcc.on.ca
Source
Can J Surg. 2006 Aug;49(4):251-8
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - mortality - surgery
Colonic Neoplasms - mortality - surgery
Esophageal Neoplasms - mortality - surgery
Female
Hospital Mortality
Hospitals - statistics & numerical data
Hospitals, Teaching - statistics & numerical data
Humans
Liver Neoplasms - mortality - surgery
Logistic Models
Lung Neoplasms - mortality - surgery
Male
Middle Aged
Models, Biological
Ontario - epidemiology
Outcome Assessment (Health Care)
Proportional Hazards Models
Registries
Surgical Procedures, Operative - mortality
Survival Analysis
Abstract
There is a lack of information from Canadian hospitals on the role of hospital characteristics such as procedure volume and teaching status on the survival of patients who undergo major cancer resection. Therefore, we chose to study these relationships using data from patients treated in Ontario hospitals.
We used the Ontario Cancer Registry from calendar years 1990-2000 to obtain data on patients who underwent surgery for breast, colon, lung or esophageal cancer or who underwent major liver surgery related to a cancer diagnosis between 1990 and 1995 in order to assess the influence of volume of procedures and teaching status of hospitals on in-hospital death rate and long-term survival. For each disease site and before observing patient outcomes data, volume cut-off points were selected to create volume groups with similar numbers of patients. Teaching hospitals were those directly affiliated with a medical school. Logistic regression and proportional hazards models were used to consider the clustering of data at the hospital level and to assess operative death and long-term survival. We also used 4 measures to gauge the degree of procedure regionalization across the province including (1) the number of hospitals performing a procedure; (2) the percentage of patients treated in teaching hospitals; (3) the percentage of rural patients treated in higher volume procedure hospitals; and (4) median distances travelled by patients to receive care.
The number of patients in our cohorts who underwent resection of the breast, colon, lung, esophagus or liver was 14 346, 8398, 2698, 629 and 362, respectively. Surgery in a high-volume versus a low-volume hospital did not have a statistically significant influence on the odds of operative death for patients who underwent colon, liver, lung or esophageal cancer resection. The risk of long-term death was increased in low-volume versus high-volume hospitals for patients who underwent resection of the breast (hazard ratio [HR] 1.2, 95% confidence interval [95% CI] 1.0-1.4, p
Notes
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PubMed ID
16948883 View in PubMed
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Standards for thoracic surgical oncology in a single-payer healthcare system.

https://arctichealth.org/en/permalink/ahliterature162350
Source
Ann Thorac Surg. 2007 Aug;84(2):693-701
Publication Type
Article
Date
Aug-2007
Author
Sudhir Sundaresan
Bernard Langer
Tom Oliver
Farrah Schwartz
Melissa Brouwers
Hartley Stern
Author Affiliation
The Ottawa Hospital, Ottawa, Ontario, Canada. olivert@mcmaster.ca
Source
Ann Thorac Surg. 2007 Aug;84(2):693-701
Date
Aug-2007
Language
English
Publication Type
Article
Keywords
Canada
Humans
Medical Oncology - standards
Single-Payer System - standards
Survival Analysis
Thoracic Neoplasms - mortality - surgery
Thoracic Surgical Procedures - standards
Treatment Outcome
Abstract
Through systematic literature review and a consensus-based approach from an expert panel, standards on the organization for delivering thoracic cancer surgery in a single-payer healthcare environment were developed. Thirty-two studies and six organizational reports were identified. Results from 32 studies showed a trend toward higher volumes and improved patient outcomes, and six consensus reports provided recommendations on thoracic care standards. Thoracic surgical oncology standards in a single-payer healthcare system were developed. The benefits associated with the implementation of thoracic cancer surgery standards should result in increased regionalization of care, improved processes of care, and better patient outcomes.
Notes
Comment In: Ann Thorac Surg. 2008 May;85(5):1840-1; author reply 1841-218442611
PubMed ID
17643675 View in PubMed
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Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma.

https://arctichealth.org/en/permalink/ahliterature170547
Source
J Am Coll Surg. 2006 Mar;202(3):468-75
Publication Type
Article
Date
Mar-2006
Author
Shimul A Shah
Riad Haddad
Wigdan Al-Sukhni
Robin D Kim
Paul D Greig
David R Grant
Bryce R Taylor
Bernard Langer
Steven Gallinger
Alice C Wei
Author Affiliation
Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
Source
J Am Coll Surg. 2006 Mar;202(3):468-75
Date
Mar-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Carcinoma - mortality - secondary - surgery
Colorectal Neoplasms - mortality - pathology - surgery
Disease-Free Survival
Female
Follow-Up Studies
Hepatectomy
Humans
Incidence
Liver Neoplasms - mortality - secondary - surgery
Lung Neoplasms - mortality - secondary - surgery
Male
Middle Aged
Neoplasm Recurrence, Local - epidemiology
Ontario - epidemiology
Pneumonectomy
Retrospective Studies
Survival Rate - trends
Time Factors
Treatment Outcome
Abstract
Patients with hepatic and pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. We examined the longterm outcomes of patients who underwent both lung and liver resections for colorectal metastases over a 10-year period.
Four hundred twenty-three hepatectomies were performed for metastatic CRC between 1992 and 2002 at two university-affiliated hospitals. Patients who underwent both lung and liver resections for metastatic CRC were studied. Demographic, perioperative, and survival data were evaluated by retrospective chart review. Disease-free survival (DFS) and overall survival (OS) were evaluated by Kaplan-Meier analysis and survival curves were compared using the log-rank test.
Thirty-nine patients underwent both lung and liver resections for metastatic CRC. Eleven patients (28%) underwent staged liver and lung metastasectomy from synchronously identified metastases. Twenty-eight patients (72%) underwent sequential metastasectomy because of recurrent disease. The median disease-free and overall survivals after initial metastasectomy were 19.8 and 87 months, respectively. Serial metastasectomy was common in this patient population. The mean number of metastasectomies performed was 2.6 per patient (range 1 to 4). There was no difference in overall survival for patients with synchronous versus metachronous presentation of liver and lung metastases (p=0.45). The site of first recurrence after initial metastasectomy was, most commonly, the lung (n=19, 49%), followed by the liver (n=8, 21%). Nineteen patients (49%) underwent subsequent resections for recurrences. Seven patients (18%) underwent 2 or more liver resections for recurrent disease, and 12 (31%) underwent multiple lung resections.
An aggressive multidisciplinary surgical approach should be undertaken for recurrent CRC metastases. In selected patients, serial metastasectomy for recurrent metastatic disease is safe and results in excellent longterm survival after CRC resection.
Notes
Comment In: J Am Coll Surg. 2006 Sep;203(3):40816931325
PubMed ID
16500252 View in PubMed
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