Skip to main content
SpringerLink
Log in

Quality Improvement in Colorectal Cancer in Local Health Integration Network 4 (LHIN 4) Project (QICC-L4): Integrated Knowledge Translation in a Large Geographic Region

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Stakeholders suggest that integrating end users into the planning and execution of quality improvement interventions may more effectively close quality gaps. We tested if such an approach could improve the quality of colorectal cancer surgery in a large geographic region (i.e., LHIN4) in Ontario, Canada.

Methods

All LHIN4 surgeons who provide colorectal cancer surgery were invited to an October 2006 inaugural QICC-L4 workshop and subsequent workshops in 2008, 2010, and 2012. At workshops, surgeons selected clinically relevant quality markers for targeted improvement and interventions to achieve improvements. Selected markers included rates of colon and rectal radiology imaging, rate of pathology reporting of rectal radial margin distance, and rate of positive rectal radial margins. To date, implemented interventions have included audit and feedback, tailoring interviews to identify barriers and facilitators to optimal quality, and preoperative internet-based patient reviews. Hospital and regional cancer centre charts provide audit data for annual feedback reports to surgeons.

Results

Participating surgeons at workshops and surgeon participants in preoperative reviews treated approximately 70 % of all LHIN4 patients undergoing colorectal surgery. For years 2006–2012, the rate of radiology imaging for colon and rectal cases increased from 70 to 91 % and from 71 to 91 %, respectively. For rectal cases, the rate of reporting radial margins increased (55–93 %), and the rate of positive radial margins decreased (14–6 %).

Conclusions

Initiation of the integrated knowledge translation QICC-L4 project in a large geographic region was associated with marked improvements in relevant colorectal cancer surgery quality markers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;2:CD003030. doi: 10.1002/14651858.CD003030.pub2.

  2. Thomas LH, Cullum NA, McColl E, Rousseau N, Soutter J, Steen N. Guidelines in professions allied to medicine. Cochrane Database Syst Rev. 1999;(1):CD000349. doi: 10.1002/14651858.CD000349.

  3. Flodgren G, Parmelli E, Doumit G, Gattellari M, O’Brien MA, Grimshaw J, et al. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2011;(8):CD000125. doi: 10.1002/14651858.CD000125.pub4.

  4. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;(6):CD000259. doi: 10.1002/14651858.CD000259.pub3.

  5. Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009;(3):CD001096. doi: 10.1002/14651858.CD001096.pub2.

  6. Simunovic M, Coates A, Goldsmith CH, Thabane L, Reeson D, Smith A, et al. The cluster-randomized Quality Initiative in Rectal Cancer trial: evaluating a quality-improvement strategy in surgery. CMAJ. 2010;182(12):1301–6.

    Article  PubMed  Google Scholar 

  7. Canadian Institutes of Health Research: More about knowledge translation at CIHR. http://www.cihr-irsc.gc.ca/e/39033.html (2013). Accessed 23 Jan 2013.

  8. National Cancer Institute of Canada: Canadian Cancer Statistics 2011, Toronto, Canada, May 2011. http://ncic.cancer.ca (2011). Accessed 23 Jan 2013.

  9. Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH, et al. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002;20:1729–34.

    Article  PubMed  Google Scholar 

  10. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTGCO16 randomised clinical trial. Lancet. 2009;373:821–8.

    Article  PubMed  Google Scholar 

  11. Berwick DM. Controlling variation in health care: a consultation from Walter Shewhart. Med Care. 1991;29(12):1212–25.

    Article  PubMed  CAS  Google Scholar 

  12. Berwick D. Continuous improvement as an ideal in health care. N Engl J Med. 1989;320(1):53.

    Article  PubMed  CAS  Google Scholar 

  13. Kritchevsky SB, Simmons BP. Continuous quality improvement. Concepts and applications for physician care. JAMA. 1991;266(13):1817–23.

    Article  PubMed  CAS  Google Scholar 

  14. Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, et al. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010;(3):CD005470. doi: 10.1002/14651858.CD005470.pub2.

  15. Royston P: “PTREND: Stata module for trend analysis for proportions,” Statistical Software Components S426101, Boston College Department of Economics, June 5, 2002. http://econpapers.repec.org/software/bocbocode/s426101.htm. Accessed 15 Jul 2013.

  16. Simunovic M, To T, Baxter NN, Balshem A, Ross E, Cohen Z, et al. Hospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population. J Gastrointest Surg. 2000;4(3):324–30.

    Article  PubMed  CAS  Google Scholar 

  17. Simunovic M, Rempel E, Thériault ME, Coates A, Whelan T, Holowaty E, et al. Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario. Can J Surg. 2006;49(4):251–8.

    PubMed  Google Scholar 

  18. Nenshi R, Baxter N, Kennedy E, et al: Surgery for colorectal cancer. In: Urbach DR, Simunovic M, Schultz SE, editors. Cancer surgery in Ontario: ICES Atlas. Toronto: Institute for Clinical Evaluative Sciences; 2008. http://www.ices.on.ca/file/Cancer%20Surgery%20in%20Ontario,%20Preliminary.pdf. Accessed 15 Jul 2013.

Download references

Acknowledgment

This research received funding from the Juravinski Cancer Centre Foundation; McMaster Surgical Associates, Department of Surgery, McMaster University; Hamilton Academic Health Sciences Organization; and, the Hamilton Health Sciences Centre for Healthcare Optimization Research and Delivery (CHORD). Our funders had no role in the planning, execution, interpretation, or writing of the study.

Ethics approval

The study received ethics approval from the Research Ethics Board of Hamilton Health Sciences/McMaster University.

Conflict of interest

All authors declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Marko Simunovic MD, Wesley Stephen MD, Stephen Kelly MD, Shawn Forbes MD, Margherita Cadeddu MD, Vanja Grubac BSc, Peter Lovrics MD & Angela Coates MEd

  2. Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Marko Simunovic MD

  3. Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Marko Simunovic MD & Lehana Thabane PhD

  4. Escarpment Cancer Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada

    Marko Simunovic MD

  5. Department of Pathology, St. Catharines General Site, Niagara Health System, St. Catharines, ON, Canada

    Franco DeNardi MD

  6. Department of Surgery, Joseph Brant Memorial Hospital, Burlington, ON, Canada

    Dwight Prodger MD

  7. Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Scott Tsai MD

Authors
  1. Marko Simunovic MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wesley Stephen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen Kelly MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shawn Forbes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Margherita Cadeddu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lehana Thabane PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vanja Grubac BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peter Lovrics MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Franco DeNardi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Dwight Prodger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Scott Tsai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Angela Coates MEd
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marko Simunovic MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simunovic, M., Stephen, W., Kelly, S. et al. Quality Improvement in Colorectal Cancer in Local Health Integration Network 4 (LHIN 4) Project (QICC-L4): Integrated Knowledge Translation in a Large Geographic Region. Ann Surg Oncol 20, 4067–4072 (2013). https://doi.org/10.1245/s10434-013-3218-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-3218-9

Keywords

Search

Navigation