Annals of Surgical Oncology

, Volume 20, Issue 13, pp 4067–4072 | Cite as

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

  • Marko Simunovic
  • Wesley Stephen
  • Stephen Kelly
  • Shawn Forbes
  • Margherita Cadeddu
  • Lehana Thabane
  • Vanja Grubac
  • Peter Lovrics
  • Franco DeNardi
  • Dwight Prodger
  • Scott Tsai
  • Angela Coates
Healthcare Policy and Outcomes

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.

Keywords

Rectal Cancer Colorectal Cancer Surgery Quality Improvement Intervention Quality Marker Permanent Colostomy 

Notes

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.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Marko Simunovic
    • 1
    • 2
    • 3
    • 4
  • Wesley Stephen
    • 1
  • Stephen Kelly
    • 1
  • Shawn Forbes
    • 1
  • Margherita Cadeddu
    • 1
  • Lehana Thabane
    • 3
  • Vanja Grubac
    • 1
  • Peter Lovrics
    • 1
  • Franco DeNardi
    • 5
  • Dwight Prodger
    • 6
  • Scott Tsai
    • 7
  • Angela Coates
    • 1
  1. 1.Department of Surgery, Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  2. 2.Department of Oncology, Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  3. 3.Department of Clinical Epidemiology and Biostatistics, Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  4. 4.Escarpment Cancer Research Institute, Hamilton Health Sciences and McMaster UniversityHamiltonCanada
  5. 5.Department of Pathology, St. Catharines General SiteNiagara Health SystemSt. CatharinesCanada
  6. 6.Department of SurgeryJoseph Brant Memorial HospitalBurlingtonCanada
  7. 7.Department of Radiology, Faculty of Health SciencesMcMaster UniversityHamiltonCanada

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