Quality Improvement in Colorectal Cancer in Local Health Integration Network 4 (LHIN 4) Project (QICC-L4): Integrated Knowledge Translation in a Large Geographic Region
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.
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.
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 %).
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.
KeywordsRectal Cancer Colorectal Cancer Surgery Quality Improvement Intervention Quality Marker Permanent Colostomy
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.
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.
- 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.
- 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.
- 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.PubMedCrossRefGoogle 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.
- 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.