Ontario SLNB Quality Data: A Provincial Snapshot May Lynn Quan MD, MSc, FRCSC 1 Why it matters to YOU!

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Presentation transcript:

Ontario SLNB Quality Data: A Provincial Snapshot May Lynn Quan MD, MSc, FRCSC 1 Why it matters to YOU!

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Improving the Quality of SLNB in Ontario How can we measure quality? What is the quality of SLNB? Where can we improve? What are the barriers/enablers? 5

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Improving the Quality of SLNB in Ontario Stakeholder interviews Population based evaluation Quality indicator development Modified Delphi Consensus ICES Data Linkages Clinicians Primary Chart Review Administrators 7

Development of Quality Indicators Modified Delphi expert panel LHIN and practice type representation – Surgeons – Pathologists – Nuclear Medicine – Medical Oncology – Radiation Oncology 11 quality indicators developed

Final Quality Indicators #Quality Indicator 1Axillary node positivity rate 2Proper identification of SLN 3SLNB on eligible patients 4Number of nodes removed >1 5Pathology evaluation protocol 6Pathology reporting as per AJCC 7SLNB concurrent with breast surgery 8Axillary recurrence rate 9Completion ALND for + SLNB 10SLNB on ineligible patients 11Radiocolloid injection protocol 9

Feasibility study Bryan Wells, MD, MSc Retrospective chart review Academic Cancer Centre n =

QI Feasibility #Quality Indicator Measurable? 1Axillary node positivity rateYES: Chart 2Proper identification of SLNYES: Chart 3SLNB on eligible patientsNO 4Number of nodes removed >1YES: Chart 5Pathology evaluation protocolYES: Institution 6Pathology reporting as per AJCCYES: Chart 7SLNB concurrent with breast surgeryYES: Chart 8Axillary recurrence rateNO 9Completion ALND for + SLNBYES: Chart 10SLNB on ineligible patientsYES: Chart 11Radiocolloid injection protocolYES: Institution 11

QI Feasibility #Quality Indicator Measurable? 1Axillary node positivity rateYES: Chart 2Proper identification of SLNYES: Chart 3SLNB on eligible patientsNO 4Number of nodes removed >1YES: Chart 5Pathology evaluation protocolYES: Institution 6Pathology reporting as per AJCCYES: Chart 7SLNB concurrent with breast surgeryYES: Chart 8Axillary recurrence rateNO 9Completion ALND for + SLNBYES: Chart 10SLNB on ineligible patientsYES: Chart 11Radiocolloid injection protocolYES: Institution 12

QI Feasibility #Quality Indicator Measurable? 1Axillary node positivity rateYES: Chart 2Proper identification of SLNYES: Chart 3SLNB on eligible patientsNO 4Number of nodes removed >1YES: Chart 5Pathology evaluation protocolYES: Institution 6Pathology reporting as per AJCCYES: Chart 7SLNB concurrent with breast surgeryYES: Chart 8Axillary recurrence rateNO 9Completion ALND for + SLNBYES: Chart 10SLNB on ineligible patientsYES: Chart 11Radiocolloid injection protocolYES: Institution 13

Population based evaluation 14

Cohort 15

Methods Volume Urban/rural LHIN, Age Tumour size OHIP CIHI Census 16

Results 5134 cases 2323 SLNB 8 quality indicators 17

Final Quality Indicators Quality IndicatorProportion Axillary node positivity rate28% Proper identification of SLN95% Number of nodes removed >164% Pathology evaluation protocol59% Pathology reporting as per AJCC38% SLNB concurrent with breast surgery94% Completion ALND for + SLNBMacromet 85% Micromet 59% ITCs 32% SLNB on ineligible patients2% 18

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Quality indicators in everyday practice Helping YOU do a high quality SLNB Giving you tools to determine if you are! Providing excellent patient care 21

Putting quality indicators to work for you 22 EXCELLENT PATIENT CARE

Case Audit - personal review Eligible patients – Offered to all? Ineligible patients – Who are they? Concurrent breast surgery – Core needle biopsy when possible? Proper ID of SLNs 23

Case Audit - personal review Node positive rate – As expected? > 1 SLN – What’s my average? Completion ALND for + SLNs Axillary recurrences?? 24

Summary Quality of SLNB in Ontario is pretty good! – Population data can provide a snapshot – Provides baseline measure for comparison Moving forward, improvements With individual practice Quality indicators can help in day to day practice – Self audit – mental checklist – Communication with the team key 25

Acknowledgements Anna Gagliardi Frances Wright David McCready David Urbach Novlette Fraser Bryan Wells Refik Saskin Nadia Gunraj 26

Expert Panel 27